LESSON 5.6 WORKBOOK. So what about the 'War on Cancer'?

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1 LESSON 5.6 WORKBOOK So what about the 'War on Cancer'? This module has provided a broad perspective to cancer as a disease, switching focus among the DNA, cellular, organ, and systemic levels. As described in Unit 1, our understanding of cancer has changed over time, and will likely continue to change as we learn more about the disease itself. This lesson is intended to take a step back and examine everything we know about cancer currently, to gain perspective on where we have come over the last several year, and where we still need to go. The War on Cancer The popular media often describes people with cancer as battling, fighting, or struggling with cancer. People that are in cancer remission are often described as survivors. Why is cancer in particular treated so emotionally? In the early 20th century, a cancer diagnosis was a death sentence. Patients were usually in denial of their diagnosis or fearful of their death. For this reason, doctors often did not tell their patients they had cancer, nor did patients tell their loved ones. Cancer was rarely mentioned in publi Then in 1913, 10 doctors and 5 other concerned citizens founded the American Society for the Control of Cancer (ASCC) to raise awareness of cancer as a disease. The ASCC believed that the best way to defeat cancer is through education. They wrote articles in magazines and professional journals to educate the public about cancer. In 1936, Marjorie G. Illig, an ASCC volunteer went one stage further. She created a Figure 1: Original poster for the ASCC What was the first organization to begin the 'War on Cancer'? American Cancer Society. American Society for Control of Cancer. Susan G. Komen Foundation. National Cancer Institute. 182

2 legion of volunteers whose purpose was to wage war on cancer The Women s Field Army wore khaki uniforms, complete with insignia of rank and achievement and went out into the streets to raise money and educate the public about cancer. Within 2 years their numbers swelled from 15,000 to 150,000 members. The Women s Field Army moved the ASCC, which was eventually renamed the American Cancer Society (ACS), to the forefront of cancer charities. Funding education, prevention, and research projects with the goal of defeating cancer by improving cancer prevention and treatment. It made a major contribution to cancer education in 1971 when lobbied President Nixon to pass the National Cancer Act, which established a War on Cancer. The Act expanded the National Cancer Institute (NCI) and increased federal funding for cancer research. Since 1971 it has spent nearly $90 billion dollars on its goal to cure cancer within 30 years. Cancer advocacy: pros and cons Other charitable organizations have since joined the ACS and the government s War on Cancer. Some, such as the Jimmy Fund of the Dana Farber and St. Jude s Children s Research Hospital have arisen from hospitals that focus on cancer care, and raise money to support research into treatments. Others such as the Susan G. Komen Foundation and Livestrong have been formed by cancer patients, survivors or their families with the goal of raising cancer awareness. While research into cancer biology, prevention and treatment is concrete and has clear goals, the notion of raising cancer awareness is rather more vague, and recently, patient advocates and activists have called into question whether encouraging the population to wear pink ribbons and buy pink merchandise or to grow moustaches in Movember raises awareness effectively. At issue is these cancer charities focus on making early screening universally available. Cancer Figure 2: Breast cancer awareness poster. Awareness campaigns promote early detection without educating individuals on what cancer diagnosis means leading to overdiagnosis and overtreatment. charities cite the 5-year survival rates for breast cancer and prostate cancer, which are among the highest for all forms of cancer within the US population, as evidence for the success of their approach. Yet activists are concerned that these numbers are misleading and serve to divert resources from more critical problems in cancer treatment and care. We have learned that while mass screening can indeed dramatically increase the number of early stage tumors and cancers that are detected, neither screening alone nor follow-up biopsies can accurately predict which of these tumors will give rise to severe disease. Because of this we currently treat all of 2. What was the major goal of the ACS? Developing new therapies for cancer treatment; Educating the public about cancer; Increasing funding for research; Organizing boycotts of tobacco companies. 3. What is Breast Cancer Awareness Month hoping to achieve? Build support for women who are terminally ill; Encourage more people to have breast cancer screens; Educate people on the biology of breast cancer; Inform people on the causes of breast cancer. 183

