Wednesday, March 29, 2000
Little progress in battle against cancer
Research and education blitz aren't helping
BY TIM BONFIELD
The Cincinnati Enquirer
Every day this year in Ohio, 70 people will die of cancer. The largest numbers by far will die of lung cancer. Others will die of colorectal cancer, breast cancer or prostate can cer — all leading forms that have shown virtually no reduction in death rates for five straight years.
This lack of progress in the battle against cancer was made clear Tuesday after the American Cancer Society's Ohio division released an updated set of county-by-county cancer statistics.
The report shows that death rates have barely budged despite a nation that has spent billions on cancer research and blitzed the public with warnings to stop smoking and get cancer screening tests.
“This data has to be seen as a wake-up call. What we're doing is not working. What's needed is a major new initiative,” said Dr. John Winkelmann, director of hematology/oncology at the University of Cincinnati Medical Center and vice president of the board of trustees for the Cancer Society's Hamilton County chapter.
In one sense, the figures released Tuesday simply put fresher numbers on old trends. Ohio has exceeded national averages for cancer deaths for many years. And cancer deaths in Hamilton County, the most populated part of the Tristate, have long been above Ohio averages.
While several types of cancer contribute to the high death rate, the biggest factor in Ohio and locally continues to be deaths from smoking-related lung cancer.
This year, the cancer society projects 7,400 Ohioans will die from lung cancer. That's nearly three times higher than the projected deaths from colorectal cancer, the second-most common cancer killer, and nearly four times the projected deaths from breast cancer.
None of this comes as much surprise to Lebanon resident Cyril Sykes, a 50-year smoker who was diagnosed 21/2 years ago with lung cancer.
“At the time, I really didn't want to hear anything about it,” Mr. Sykes said. “I figured, "What the hell is this? I came in for a heart condition and left with lung cancer.'”
“I sure wish they would have found a cure years ago,” Mr. Sykes said. “But as far as I'm concerned, the cancer was my own fault. I knew it was bad for me, but I guess I always thought it would happen to someone else.”
Now 75, Mr. Sykes has outlived his doctor's early estimate that he had about four to 18 months to live. Seven months of chemotherapy and five weeks of radiation treatments have not eliminated his tumor, but apparently have stopped its growth.
“Every day is a good day,” he said.
The American Cancer Society contends that up to 65 percent of the cancer deaths in Ohio could be prevented without spending another dime on medical research. All it would take is smokers kicking their habits and everybody actually getting the mammograms and prostate exams they are supposed to get.
Early detection makes a powerful difference in curing many types of cancer. For example, catch breast cancer while the tumor is still small and localized and the five-year survival rate is 97 percent. Catch it after tumors spread to other parts of the body and survival dips to just 22 percent.
For lung cancer, however, prevention is key. Unlike mammograms for breast cancer, there is no reliable and widely used screening test for lung cancer. Five-year survival rates for localized tumors are just 50 percent - an unusually low rate - and five-year survival drops to just 2 percent when the cancer has spread.
“The most cost-effective way to make large reductions in the number of cancer deaths in this country is simple — stop smoking!” said Tristate oncologist Dr. Rebecca Bechhold.
“Lung cancer isn't a very sexy disease. There aren't very many celebrities out there talking about lung cancer because all the celebrities that got it are dead,” Dr. Bechhold said.
Mr. Sykes said “weak” Republicans and “hypocrite” Democrats talk about excise taxes and regulating nicotine as a drug, but they won't take decisive action to stop smoking-related deaths.
The new report for Ohio is intended to serve as a local baseline for the American Cancer Society's national cancer reduction goal. The group hopes to slash cancer deaths by 50 percent by 2015 and reduce cancer incidence by 25 percent.
The data will be used to adjust the agency's programs and spending decisions. For Hamilton County, specific program changes will be decided as soon as June, said Barb Hopping, cancer control director.
But with so many years of inch-along progress, some cancer experts questioned whether a more ambitious cancer reduction goal can be reached.
In five years, the lung cancer death rate dipped a fraction from 55.6 per 100,000 in 1993 to 53.2 in 1997. Youth smoking rates went up during the same period, sowing the seeds of lung cancer cases that will take another 20 or 30 years to develop.
Similar flat lines were reported for prostate, breast and colorectal cancer death rates. So how can those rates be pushed down 50 percent in 15 years?
“It makes you wonder how realistic that goal is,” Dr. Winkelmann said. “I do not think medicine can be expected to carry the ball. The only way that goal can be achieved is by gathering many groups together .. the Cancer Society, providers, insurers and local leaders.”
But so much health education has already been done that adding on more seems futile, Dr. Bechhold said.
“I don't know how much more in-your-face you can be,” she said. “Yet most of my lung cancer patients continue to smoke even though we advise them not to.”
“What disturbs me even more is to see so many well-educated high school and college kids taking up smoking,” Dr. Bechhold said. “I don't know how to reach those kids.”
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