Why Don’t We Pay As Much Attention To Prevention And Better Cancer Care As We Do To The Next Great New Cancer Drug?

The largest and most important cancer meeting of the year, the American Society of Clinical Oncology Annual Meeting, is going on this weekend in Chicago, and that’s a good time for one to give some thought to the broader topic of what has happened in cancer care over the past year.

But as I have started sitting in the sessions listening to stories of progress and new breaking research on truly innovative therapeutics and diagnostics, a lingering, somewhat troubling thought has persisted. I find myself coming back to a very basic question: we are spending billions—yes, billions—on new approaches to detecting and treating cancer. But we are spending nowhere near that amount on the fundamental “blocking and tackling” in cancer: the tactics that can help prevent the disease and –by applying what we know—can reduce its deadly toll.

What has been on my mind is a chance meeting I had with a lady during my recent travels. She saw the American Cancer Society lapel pin that I wear on my suit jacket and asked me if we are making progress in treating cancer. I answered her question with my usual cautious optimism (for some diseases, significant progress; for others, not so much; for all, we could do much more). Then she told me how excited she was about her sister who had been diagnosed over 30 years ago—in her early 30s—with breast cancer, and was a thriving, healthy survivor.

Her response piqued my interest, so I asked further (with her permission, of course) whether any other members of her family had cancer. She responded that her mother had ovarian cancer. If you’re familiar with what we know about cancer and heredity, you are probably hearing the same alarms bells I did. My next question was whether she or preferably her sister had ever been told they should be tested for hereditary cancer. The answer, to my surprise, was no. In fact, no one had ever talked to the family about that possibility.

For those of you who aren’t familiar with these issues, this case is about as clear as they come: a young woman has breast cancer, her mother had ovarian cancer; the next step is genetic counseling and possibly testing to see if she has an increased risk of breast, ovarian and other cancers. And then determine how many other family members may need to be tested, and what preventive measures should be recommended. There are things we can do, from lifestyle changes, to more intensive screening, to drugs and even surgery. It may prevent a serious cancer, and even death.

There are always more parts to the story, and my short conversation didn’t uncover all the details. Still, let’s assume the accuracy of the facts in front of us. They raise the substantial question: In a world of incredible investment in curing cancer, isn’t there room to invest in making sure we’re doing all we can now to prevent cancer, provide access to cancer care, and make certain consumers can get the advice and preventive tests they need when they need them?

Our science marches on, and that’s a good and wonderful thing. The impact of that science on our health is enormous, and has the potential to become even more enormous. However, we should never forget that lost in all the excitement about new drugs, new techniques to monitor cancer under treatment and predict which ones need to be treated aggressively, and new ways to find cancer earlier and earlier, we still aren’t paying sufficient attention to the basics—the blocking and tackling that really could help us prevent cancer in the first place or make certain that the best care possible is offered—the first time around.

Let’s face it: the return on an investment into prevention and adequate care is more difficult to demonstrate. It isn’t glamorous. It isn’t flashy. It doesn’t get headlines. But we should never forget that the best cancer outcome happens when we do everything we can to educate consumers, make certain they have access to care, offer them the appropriate preventive advice and prevention services, and if they develop cancer make certain that what we do is the most appropriate care at the beginning of the journey where it can offer immense benefit for so many.

The reality is that not many are lining up at the door to hear that conversation and you certainly don’t see much coverage in the media, unlike some of the breakthroughs coming from this conference. Maybe it’s time to change that reality.


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J. Leonard Lichtenfeld's Biography

Dr. Len

J. Leonard Lichtenfeld, MD, MACP: Dr. Lichtenfeld currently serves as Deputy Chief Medical Officer for the American Cancer Society in the Society's Office of the Chief Medical Officer located at the Society's Corporate Center in Atlanta. Dr. Lichtenfeld joined the Society in 2001 as a medical editor, and in 2002 assumed responsibility for managing the Society's then newly created Cancer Control Science Department which included the prevention and early detection of cancer, emerging cancer science and trends, health equity, quality of life for cancer patients, the science of cancer communications and the role of nutrition and physical activity in cancer prevention and cancer care.  In 2014, Dr. Lichtenfeld assumed his current role in the Office of the Chief Medical Officer where he provides extensive support to a number of Society colleagues and activities. As a result of his over four decades of experience in cancer care, Dr. Lichtenfeld is frequently quoted in the print and electronic media regarding the Society's positions on a number of important issues related to cancer. He has testified regularly in legislative and regulatory hearings, and participated on numerous panels regarding cancer care, research, advocacy and related topics. He has served on a number of advisory committees and boards for organizations that collaborate with the Society to reduce the burden of cancer nationally and worldwide. He is well known for his blog (www.cancer.org/drlen) which first appeared in 2005 and which continues to address many topics related to cancer research and treatment. A board certified medical oncologist and internist who was a practicing physician for over 19 years, Dr. Lichtenfeld has long been engaged in health care policy on a local, state, and national level.  He is active in several state and national medical organizations and has a long-standing interest in professional legislative and regulatory issues related to health care including physician payment, medical care delivery systems, and health information technology. Dr. Lichtenfeld is a graduate of the University of Pennsylvania and Hahnemann Medical College (now Drexel University College of Medicine) in Philadelphia.  His postgraduate training was at Temple University Hospital in Philadelphia, Johns Hopkins University School of Medicine and the National Cancer Institute in Baltimore. He is a member of Alpha Omega Alpha, the national honor medical society.  Dr. Lichtenfeld has received several awards in recognition of his efforts on behalf of his colleagues and his professional activities.  He has been designated a Master of the American College of Physicians in acknowledgement of his contributions to internal medicine.  Dr. Lichtenfeld is married, and resides in Atlanta and Thomasville, Georgia.

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