The war against cancer

The long war against cancer has not been won, but there is real progress, as we are finally graduating from having only primitive weapons to use like toxic chemotherapy. The new era of targeted therapies has changed the battlefield.

Personalized immunotherapies and genetic treatments mean identifying abnormal proteins on the surface of the tumor that varies from one patient and one tumor to the next. Since cancer cells may evade the immune system’s detection by “pretending” to be like healthy cells, new drugs like checkpoint inhibitors change tumors to a form where they are vulnerable for attack by our immune system.  

At the same time, less invasive surgical techniques and advanced radiotherapies allow us to access and remove cancers that we could never approach before. Screening blood tests like the Prostate Specific Antigen and imaging studies, including MRI, CT, and PET scans, have evolved to the point where we can identify many cancers while they are still curable. The development of artificial intelligence as a useable tool will advance early detection further. 

Our rate of cancer-causing tobacco smoking is down to a low of only 14 percent of the population, which translates to a significant drop in the incidence of lung cancer as well as lung cancer deaths. Consider that lung cancer kills more people in the U.S. than colon, breast, prostate and brain cancers combined. High-resolution CT scans may pick up lung cancer while it is still operable, and more sophisticated surgeries enable cancer removal that wasn’t previously possible.

The same is true for melanoma. Better and more frequent skin screening picks up abnormal pigmented lesions earlier, increasing the chance of a cure. For those cancers that have spread, targeted immunotherapies have been proven effective in causing metastases to shrink and patients to survive longer.

So even though cancer is still the second leading cause of death in the U.S. with over 600,000 deaths per year, at the same time, according to the American Cancer Society, there has been a steady decline of cancer deaths by 29 percent since 1991. 

But the incidence of several cancers, including colon, breast, and prostate here are still increasing, even if the five-year survival rate for prostate and breast cancer is now over 90 percent. The U.S. gains against cancer outpace the UK, France, and Canada.

These countries have innovative detection techniques and treatments as well, but are restricted by short term cost-saving attempts by single-payer systems. They — and we — are also plagued by an obesity and inactivity epidemic, which leads to an increase in inflammation and cancer.

In the underdeveloped world, the story is different. Lung, liver, stomach, and bowel are the most common causes of cancer death worldwide, accounting for more than four in ten of all cancer deaths. According to the World Health Organization, 70 percent of deaths from cancer occur in low and middle-income countries. It’s is because these countries lack well-balanced diets, have high smoking rates, and require proper screening and up to date treatments.

Nothing illustrates the problem of health-care disparity affecting cancer risk than the case of cervical cancer, which occurs as a result of Human Papilloma Virus infection. Cervical cancer is the fourth most common cancer in women worldwide and the primary cause of cancer-related deaths among women in low- and middle-income countries. Nearly 90 percent of the cases and deaths occur in these countries where screening and HPV vaccines are lacking. 

The same problem occurs with children in low and middle-income countries, where cancer is a leading cause of death. Children with cancer in low- and middle-income countries are four times more likely to die of the disease than children in high-income countries. Leukemia and lymphoma are the most common childhood cancers in these countries, where primary treatment is often lacking. 

The solution is a push for greater consistency worldwide in terms of cancer prevention, diagnosis, and effective treatment. We need much more HPV vaccine usage around the world. We need to rely on the free market, working with governments, to provide state of the art screening as well as potential cures. Eating well and living healthy is the best weapon we have in the war against cancer. Staying alive longer with cancer is only one winnable battle in the greater war.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter: @drmarcsiegel.