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Cancer Facts and Figures 2011 Poverty is a Carcinogen. Does Anyone Care

Those were the words of Dr. Samuel Broder when he was director of the National Cancer Institute in 1989.  

As amply documented in the annual "Cancer Facts and Figures 2011" released today by the American Cancer Society, cancer shows that poverty remains one of the most potent a carcinogen-rivaling tobacco and obesity-as we have ever seen.

We have heard lots and lots about how cell phones and Styrofoam cause cancer.  But do you hear anyone talking about the huge impact of poverty and limited education on cancer?

If you don't hear anything about a true carcinogen that statistics show causes 37% of the deaths from cancer in people between the ages of 27 and 64, then maybe you have the answer to a very important question: If we are serious about reducing the burden and suffering from cancer, why aren't we paying attention to those most in need?

The report is one that is eagerly awaited every year by researchers, the media and many others.  It is the source for a lot of the mind-numbing cancer statistics that you see all year long, such as "The American Cancer Society estimates that (fill in the number) of Americans will be diagnosed with (fill in the cancer) in (fill in the year)."  It is one of the most widely cited scientific articles in the medical literature, year after year.

I could fill this page with interesting findings from this year's report, such as the fact that the American Cancer Society estimates that 1.56 million people in the United States will be diagnosed with an invasive cancer in 2011 and 571,950 people will die from cancer in 2011.

More encouraging numbers are that the rates of cancer deaths continue to decline as they have for many years, while over the past several years the incidence of cancer in men has remained stable year over year and declining slightly in women annually.  Overall, between 1990/91 and 2007, cancer death rates decreased by 22.2% in men and 13.9% in women.  

In particular, the rates of diagnosis of colorectal cancer in men have dropped 3% EVERY YEAR from 1998 through 2007, and for women the comparable decrease was 2.2%.  And, finally, after waiting for years, we are seeing a decline in deaths from lung cancer in women has finally started a downward trend.

Those are all interesting and important numbers.

But how about these?

By doing what we already know-with prevention, early detection and better treatment-we have avoided 898,000 deaths from cancer between 1190 and 2007.  

We can't tell you how many people are actually alive because those deaths were avoided, since some people today never hear "you have cancer" (think colorectal and cervical cancer, for example since they can be effectively prevented through screening and better diet and exercise) or perhaps because they never started smoking in the first place.  And then there are the people who are the offspring of those people whose deaths have been avoided or who never developed a cancer they would have otherwise developed.  

Bottom line, the people alive today because of the progress we have made likely number in the millions.

But don't start the party just yet.

Not are so fortunate, and that is one of the key points made in today's Cancer Facts and Figures are those who are poor and poorly educated have much, much higher cancer incidence and death rates.  That's unfortunately why I can say that cancer remains a potent carcinogen.

Here are some of the facts:

We know that there are significant gaps in cancer incidence and survival between various ethnic and socioeconomic groups.  I am always reminding people that it isn't the color of your skin that makes all the difference, it's also your education, your job, where you live and other factors that contribute to your risk of developing and dying from cancer.

Some examples include the fact that lung cancer deaths are 4 to 5 times higher in the least educated vs. the most educated people.  4 to 5 times.  That is an immense difference in risk.

The American Cancer Society estimates that about 164,000 men and women between the ages of 25 and 64 died of cancer in the United States in 2007.  More than 60,000 (37%) of these deaths could have been avoided if everyone had the same death rates of the most educated whites. 60,000 lives in one year!!!!!!!!

Do you understand that being able to avoid 37% of cancer deaths in this age group shows that this educational disparity makes it a true carcinogenic factor?  It isn't as obvious as tobacco or an HPV virus, but its impact is every bit as significant.

About 24,560 African Americans between the ages of 25-64 died from cancer that same year.  If all African Americans in 2007 had the same death rates from cancer as the most educated African Americans, then 10,000 of those deaths-almost 40%--could have been avoided.

Here is the tricky part:

If you took the same statistic about deaths in the 25-64 YO age group for African Americans, and compared their death rates to their white counterparts with the same education as the African Americans, 5000 (or 20%) of African American deaths would have been avoided.

Wait a minute... 10,000 in the first example and 5,000 in the second?  That's a big difference. Why?

Because in the first example, we are keeping the comparison within the African American community and making the example based on education.  In the second, we are making the comparison to whites with a similar education to African Americans.  In the first, we are looking at socioeconomic and educational differences within a community; in the second we are looking at the differences between similar socioeconomic and educational factors.

If you are a poor African American and don't have an education, you are more likely not to be financially successful-and you have a much higher chance of dying from cancer than your ethnic counterpart who is better educated.

If you are a poor African American, you are still at a disadvantage compared to your poor white counterpart, but for a variety of unacceptable reasons, you still have a higher chance of dying from cancer.  But that increased risk is much less based on race as compared to education.  Education trumps ethnicity.

The report concludes:

"Among African Americans, eliminating socioeconomic disparities has the potential to avert twice as many deaths as eliminating racial disparities....Much of the disparity between African Americans and whites within the same level of education results from differences in risk factors and access to health care that cannot be captured in terms of educations attainment."

Why these differences?  There are many factors, some of which we know and some of which we don't.

I already talked about the impact of education.  That clearly has a lot to do with our habits, our daily lives, whether or not we smoke, our risk of obesity and on and on.  Health insurance is a major predictor of healthier behaviors and better treatments, as well as access to care generally.  

And never, never underestimate the power of discrimination to impact health and outcomes from illness, as reflected in the example I offered above.

From the report:

"Racial and ethnic minorities tend to receive lower-quality health care than whites, even when insurance status, age, severity of disease and health status are comparable.  Social inequalities, including discrimination, communication barriers, and provider assumptions, can affect interactions between patient and physician and contribute to miscommunication or delivery of substandard care."

So for a moment, let's put aside our gratitude that we have avoided the deaths of almost 900,000 people in the United States over 17 years and let's start to focus on the fact that we could save thousands upon thousands of lives every year if we all followed some basic living habits and had access to the services that reduce the risk of dying from cancer.

For me, here is the punch line to this story:

We have been hearing for the past several weeks about the things that could cause cancer.  We have been inundated with media reports telling us what is bad for us and perhaps not so good for us.  We have started a national conversation about cell phones, airport scanners and now Styrofoam and formaldehyde.

But sitting right in front of our noses is the fact that if we did what we already know, at least 37% of cancer deaths in people between the ages of 27 and 64 could be avoided right now.

So who, my friends, is talking about that?  Where is the national conversation about the fact that poverty is a carcinogen?  Are you talking about it?  Is the media talking about it? Are the politicians talking about it? Are your friends talking about it?

If the silence is deafening, then perhaps you have your answer. 



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