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In 2019, according to the American Cancer Society, an estimated 1,762,450 people will be diagnosed with cancer in the United States and an estimated 606,880 will die of the disease. In order to make a dent in a public health sense, we must prevent cancer.” A Grim Tally “But we can’t treat our way out of this problem. Chan School of Public Health and Dana-Farber Cancer Institute, and director of the School’s Zhu Family Center for Global Cancer Prevention. Professor of Cancer Prevention at the Harvard T.H. “We will always need good treatments,” says Timothy Rebbeck, the Vincent L. Put simply, cancer must be framed not just as a curable disease but equally as a preventable one. The other half of cancer cases-including the elusive and often deadly types often caught too late to make a difference, such as ovarian, pancreatic, and brain tumors-could be detected and potentially even prevented far earlier if basic science and promising diagnostic technologies received the sustained government support they need. Current research suggests that at least half of cancer cases-estimates range from 30 percent to upward of 70 percent-could be prevented by applying what we already know. The reality of cancer lies somewhere between the public health ideal of perfect prevention and the depressing stochastics of bad luck. For that reason, it is unlikely that cancer could ever be eradicated. Cell division is an imperfect process like a biological keyboard with a letter missing, it makes mistakes. The majority of risk, the researchers concluded, was due to “bad luck”-random mutations during normal DNA replication.Īnd though that study provoked torrents of criticism about whether its conclusions based on tissue studies could be spun up to populations, it’s true that cancer is the price we pay as organisms composed of trillions of cells. It argued that only one-third of the variation in cancer risk in tissues is due to environmental assaults or inherited genetic predispositions. In 2015, a study in Science seemed to confirm our primal fear. Anyone who has suffered cancer, or has suffered alongside a loved one with the disease-a considerable portion of the population, given that more than one in three of us will be diagnosed with a malignancy during our lifetime-knows the anguish and helplessness that trail the diagnosis. Even today, it continues to occupy our collective imagination as the king of terrors: insidious, capricious, relentless.

We tamed heart disease through smoking cessation, better medical management of risk factors such as high cholesterol, and improved interventions for a condition that has clear points of intervention and responds more readily to lifestyle changes.Ĭancer is a different story. We tamed infections with sanitation and vaccines, abetted by antibiotics. And on a broad scale, we have made far less progress preventing cancer than preventing its predecessor scourges.
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But advances in treatment alone will never be enough to fully stem the burden of cancer.Īs every public health professional knows, on a population level, the only way to substantially reduce incidence and mortality for any disease is through prevention.
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He left out the second part of the surgeon’s epithet: “the king of terrors.” Modern targeted treatments and immunotherapy have in some cases led to wondrous cures, and many malignancies are now caught early enough so that their sufferers can live out full lives. Siddhartha Mukherjee titled his magisterial biography of cancer The Emperor of All Maladies, quoting a 19th-century surgeon. The bad news is that cancer continues to bring pain and sorrow wherever it strikes. Cancer’s new ranking also reflects public health’s impressive gains against infectious disease, which held the top spot until the last century, and against heart disease, the current number one. Cancer is primarily a disease of aging, and the dubiously good news is that we are living long enough to experience its ravages. The shift marks a dramatic epidemiological transition: the first time in history that cancer will reign as humankind’s number-one killer. Later in this century, it is likely to be the top cause of death worldwide. In the next few years, cancer will become the leading cause of death in the United States. The only solution is a full-scale defense, so that nobody suffers the disease in the first place. We cannot treat our way out of the rising cancer caseload.
