Maurie Markman, MD
The state of oncology in the United States today is on the verge of chaos. At a time of stunning advances in our understanding of the fundamental mechanisms responsible for the establishment and progression of malignant disease and of the process of inherent or acquired drug resistance, along with the development of increasingly effective molecularly targeted and immune-based therapeutics, a simply unsustainable nancial model threatens to dismantle our poorly coordinated and distressingly fragile cancer care delivery system.
Regardless of whether we are talking about a developed or a developing country, it is essential to acknowledge approaches to cancer care that have been documented or strongly suggested to be effective in the prevention of malignant diseases and that do not require expensive technology or drugs. Although the 3 strategies highlighted in this commentary may sound to some like a broken record, a truly sustained focus on low-cost measures that can favorably reduce cancer incidence becomes ever more relevant in light of the relentless escalation in the costs associated with care of a confirmed malignancy.
Targeting Tobacco Use
Of course, the No. 1 item on any list of interventions must be a renewed emphasis on effective strategies for tobacco control. Currently, it is estimated that approximately 17% of all adults in the United States smoke cigarettes, and that 1 in 4 high school students use tobacco products. Furthermore, recent data suggest that at least 167,000 deaths in the United States in 2014—or a truly staggering 28.6% of all cancer deaths—were related to cigarette smoking. And, one must add to this figure an unknown number of smoking-related cancers resulting from second-hand smoke exposure.
Although it must be acknowledged that all efforts to reduce cigarette smoking would be strongly opposed by the powerful tobacco lobby, legislators need to be constantly reminded of both the individual impact of tobacco-associated cancers (and other serious medical conditions) and the enormous financial burden this addiction imposes on families and society.
Strategies to Fight Obesity
The second area to highlight is the increasingly recognized, rapidly progressing, and extremely worrisome epidemic of obesity (defined as a body mass index >30) in the United States, estimated to include 38% of all adults, and its impact on the development of cancer. The risk of certain malignancies, such as liver, esophageal, gastric, colon, pancreas, endometrial, gall bladder, and postmenopausal breast cancers plus multiple myeloma is considerably greater for obese patients compared with normal weight individuals, and mortality may also be increased.
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