Friday, April 12, 2013

Cancer

Last month I lost my good friend and mentor Rusty Uhl to a long fight with cancer and it was this reason that I decided to write this blog post.  Rusty was diagnosed with stage four prostate cancer almost three years ago and was given less than six months to live by his doctor at the VA hospital here in town.  Rusty, being an incredibly focused and  sometimes cantankerous individual, did not accept the prognosis that he was given. Much like some of the patients which we read about he shopped cancer clinics around the country and eventually ended up at the oncology department at UCLA. Although he consistently complained about the long trips back and forth to California the doctors there were able to give him quality and increased quantity of life for his last couple of years and for this I am grateful. 
After viewing the 60 Minutes segment today concerning Dr. Potti’s manipulation of his research in the Duke University Cancer study scandal it made me consider cancer in a different light.  Although there are advanced clinical trials available to some patients it is not all patients who get this type of treatment, as Rebecca pointed out, and not all patient’s cancers will be recognized in time for any sort of intervention.  With this in mind I did a quick search for cancer on Google News and found a report within minutes which brightened my outlook considerably.  For this Media Blog post I will discuss the concordance rate of cancer and smoking, the World Health Organization (WHO) and the American Cancer Society (ACS), and the differing models of preventative care.
                Cancer and death are two words that are so often associated together that over the years they have began to become synonymous.  Fatalism is not a type of attitude which I approach lightly so I was honestly curious about what specific cancers were the most deadly and what/if any had some sort of preventable cause.

  • ·         Pancreatic Cancer: has a 94% mortality rate and the factors which increase risk are: family history, age, smoking (this increases the risk ratio by 1.74), diets low in fruits and vegetables, and diets high in red/ processed meat  The definition of the Risk Ratio is the probability of someone developing a disease.
  • ·         Liver Cancer (Hepatocellular carcinoma) Mortality rate: 93% and the factors which increase risk are most commonly Hepatitis B and Cirrhosis.  Interestingly liver cancer is especially prevalent in low/moderate income countries where vaccination for hepatitis B is not common; whereas, in more developed countries it is less common but more likely to have been caused by Cirrhosis.
  • ·         Esophageal Cancer has a 92% mortality rate and the factors which increase risk are age, sex, heredity, and  alcohol and tobacco use (both increase RR at the same rate and enhanced synergy occurs), etc.
  • ·         Lung Cancer has a 87% mortality rate and the factors which increase risk are smoking (this accounts for between 80-90% of cases), asbestos exposure, radon gas, air pollution, and heredity
  • ·         Stomach Cancer 83% mortality rate and the factors which increase the risk are Heliobacter Pylori (H Pylori), smoking, alcohol ingestion, and a diet high in nitrates.

So what does the World Health Organization currently say about the rates of cancer deaths in the world?  In 2008 the WHO stated that 7.6 million people worldwide died from cancer deaths and that 70% of those who died lived in low/moderately developed countries.  Although these numbers are shocking to consider the WHO also said that 30% of cancer deaths are preventable.  This is good news when we reflect on the CNN article which said that between 1991 and 2009 the rate of cancer deaths dropped by 20%.  The CNN article cites several reasons for this drop in mortality; however, the top three were reductions in smoking, improvements in detection, and improvements in treatment. 
These differing models of preventative care may have different sources but they all have the interest of lowering the deaths of rates by cancer.  The number one preventable cause of death (PERIOD) in our country is smoking.  Although the programs are available for quitting smoking it is incredibly difficult, I can attest, to quit and with the distal economics of the end result it is often difficult for smokers to see the reality.  Recently the tax on cigarettes has increased exponentially by year across the country to pay for the burden which smoking puts on the taxpayers and this has been cited by some as the reasons for the decrease in smoking.  The increase in early detection has oddly been most often attributed to physician recommendation.  It would seem that the interest of a physician would be the health of their patient; however, this does not always make the case when a patient might have a vehement objection to an invasive test.  As times change and doctors are more concerned with their own practice they have begun to recommend regular screenings for patients regardless of a patient’s personal concerns.
Finally, to come full circle we have improvements in treatment being a cause for the decline in cancer.  Although we can say, after viewing the 60 Minutes segment, that not all cancer treatments are a technical improvement in treatment it would seem that the aim of some clinical trials is to improve upon quality of patient care.  Medications, chemotherapy, and other treatments are becoming not only life extensions for some patients but honest life savers.  Dr. Paulo Hoff with the Oncology department at the University of Texas is saying of metastatic colorectal cancer that hope is beginning to become more common, even in the face of this common killer.  This blog post has focused on the top five causes of cancer death in the United States, the reports by the WHO and ACS, and the differing models of preventative care.

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