3 breast tumors as though they will, which as we have learned leads to overtreatment that can be extremely problemati In fact in cases, such as prostate cancer, where we now have a better handle on which tumors will progress to severe disease, recommendations for screening have been significantly reduce Hence labeling those individuals who have been diagnosed with early stage tumors that would never have progressed to severe disease as survivors gives a misleading impression of the effectiveness of the screen, since the principal thing they may have survived is the unnecessary treatment they have received as a result of the screen. On the other hand these same screening programs are not effective in reducing the death rate from fast-growing metastatic cancers, if the tumor has spread before the screen has detected it. Activists argue that resources would be more effectively used by figuring out how to tie screening results to prediction of outcome at the individual level which is the hope of personalized medicine as we learned in the last lesson. Moreover patient advocates consider that labeling patients who would never have developed serious disease as survivors while labeling patients who cannot be helped losers in the war on cancer is divisive and counterproductive. Few of the prominent cancer charities focus on awareness of cancers that are still essentially death sentences, such as lung, stomach, liver and pancreas. In this case activists argue that even though we may not yet have screens to detect early stage tumors or viable treatment options awareness campaigns should prioritize education into minimizing risk. For example, lung cancer is one of the highest causes of death in the US population and is most frequently associated with smoking. In fact smoking is one of the leading causes of all forms of cancer, and is estimated to be responsible for about 30% of all cancers, yet cancer organizations focus little attention on raising awareness of the dangers of smoking, and smoking prevention campaigns have declined in the last several years Figure 3: Smoking is one of the most preventable causes of cancer. It is believed at around 30% of all cancers are caused by smoking tobacco products. We now understand that unbalanced diets and obesity are other major risk factors for cancer. We learned in Unit 3 that not only does obesity give rise to chronic inflammation that in turn can promote cell transformation, but it also reduces the ability of the immune system to handle cancers. Knowing this it is particularly puzzling that cancer awareness organizations have actually promoted the consumption of unhealthy foods in order to raise money. For instance in a campaign to raise money for breast cancer awareness, the Susan G. Komen Foundation partnered with KFC so that KFC would donate 50 cents for every bucket of fried chicken it sol Fried chicken, particularly from fast food restaurants like KFC, is generally high in the calories fat and salt known to promote risk for obesity and potentially cancer. Once the media began 4. Which of the following would be a useful awareness program from a cancer charity? (Circle all correct) Advertisements encouraging people to stop smoking. Partnership with McDonalds to sell fried chicken to raise money for research. Labels on foods that contribute to obesity. Education materials explaining what mammogram diagnoses mean. 184

4 reporting on this contradiction the Susan G. Komen foundation cut its ties with KFC, but the event raised questions about the extent to which other corporations were using connections to the cancer awareness promotions run by charities like Susan G. Komen, to deflect attention from their involvement in increasing the risk for cancer. Defeating cancer In the 40 years since the passage of the National Cancer Act that started the War on Cancer it is estimated that $90 billion has been spent in the US on research and treatment of cancer. Yet, major questions about cancer what causes it and how can we predict whether a cancer will spread and cause disease not only remain unanswered but are a minor target of our research dollars: It is estimated that of the $2 billion that the ACS and NCI spent last year on the war on cancer only ~$300 million was spent on research that focuses on metastasis. Likewise only $233 million is spent on education on cancer prevention. Activists ask whether patient advocates are dictating where money is spent and impeding progress. Figure 4: The KFC Buckets For The Cure partnership with Susan G. Komen was criticized by many patient advocates for raising money for cancer research and awareness while also promoting obesity and increasing cancer risk. Will we ever be able to prevent cancer. Unlikely. Random DNA mutations accumulate no matter what we do so preventing the random DNA mutations that mutate protooncogenes or tumor suppressor genes to drive cell transformation is an impossible task. Accumulation of random mutations increases with age, which is why cancer is more frequent in the elderly. So while we cannot prevent all random DNA mutations, it is likely we will be able to reduce the extent to which they occur by minimizing exposure to environmental carcinogens particularly cigarette smoke, diet, and pathogens that increase the frequency of mutation. Will we ever be able to cure cancer? Research funded by the War on Cancer has taught us so much about how cells behave, much of it so completely unexpected that it is not surprising we have not yet solved the problem. But as we learn more we move further towards treating individuals diagnosed with cancer so they can lead long healthy lives. While cancer may be inevitable for the very old, we may indeed be able to eradicate it in the young. Understanding metastasis is one key, another is the choices we ourselves make to reduce risk. Notes: 185

5 STUDENT RESPONSES Why have concerns been expressed about cancer awareness campaigns? Remember to identify your sources Workbook 186