A tired old elephant hunched in the room as President Obama announced the launch of a new moonshot against cancer during his State of the Union address a month ago. We’ve heard that promise before. On 23 December 1971, when President Nixon first declared a national war on cancer, he also based his conviction on the successfully completed moonwalk. In truth, what it will take to reduce the burden of cancer in our lives has little to do with what it took to land a man on the moon. That stellar accomplishment came about by spending money on existing technologies. In fact, for more than fifty years we have known a lot about how to prevent cancer, yet we remain focused on finding and treating the disease. In 1971, one in six Americans developed cancer. Today the toll is far greater, affecting one in every two men and one in every three women during their lifetimes.
As the National Cancer Institute (NCI) reports, the modest decline in overall cancer deaths after more than $100 billion has been spent is largely due to declines in smoking and improvements in treating childhood and screening related cancers. There’s been little real advance in treating the most deadly adult cancers. Tobacco, alcohol, diet, daily exposures from the environments at work, home, school, viruses, exercise, and radiation are understood to trigger the disease in nearly nine out of ten cases – as the president’s cancer panel reminded us in 2010. A detailed analysis by expert statisticians explains that “The decline in overall cancer mortality in the United States (US) chiefly reflects successful efforts to discourage smoking and advances in screening and treatment for breast, cervical, prostate, and colorectal cancers.”
Much of the past war on cancer has focused on the wrong enemies, with the wrong weapons. No matter how impressive the gains we may make from immunotherapies, we must figure out how to keep the disease from happening in the first place. While we focus on the genome within, we are ignoring the “exposome” – all that we breathe, drink, eat and absorb through our skin. Cancer prevention requires controlling and reducing agents known to increase the chance that cancer will develop with major support to responsible agencies and incentives to companies to use and produce less toxic products.
Studies of identical twins tell us that most cases of cancer do not arise because of inherited defects. The NCI notes that only one in ten women who develop breast cancer is born with defective genes. This means that most cases come about because of ways that our healthy genes interact with the world around us. Women who work at night—like nurses or those who work in electronics—have lower levels of melatonin and higher rates of breast cancer. CDC finds that men who work with chemicals or electromagnetic fields have higher rates of brain cancer and leukemia. Those who work with wood dust and formaldehyde have higher rates of nasal cancer. The list of workplace causes of cancer provides a litany of mostly under-regulated and unrecognized factors.
The history of American efforts to regulate chemicals makes it clear, it can take three weeks to approve a new chemical and more than thirty years to remove it from the market.
Cancer is not the business of NIH alone, but arises from policies on energy, buildings, food, and manufacturing. Fossil fuel emissions are not only climate changing greenhouse gases, they also include a soup of toxic agents and engine exhausts. A true moonshot on cancer would mean altering purchasing and investment decisions across the board and enhancing environmental protection to prevent cancer from occurring, as well as seeking novel approaches to treatment through immunotherapies.
If we want to win the battle against cancer, we can start with what we’ve known for half a century, to tackle those things known to cause cancer. Ask yourself this: When should we have acted against tobacco? Why did we wait until nearly 40 years after tobacco was understood to cause cancer and other diseases before mounting a major effort to curtail tobacco production and use? What took us so long to reduce the amount of benzene in gasoline or toxic flame retardants in our waters, food, furniture, bedding, and fabrics? The answers have less to do with science than to do with the power of highly profitable industries that rely on public relations to counteract scientific reports of risks.
We can lead with a concerted effort to tackle the 1000 physical and chemical agents evaluated as possible, probable, or known human carcinogens by the International Agency for Research on Cancer of the World Health Organization. These include engine exhausts, pesticides, many synthetic chemicals and hormones, and cell phone and wireless radiation. If the president wants to take a presidential step here, he should appoint an inter-agency cabinet level task force empowered to take concrete steps to reduce the production, consumption, and disposal of agents known or suspected to cause cancer. The Office of Management and Budget should change their existing purchasing guidelines just as they did for energy efficiency, requiring an investment in the infrastructure for green energy. The Departments of Defense, Commerce, and all government agencies need to alter their procurement policies to avoid and reduce (to the extent possible) exposures to toxic agents and seek safer substitutes as part of an overall sustainable purchasing effort.
Vice President Biden has tragically lost his adult son, Beau, to brain cancer. He is not alone. Cell phone radiation is taking a growing toll on young adults like Beau who are regular, heavy users at work and at home. Brain cancer patients have a right to know that those with their disease who continue using their cellphones or cordless phones next to their heads live half as long as those who do not.
To reduce the burden of cancer, we must prevent it from arising in the first place, and we have to keep the millions of cancer survivors from relapsing by encouraging them to avoid exposures to known or suspected cancer-causing agents in their homes and workplaces. Improving cancer therapies and delivery are important goals, but we have to tackle those things that cause the disease to occur or recur. I believe that if we had acted on what has long been known about the industrial and environmental causes of cancer when this so-called war first began, millions of lives could have been spared – a huge number of casualties for which those who have managed the war on cancer must answer.
Featured image credit: Power station by stevepb. CC0 public domain via Pixabay.