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EDITORIAL |
Dr. Vance is President, American Cancer Society, Atlanta, GA, and Professor of Medicine, University of Mississippi School of Medicine, Jackson, MS.
In this issue of CA, and concurrently in Diabetes Care(American Diabetes Association [ADA]), Circulation(American Heart Association [AHA]), and Stroke(AHA), the American Cancer Society (ACS), the ADA, and the AHA are announcing a new strategic partnership to reduce disability and premature death from cancer, cardiovascular disease, and diabetes.1 In my judgment, the potential for this collaboration is far reaching and, if successful, will contribute to far greater and faster progress in chronic disease control than the total of our individual organizational efforts.
As a medical oncologist and President of the ACS, my overriding focus in both roles is on cancer. The ACS’ stated mission is "eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service."2 However, as a physician, I also recognize that other chronic conditions, such as cardiovascular disease and diabetes, account for even more disability and death.
The ADA and the AHA have mission statements that are similar to the ACS, and they also support broad agendas focused on prevention, early detection, and therapy.3,4 Each organization is making headway against some aspects of their respective diseases, but each also faces enduring as well as new challenges.
Some challenges are the result of broad, long-term societal trends, such as the annual toll of tobacco-related illness and the worsening epidemic of childhood and adult obesity. However, other challenges are inherently due to the absence of a system for delivery of preventive care and counseling. In this respect, it is quite clear that much of the current disease burden from cancer, cardiovascular disease, and diabetes is preventable if we were able to systematically apply present knowledge about risk reduction and disease prevention. Furthermore, it is increasingly evident that the common causes of these chronic illnesses are not unique to any one of these conditions but, in fact, are shared by each of them. Physical inactivity, poor diet, and obesity are each risk factors for cancer, cardiovascular disease, and diabetes. Smoking is responsible for more deaths from cancer and cardiovascular disease than any other single risk factor and substantially worsens the complications of and mortality from diabetes. Recent studies suggest that that smoking may also be a risk factor for type 2 diabetes.
Each of these chronic diseases is, to a great degree, preventable. Each also has a long developmental period during which secondary prevention could reduce risk, and each has a preclinical period where early interventions could alter the natural history of the disease and its complications. It is also the case that a significant percentage of the population steadily accumulates risk without guidance or intervention and that a significant percentage of the adult population has undiagnosed disease. The glaring reality is that current approaches to prevention and early detection are fractionated and sporadic for those with access to care and largely nonexistent for those without health insurance. Patients largely depend on a coincidence of interests and opportunity during doctor-patient encounters for illness. We establish goals for prevention and early detection, but health care delivery focuses far more on treatment than prevention. Indeed, we are seemingly helpless in the face of a growing epidemic of obesity. Mokdad and colleagues estimate that physical inactivity and poor diet will soon account for more annual deaths in the United States than smoking.5
It is time for a new approach. Cancer, cardiovascular disease, and diabetes account for nearly two out of three deaths each year in the United States. These three major chronic diseases should not be competing for the attention and time of patients, clinicians, insurers, and policy makers. Rather, we must realize the synergy of focusing attention on a limited number of risk factors and screening tests that have tremendous potential to reduce suffering and death, so as to improve health and quality of life of the American public.
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