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- “Make Statistics look good”
- Statistics determine funding
The National Cancer Institute (NCI) has claimed to be winning the war on cancer. Last March, newspapers across the country dutifully heralded a decline in cancer incidence and mortality, citing the latest annual report of the National Cancer Institute. The report credited the decline to lifestyle changes, improved detection, and reduced smoking.
Despite such celebrated claims of progress against the disease, the facts tell a different story. See Statistics. Reversal in overall mortality rates has been minimal and due largely to a reduction in lung cancer deaths from reduced smoking in men rather than to advances in treatment. Overall five-year survival rates for all cancers have remained virtually static since 1970, from 49 to 54 percent for all races combined, and from 39 to 40 percent for African Americans. Dr. John Bailar, formerly an epidemiologist at the NCI and now chair of the Department of Health Studies at the University of Chicago, has found that reduced mortality rates are more likely the result of earlier detection and diagnosis rather than improved cancer treatments.
Meanwhile, cancer incidence has escalated to epidemic proportions over recent decades, with lifetime risks in the United States now reaching one in two for men and one in three for women. In 2000, more than 1.2 million new cancer diagnoses are expected, and some 550,000 Americans will die from the disease. The overall increase of all cancers from 1950 to 1995 was 55 percent, of which lung cancer accounted for about a quarter. Meanwhile, the incidence of a wide range of non-smoking cancers, such as non-Hodgkin's lymphoma, multiple myeloma, and adult brain cancer, is increasing at proportionately greater rates, including an alarming rise in childhood cancer of over 20 percent.
Longer life expectancy cannot explain these increases, as incidence and mortality rates in cancer registries are age-adjusted to reflect these trends. Nor can the epidemic be attributed primarily to poor lifestyle habits. Smoking is clearly the single most important cause of cancer, but lung cancer rates for men are declining because men are smoking less. (Rates for women are about the same, as the number of women smokers has remained steady.) And while a high-fat diet may increase risk by passing on toxic chemicals that accumulate in fatty tissues, fat per se cannot be incriminated as a major cause of cancer, in sharp contrast to heart disease. In Mediterranean countries, where up to 40 percent of the average person's diet is composed of olive oil, breast cancer rates are low, and epidemiological studies over the past two decades have consistently failed to establish any causal relationship between breast cancer and fat consumption.
Finally, rising rates cannot be attributed to genetic factors. Not only do genetic factors alone account for relatively few cancers, the genetics of human populations cannot possibly have changed within the past few decades. And in what may be the largest study ever to compare the role of genes versus environment in cancer, Dr. Paul Lichtenstein and his colleagues reported in The New England Journal of Medicine last July that "the overwhelming contributor to the causation of cancer in the populations of twins that we studied was the environment."
What then is driving the modern cancer epidemic? Study after study points to the role of runaway industrial technologies, particularly those based on petrochemicals. The explosive growth of the petrochemical industry since the 1940s has far outpaced legislative and regulatory controls, producing a dizzying array of synthetic chemicals that have never been screened for human health effects: of the roughly 75,000 chemicals in use today, only some 3 percent have been tested for safety. For over fifty years, in other words, the American public has been unknowingly exposed to avoidable carcinogens from the moment of conception until death.
Over recent decades, the incidence of cancer has escalated to epidemic proportions (1), now striking nearly one in two men (44%) and more than one in three women (39%). This increase translates into approximately 56% more cancer in men and 22% more cancer in women over the course of a single generation (2). As admitted by recent NCI and ACS estimates, the number of cancer cases will increase still further because of the growth and aging of the population, dramatically doubling by 2050 (3).
From 1973 to 1999 (a 26-year period), based on the latest (now three years old) available data (1), the overall incidence of cancers (expressed as the numbers per 100,000 population), adjusted to reflect the aging population, has increased by approximately 24% (Appendix II).
Although the overall incidence of lung cancer increased by 30%, it decreased by 6% in men and increased by 143% in women, reflecting major changes in their respective smoking practices; these rates also reflect the well-recognized and significant risks of passive smoking. Unquestionably, smoking has been and remains the single largest and most important cause of cancer. Particularly striking, however, has been the increase of predominantly non-smoking cancers, notably: malignant melanoma (156%); liver (104%); non-Hodgkin's lymphoma (87%); thyroid (71%); testis (67%); post-menopausal breast cancer (54%); brain cancer (28%); and acute myeloid leukemia (16%). Childhood cancers have increased 26% overall: acute lymphocytic leukemia (62%); brain (50%); bone and joint (40%); and kidney (14%). Childhood cancers remain their number one killer, other than accidents. The median age for the diagnosis of cancer is now 67 in adults and 6 in children.
During recent years, the incidence of lung cancer in men has decreased more sharply, while that of predominantly non-smoking cancers has continued its steady increase (1). From 1992 to 1999 (a seven-year period), increasing incidences (Appendix III) include: thyroid (22%); malignant melanoma (18%); acute myeloid leukemia (13%); and post-menopausal breast cancer (7%). Childhood cancers have increased 7% overall: bone and joint (20%); leukemias (18%); acute lymphocytic leukemia (16%); and kidney (14%). It should be noted that the overall age-standardized incidence of cancer has increased steadily from 1973 to 1999 (Appendix II), despite NCI's escalating budget (Appendix IV). It should be further recognized that the increasing incidence of cancer in the U.S., particularly of non-smoking cancers, is also reflected in other major industrialized nations (4).
Excess Incidence Rates in Blacks
Overall, blacks have the highest age-standardized cancer incidence and mortality rates than other racial and ethnic groups (1). The incidence rate for blacks is about 9% higher than whites (Appendix V); the excess rates for a wide range of other sites range up to 124%. As disturbingly, the death rate for all cancers combined is about 30% higher in blacks than whites.
