The Fairfield community recently suffered a devastating loss as Holy Spirit School’s principal, Sister Liz Curtis, succumbed to metastatic breast cancer.
In years past, a malignancy would be referred to euphemistically as a “long illness.” At Sister Liz’s memorial services, however, she was lauded for fighting valiantly against cancer up until the end.
We have come a long way. High-profile cancer patients began to discuss their diseases in frank terms only a few decades ago.
Betty Ford, the former first lady, was among the first to describe her battle with breast cancer. Film star Angelina Jolie chose to undergo prophylactic mastectomies upon learning that she was at high risk of the disease due to an inherited gene mutation, BRCA1.
The late Gen. Norman Schwarzkopf Jr. similarly was open in discussing his prostate cancer. As cancer comes out of the closet in terms of public recognition, a high toll on our communities is highlighted.
Breast cancer, for example, afflicts 1 million people worldwide annually, with 230,000 cases in the United States causing 40,000 deaths. Some public health experts estimate that one in seven women will be diagnosed with the disease. To be sure, a “lead time bias” effect causes more and more women to undergo minimally invasive procedures that eradicate minute “in situ” cancers.
Similarly, some affluent communities appear to be affected by the illness disproportionately, reflecting more aggressive screening. Nonetheless, this is a public health challenge of immense proportions. Each of the women affected has co-workers, family and friends who will be affected emotionally, economically and spiritually.
In terms of overall mortality rates in the U.S., the real success stories have been in the treatment of heart attacks and strokes. According to National Vital Statistical Report data published by the Department of Health and Human Services and Centers for Disease Control and Prevention, the rate of cardiovascular death dropped 3 percent from 2010 to 2011.
To be sure, cancer deaths also declined by 2.4 percent during that period. But we still suffer in excess of half a million deaths a year in the U.S. due to cancer. Only heart disease causes more deaths.
There are grounds for some optimism. For example, lung cancer deaths should continue to decline with lower prevalence rates of smoking. Cervical cancer rates also declined with the advent of Pap smear screening, and the recent development of a vaccine against the causative viral agent should propel a trend toward lowering the incidence of that disease.
Screening for colon cancer is also a positive development, although we are not as successful in screening for pancreatic or esophageal cancers.
Ongoing research in terms of prostate cancer is attempting to resolve complicated issues relative to the role of screening modalities, such as the prostate specific antigen test for that disease. Many childhood malignancies and lymphomas are curable. Indeed, cancer is not one disease, but a family of disorders, and we are making enormous progress. But can we do better?
The federal budget for 2014 proposes $30 billion for the National Institutes of Health, 1 percent of federal spending. Six percent of federal spending, however, is necessary to service debt. I would like to see those numbers reversed, some day.
Let us battle diabetes, arthritis and infectious diseases more aggressively, as well. Research insights often influence different areas of medicine simultaneously. For example, viruses may cause some cancers.
John F. Kennedy pledged to put a man on the moon within 10 years. Perhaps a presidential pledge to eliminate cancer deaths would be an even more daunting challenge. Nonetheless, I believe we can do better. I suspect that Sister Liz would agree with me. Do you?
Scott T. Anderson, M.D., Ph.D. (firstname.lastname@example.org) is clinical professor of medicine, UC Davis. This column is informational and does not constitute medical advice.