We see good news and bad news about cancer almost everyday. It — and the quest to control and abolish it — is amongst the highest priority for doctors, researchers, patients, their families and friends.

You don’t have to go far to see where progress is being made. A recent visit to the American Cancer Society’s Website provided details of a 30-year landmark study that continues to confirm that radical mastectomy doesn’t save more lives than smaller surgeries combined with radiation and chemotherapy. This Fisher study, in truth, has not only been credited with changing the course of breast cancer treatment, but has altered and focused overall cancer treatment to a more systematic approach over the past 25 years.

This year, the ACS estimates 203,500 women in the U.S will be diagnosed with invasive breast cancer, while about 39,600 will die from the disease. There’s been a lot of controversy regarding breast cancer diagnosis and treatment of late, but the truth is that breast cancer death rates declined significantly from 1992 to 1996 (with the largest decrease in younger women) and continue their downward slide — most likely due to earlier detection and improved treatment.

Cancer treatment via various radiation therapy methods is the focus of our special section this month. In the section, beginning on page 31, we detail the cutting edge in intensity modulated radiation therapy (IMRT), brachytherapy, linear accelerators, simulation and planning, and prostate cancer therapy.

Approximately half of all cancer patients receive radiation therapy in the course of their treatment. Advances in this area are focused on delivering the most effective treatment, often in 3D volumes, while minimizing negative effects to healthy surrounding tissue. This promise is nothing new, but advancements are now making it reality for the masses.

These evolutionary technologies are vital to cancer survival, but beating cancer really starts before a diagnosis. Screening and prevention are the best way to ward off cancer. ACS estimates that screening methods detect half of all new cancer cases (which number about 1,284,900 annually), while the five-year survival rate for these cancers is about 82 percent.

This year, about 170,000 cancer deaths are expected to be caused by tobacco use — that’s one in five deaths in the U.S. And about 19,000 cancer deaths will be related to excessive alcohol use, frequently in combination with tobacco use. Through lifestyle change, willpower and treatment, these deaths could be prevented.

Even more commonly, about one third of the 555,500 cancer deaths expected to occur this year (1,500 every day) will be related to nutrition, physical inactivity, obesity and other lifestyle factors — which could largely be prevented by eating more fruits, vegetables and whole grains and less fat and exercising 30 minutes a day (twice that for kids). Cancers related to infectious exposures such as HIV, hepatitis B and human papillomavirus could be prevented too through behavorial changes, vaccines and antibiotics. An additional 1 million-plus skin cancers could have been prevented annually with a $6 bottle of high-SPF sunblock, a commitment to wear it regularly and avoidance of the sun during mid-day hours.

If you are male, your lifetime risk of developing or dying from cancer is 1 in 2, while females have a little more than a 1 in 3 lifetime risk. And it is true that only 5 percent to 10 percent of cancers are hereditary — all the more reason to be vigilant in screening and prevention.

And what is the overall cost of cancer? The National Institutes of Health estimate cancer costs in 2001 totaled $156.7 billion: $56.4 billion for direct medical costs (total of all health expenditures); $15.6 billion for indirect morbidity costs; and, $84.7 billion for indirect morbidity costs (cost of lost productivity due to premature death). That’s the bad news. But the new goods? Cancer survivors number about 9 million. That’s reason to fight.

Mary C. Tierney, Editor
mtierney@mwc.com