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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.
Statistics
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.
Appendix III
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.
Appendix V
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
CONTACT:
Cancer Prevention Coalition
University of Illinois at Chicago
School of Public Health
2121 W. Taylor St., MC 922
Chicago, IL 60612
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