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GUEST EDITORIAL |
Dr. Vance is President, American Cancer Society, and Professor of Medicine, University of Mississippi School of Medicine, Jackson, MS.
Cancer is the nation’s leading health concern and its second leading cause of death. During the next 12 months, approximately 1.3 million Americans will hear the words, "You have cancer," and more than 550,000 will die of the disease.1 Although cancer continues to take an enormous toll on our country, we have an unparalleled opportunity to reduce suffering and death from malignant diseases, as reflected in the article by Jemal and colleagues in this issue of CA. For progress in research to have a substantial impact on this cancer burden, it must be translated to public health and clinical interventions that reach all members of our society. This will require continued federal and state support of cancer research and control programs, as well as sustained efforts to ensure that the health care system provides access to diagnosis and treatment for all. Thus, we must wed cancer control to advocacy to achieve our mission of diminishing suffering and saving lives.
The American Cancer Society (ACS) has established necessarily ambitious goals to advance the nation’s progress against cancer by 2015. In collaboration with the federal government and other public, private, and voluntary health organizations, we hope to achieve a 50% reduction in the age-adjusted cancer mortality rate, a 25% reduction in the age-adjusted cancer incidence rate, and a measurable improvement in quality of life (in physical, psychological, social, and spiritual domains) from the time of diagnosis throughout cancer survivors’ lives.
To achieve these ambitious goals, the nation must reaffirm its commitment to the fight against cancer. By applying our existing knowledge of cancer control more fully—including effective prevention and early detection programs—we can make significant strides toward the 2015 goals. The last decade has seen major advances in comprehensive cancer control efforts at the state level. Federal efforts are also making a difference, such as the recently completed doubling of the National Institutes of Health (NIH) budget. However, cuts in federal funding, diversion of state tobacco settlement funds, increasing poverty, and declining health insurance coverage impede states’ efforts and pose new challenges.
Many believe that recent advances in biotechnology will help us surmount these challenges. We may be on the brink of being able to interrupt or reverse the biological processes by which cancer occurs. According to Dr. Andrew von Eschenbach, Director of the National Cancer Institute, "Today, we still may not be able to ‘cure’ cancer, but we can now implement a comprehensive strategy to preempt the onset and progression of the disease. The exponential advances in cancer research are defining with ever-greater specificity the many genetic, molecular, and cellular events that determine the disease process of susceptibility, disease initiation, and fatal progression. And this new knowledge can be translated into innovative and more effective strategies of prevention, elimination, and modulation."2 We have indeed made significant advances in cancer prevention, but we can fully realize this potential only with continued support of basic, clinical, and applied research.
This support will continue only through the successful marriage of cancer control and advocacy. Many people tend to think of cancer as a purely medical or scientific issue, but it is also a political one. Every day legislators introduce bills, pass laws, and allocate funds that profoundly affect persons with cancer and their families. Health insurance coverage, clinical trial participation, the development of new treatments, and the delivery of quality care all involve legislation. I share the belief of many Society volunteers and staff that advocacy on behalf of cancer control is critical to reaching our 2015 goals. It is a force multiplier in the fight against cancer.
One example of the synergy between cancer control and advocacy is tobacco control. Cigarette smoking alone causes approximately 30% of cancer deaths in the United States and a total of 440,000 premature deaths annually. Most of the deaths are from lung and other cancers, ischemic heart disease, stroke, and chronic obstructive pulmonary disease. An estimated $157 billion in annual health-related economic losses are also attributed to smoking.3
Advocacy can accelerate the goal of ending the epidemic of deaths caused by tobacco. At the federal level, we can work to enact legislation supported by the public health community that grants the Food and Drug Administration meaningful regulatory authority over tobacco products. In addition, increasing federal and state excise taxes on tobacco is a proven means of reducing tobacco use, especially among young people. In fact, a 10% cigarette price increase decreases overall consumption by approximately 4%. Funding state programs that help people quit smoking and that prevent kids from starting is another avenue, as is providing health care coverage for tobacco cessation services to patients in the Medicare, Medicaid, and Maternal and Child Health Block Grants. The last piece of this tobacco puzzle is enacting effective state and local smoke-free laws in every state. Smoke-free environments are becoming the norm rather than the exception in some states, but the number of smoke-free communities is still far too small.
As a community-based organization, the Society unites millions of people nationwide in the fight against cancer. We have a presence in more than 3,000 communities across the country. Just more than one year ago, we made that presence felt in Washington, DC with the Relay for Life® Celebration on the Hill. Thousands of volunteers from every state and congressional district came together to insist that Congress make cancer a priority. This unprecedented and extraordinary event delivered a powerful message, within the organization and beyond, about the unique power of advocacy in the fight against cancer.
Activities such as the Relay for Life Celebration, combined with the ongoing efforts of advocacy volunteers, are helping the Society build and flex its grassroots muscle. Working together, dedicated volunteers, staff, and coalition partners have restored $1 billion in NIH funding in 2003. We have secured coverage for cancer screenings and clinical trials in Medicare and through private insurance in many states. The Society worked to ensure that women can obtain treatment for breast or cervical cancer no matter what their socioeconomic level. Tobacco excise taxes increased in 30 states in just two years, and five states and more than 1,600 communities are now completely smoke-free.
Clearly, the public policy arena can be as powerful a tool against cancer as clinical and laboratory research. But we still have much work to do. That is why the Society created the Cancer Action Network (Society CAN), a sister organization that will empower the Society to take our advocacy efforts even further. A nonprofit, nonpartisan issue advocacy group, ACS CAN is dedicated to eliminating cancer as a major health problem through voter education and issue campaigns that ensure politicians and policy makers are held accountable for their votes on cancer issues through our votes at the ballot box.
As the new volunteer president of the Society, I ask you to join me in affirming the marriage of cancer control and advocacy, which is now at hand. This marriage has had an appropriate interval of engagement. The effective tools for the wedding are already in place. Let the ceremony begin.
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