Cancer in the New Millennium

From the desk of the Paul Calabresi, M.D., M.A.C.P., Professor of Medicine and Chairman Emeritus, Department of Medicine, Brown Medical School and the Rhode Island Hospital; and Chairman of the Rhode Island Cancer Council.
April 2002

Thirty years ago, in December 1971, our nation declared war on cancer. With the beginning of a new millennium, this is an appropriate time to re-evaluate our progress, assess our current status, and chart a rational course for the future. In the 1960's, approximately 30% of patients with cancer survived. Today more than 60% are cured. Of the remaining 40% of cancer cases, approximately half, or an additional 20%, could be prevented or saved, if all the knowledge we have today were applied to all of the people. For the other 20%, we need more research.

The cancer burden, however, is increasing in America. This is due, in part, to more effective prevention and treatment of heart disease, infections, and strokes, as well as to an increase in aging of our population. Sixty percent of new cancer patients are older than 65 years and the median age for cancer in the United States is now 70 years. It is estimated that, at current rates, the rise in cancer will be such that one in two Americans will experience the disease in their lifetime and it will surpass heart disease as the leading cause of death in just a few years.

The National Cancer Legislation Advisory Committee was created in order to address this mounting threat and to chart a strategy that would ultimately eradicate cancer as a major public health problem. A group of 21 concerned cancer scientists and survivors, patient advocates and health providers, non-profit leaders and business executives met for 2 years to develop a comprehensive report entitled: “Conquering Cancer: A National Battle Plan to Eradicate Cancer in Our Lifetime” (Table I).1 Building on the success of the National Cancer Act of 19712 and previous major reports on this subject,3,4,5,6,7 the recommendations included in this document provide the President and the Congress of the United States with a roadmap for achieving this vital goal. It should be noted that, notwithstanding the current international problems with terrorism, the White House has already expressed great interest in this report and Senator Dianne Feinstein (D-CA) has introduced relevant legislation in February, 2002, in order to implement its recommendations.

What can we do in Rhode Island, at the local and regional level, in order to reduce mortality and suffering from cancer? Outlined below are 4 broad approaches that would enhance our participation in this renewed national effort to conquer cancer:

Familiarize ourselves with the goals and recommendations provided in this report and participate in implementing those that apply to our individual activities, institutions and organizations. A summary of these actions is listed in Table I; it is clear that some apply primarily at the Federal level, while others can be implemented in the State.

Unite the many resources in our community to re-establish a Cancer Center with translational research capabilities that would move new drugs and technologies forward into clinical trials, and ultimately develop new methods and products to prevent and cure cancer (Table I, Goal 4).

Provide an organization for coordinating and implementing State-based cancer action plans, in collaboration with all relevant experts in the region (Table I, Goals 9, 10, 11, 12). The Rhode Island Cancer Council, established in May 1999, already provides the basic mechanisms and initial resources for implementing these programs. In this respect, we are already ahead of most other states in the country.

Improve access to and delivery of quality cancer care to all of our patients. Although these goals are addressed in public health terms in the Conquering Cancer report (Table I, Chapters 3 and 4), specific recommendations (Table I; Goals 8, 11 and 12) can only be implemented if every physician and health care professional assumes a personal obligation to become more informed, knowledgeable, and qualified to provide quality cancer care.

The Rhode Island Cancer Council was established in May, 1999, to encourage cooperative, comprehensive and complementary planning among public, private and volunteer sectors of the State. This important community resource provides critical cancer information to the public and develops cancer control and education programs with the participation and collaboration of a broad spectrum of recognized leaders in oncology.

The goal of the Rhode Island Cancer Council is to reduce the cancer burden in the State and serve as a model for other communities.

If we all work together, we can achieve our mission to eradicate cancer as a major public health problem in our lifetime.

REFERENCES

Conquering Cancer: A National Battle Plan to Eradicate Cancer in our Lifetime. Washington, DC, 2001. National Cancer Legislation Advisory Committee, DeVita VT, Seffrin JR, Barker AD, Brown, HG, Brugge JS, Calabresi P, et al.

National Cancer Act of 1971, J NCI 1987; 78:5.

Hewitt M, Simone JV (eds.) Ensuring Quality Cancer Care. National Cancer Policy Board, Institute of Medicine and National Research Council, 1999.

Calabresi P, Bettinghaus E, Coleman CN, et al. Cancer at a Crossroads: A Report to Congress for the Nation. Cancer 1995; 76:135-48.

The MARCH – Coming Together to Conquer Cancer. Report from the March Research Task Force, Sigal EV, Barker AD, Co-chairs, Washington, DC, 1998.

Freeman H, Visco F, Calabresi P. Annual Report of the President's Cancer Panel. Cancer Care Issues in the United States: Quality of Care, Quality of Life, 1998.

Freeman H, Visco F, Calabresi P. Annual Report of the President's Cancer Panel. The National Cancer Program: Assessing the Past, Charting the Future, 1999.

TABLE I

Conquering Cancer: A National Plan to Eradicate Cancer in Our Lifetime1

Chapter One:       Discovery Research and Training

Goal 1       Fund the National Cancer Institute (NCI) Bypass Budget in this and future years and provide additional supplemental funding for critical research that is not adequately covered in the Bypass Budget.

Goal 2       Increase the pool of talented and well-trained biomedical researchers.

Goal 3       Increase National Institute for Environmental Health Science and NCI funding for cancer research that examines the interaction of genes and the environment.

Goal 4       Enhance our cancer research centers (and other cancer-focused efforts) to build a multidisciplinary network of “translational centers” to move new drugs and technologies forward into clinical trials, and ultimately develop new methods and products to prevent and cure cancer.

Goal 5       Streamline and accelerate the Food and Drug Administration's approval system for cancer drugs, biologics, devices and technologies.

Goal 6       Empower federal agencies to build public-private partnerships across the entire continuum of cancer research to ultimately develop new cancer treatments, preventives and technologies.

Goal 7       Provide adequate health insurance coverage for all Americans concerned about or diagnosed with cancer.

Goal 8       Significantly increase the pool of health care professionals trained to conquer cancer.

Goal 9       Launch a National Cancer Screening Initiative to increase substantially the early detection of cancer.

Goal 10       Implement comprehensive state-based cancer action plans, in collaboration with all relevant experts in the region.

Goal 11       Develop, communicate and use universal guidelines and practice standards to provide quality cancer care to all cancer patients, and monitor progress through improved quality care surveillance systems.

Goal 12       Implement a National Cancer Prevention Initiative that focuses on eliminating tobacco use, increasing physical activity, and improving nutrition.

*This is an abridged version of an editorial published in the Medicine & Health/Rhode Island, 2002; 85: 4-6

For more information and answers to specific questions contact the Rhode Island Cancer Council at Tel@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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