News at NCH
"Cancer—Opportunities to Improve" By Allen Weiss, MD, MBA, President and CEO


Cancer—Opportunities to Improve

January 15, 2011 - Cancer is still too common and deadly—even though early diagnosis and better treatments are available. Between 1975 and 2007 cancer death rates decreased modestly, while cardiac death rates went down dramatically. In fact, for ages under 65, neoplasms (cancer) account for 26 percent of deaths while heart disease only 18 percent. For individuals over age 65, cancer fatalities drop to 22 percent, while cardiac disease deaths increase to 29 percent. Although both cancer and heart disease prognoses have improved since 1975, the rate of improvement for cancer lags behind that of heart disease.

One in thirty Americans, about 11 million people, have either had cancer or are currently being treated for it. Sixty-five percent of those diagnosed with cancer are expected to live at least five years or more after discovery of their disease.

A report from the National Cancer Institute last year showed decreasing rates of new cases and deaths from the three most common types of cancer for men—lung, prostate, and colorectal, and for the two most common types for women—breast and colorectal.

The above is good news but still not good enough! Too many types of cancer are still not being prevented or detected early enough to be cured. Many do not receive effective treatment even though oncology—the medical specialty dealing with cancer—has improved markedly over the past few decades.

Seven points for cancer prevention, even though they are somewhat obvious, still need to be publicized and assimilated:

  • Smoking cessation—single biggest opportunity with 20% of Americans still smoking
  • Healthy diet—at least five servings of fruits and vegetables daily, limited fat and alcohol
  • Daily exercise—control weight with activity
  • Protection from the sun—especially important in Florida
  • Immunization—Hepatitis B and Human papillomavirus (HPV)
  • Avoid risky behaviors—Collier County has a higher-than-expected incidence of sexually transmitted diseases and teenage pregnancy

The final point is screening for early detection. This is especially important and available for most people who have health care insurance under the new healthcare reform: the Patient Protection and Affordable Care Act.

No matter what screening is recommended, if a person has any signs or symptoms of disease, they should seek medical attention for further evaluation. If everything appears normal and there are no problems or family history of the disease, routine screening recommendations apply.

Screening is now centered on evidenced-based medicine—the science of understanding what works best in healthcare. This objective view has been applied to screening for cancer and has caused some recent controversies. Mammogram screening, for example, was once thought to be best started at age 40 and then every other year. Side effects from false positive mammogram tests have caused experts to reconsider their original recommendation, and many now believe screening should begin at age 50. So the jury is still out on this important subject.

Colon and rectal cancer screening is less controversial. With no family history or symptoms, colonscopy at age 50 and every decade thereafter is prudent. Screening for blood in the stool is safe, inexpensive, and is in addition to colonoscopy.

Gynecological cancer screening should be routine in adult women and is highly effective in detecting cervical and uterine cancer. Unfortunately, ovarian cancer is still hard to detect early.

Prostate cancer screening was revolutionized a couple of decades ago by a simple blood test called a PSA—prostate-specific antigen. Now the controversy exists regarding the age at which this screening should start, and how to treat the disease; there are numerous effective procedures. In fact, in elderly men, sometimes treatment may not be needed at all.

The bottom line is that we can and should do better with prevention, early detection and therapy. Many new and innovative medications are now available for very specific types of cancer. Genetic analysis of cancers holds promise, as does immunology for the treatment of certain forms of the disease.

Stay informed and optimistic; taking care of yourself and your loved ones is the most effective manner of prevention. Do take screening seriously and diligently, and keep watching what medical science can do with evidence-based medicine for oncology.
 

Past Health Advice Articles

 
Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.