Excess rates in blacks reflect denial of environmental justice, and a wide range of racially-linked risk factors. These include: residence in highly polluted urban communities; residence in proximity to chemical industries and hazardous waste sites; excess consumption of high animal fat fast foods, highly contaminated with industrial pollutants and pesticides; and discriminatory occupational employment. The excess mortality in blacks from cancer, overall and at all sites, most likely reflects delayed access to diagnosis and treatment, besides lower quality health care.
In striking contrast to the escalating incidence of overall and site-specific cancers from 1973 to 1999, and in spite of massively increased resources, the NCI and ACS have continually made empty claims for major progress in the war against cancer.
In 1984, reacting to growing concerns about increasing mortality, for which lack of funding and Congressional support were blamed, the NCI launched the "Cancer Prevention Awareness Program." It was claimed that this would halve the 1980 overall cancer mortality rate of 160/100,000 to 84/100,000 by 2000 (12). This was followed by a 1986 NCI document on Cancer Control Objectives, which similarly claimed that the overall mortality rate would be halved by 2000. In fact, this rate has remained unchanged, other than a minor reduction, reflecting decreased lung cancer in men due to their reduced smoking. The lifetime risks of dying from cancer are now 24% for men, and 20% for women.
On March 12, 1998, at a heavily promoted Washington, D.C. press briefing, the NCI and ACS released a Report Card, announcing a recent "reversal of an almost 20-year trend of increasing cancer cases, and deaths. These numbers are the first proof that we are on the right track," enthused then- NCI director Dr. Richard Klausner. Media coverage was extensive. A New York Times headline announced: "A sharp reversal of the incidence [of cancer, and that] the nation may have reached a turning point in the war against cancer.” Science commented: "The news could not have come at a better time for cancer researchers. Just as Congress began working on the 1999 biomedical budget, a group of experts announced . . .that the U.S. has 'turned the corner' in the war on cancer."
In fact, the "reversal" of overall incidence rates from 1992 to 1998 was manipulated and small (about 7%). This was largely due to the reduction of lung cancer in men following their decreased
smoking. Also, any true decline would then have been considerably less had incidence rates, besides mortality, been more appropriately age-adjusted to the then current age distribution of the population rather than that of 1970, as misleading calculated by NCI, with its relatively higher representation of younger age groups (5). It should further be noted that the recent claimed declines in mortality, based on five-year survival rates, ignore factors such as "lead-time basis," earlier diagnosis resulting in apparently prolonged survival even in the absence of any treatment (12).
The reduction in the incidence of prostate cancer is also highly questionable, as admitted by the Report Card authors: "These decreased incidence rates (purportedly by approximately 20%) may be the result of decreased utilization of PSA screening tests." Moreover, the incidence rates for many non-smoking cancers have continued to escalate sharply (Appendix III), and to outweigh the decline in lung cancer incidence in men (1, 6).
Ignoring these criticisms, the cancer establishment persisted in empty promises for winning the cancer war. The NCI 2001 Cancer Progress Report claimed that rates of new cancers and deaths were falling overall, while admitting that this decline largely reflected a reduction in smoking-related deaths in men, a notable achievement for which the American Lung Association played a major role. However, the Report again ignored the sharply increased incidence, both overall and for a wide range of non-smoking cancers, from 1973 to 1999. The Report also ignored the 4% increase in cancer mortality over the same period, in spite of multibillion-dollar expenditures on treatment and treatment research. Of further interest is an analysis of leading causes of death from 1973 to 1999. Cancer has increased by 30%, from 17.7% to 23.0% (1); in striking contrast, according to the CDC National Center for Health Statistics 2001, mortality from heart disease decreased by 28%, from 38.4% to 30.3%. As a leading critic on the politics and finance of science recently commented, "The good news about cancer must be emphasized and, if need be, manufactured, to keep up public spirits and support . . .for more money . . .without public interference in the use of the money" (7). The Report also admitted that the costs of cancer treatment, direct costs, had more than doubled from $18 billion in 1985 to $41 billion in 1995. Additionally, indirect costs from loss of wages, taxes, earnings and productivity were estimatedly $100 billion; in 1999, there were about 8.3 million cancer survivors, 3.2 million of whom were less than 65 years old.
Of further interest is an analysis of leading causes of death from 1973 to 1999. Cancer has increased by 30%, from 17.7% to 23.0% (1); in striking contrast, according to the CDC National Center for Health Statistics 2001, mortality from heart disease decreased by 28%, from 38.4% to 30.3%. Of related interest is the fact that, according to CDC, AIDS deaths over the last 20 years total under 500,000 in contrast to current cancer deaths of 550,000.
In May 2002, in a stunning reversal, the NCI and ACS suddenly abandoned their long-standing promises for winning the war against cancer. In their Annual Report to the Nation, they admitted that the incidence of cancer is expected to double by 2050 due to the aging population (3). No reference, however, was made to the sharply increasing incidence of cancers in younger age groups, such as childhood and testes (Appendix II). Most recently, NCI investigators have admitted that “reporting delay (of over two years) and reporting error – (have resulted in) downwardly biased cancer incidence trends, particularly in the most recent diagnostic years” (8). As reported in the Wall Street Journal, these “revised estimates present a dispiriting picture of the nation’s progress in preventing cancer” (9). Of concern is the silence with which other mainstream media have greeted NCI’s admission.
Excerpted from “The High Stakes of Cancer Prevention” by Samuel Epstein and Liza Gross, Tikkun Magazine, Nov/Dec 2000 www.tikkun.org
and Stop Cancer Before It Starts: How to Win the War on Cancer by Samuel S. Epstein, 2003
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612