Author: George Weiner
Date: 2017-03-20 16:14:41

Mark Twain spoke about “lies, damn lies, and statistics”. His point was that statistics can be twisted to argue almost any point (something that we see every day in the current political climate). Twain also said “Get your facts first, and then you can distort them as much as you please.” When viewed and used appropriately, facts are a fantastic tool in helping us understand complex information. In cancer, such facts help us understand complex molecular data as well as data reporting the pain and suffering from cancer.

Recently, Dr. Mary Charlton, a member of the Holden Comprehensive Cancer Center, and her colleague Amanda Kahl provided me with the below figure that illustrates the burden of cancer in Iowa. It is a busy and complicated figure, but bear with me as I describe my general observations from this figure, the important lessons I take away from this information and how this might impact our future efforts.

I’ll start with a description of the figure itself. It illustrates the burden of individual cancer types in Iowa year by year. The blue columns represent the number of new cases diagnosed in Iowa each year (incidence) and Red columns represent the number of cancer deaths in Iowa each year (mortality). I won’t go into the technical details, but the numbers are adjusted to allow us to compare the burden of cancer between years.

Here are three observations, three conclusions and three lessons I take from this information:

Observations

• We are making progress in the four most common cancers. The numbers are falling – albeit not fast enough - in both incidence and deaths caused by breast, lung, prostate and colorectal cancer.

• Slow but steady. Changes over time can be difficult to detect year to year. However, by viewing the burden of cancer over time, real progress can be seen.   Sometimes it takes many years before an intervention has a clear positive impact. For example it took over a decade of efforts to decrease tobacco use before a reduction in lung cancer was apparent.

• Not all cancers are alike. Progress in reducing death from various cancers is uneven. For some cancers, we are making steady progress.  For others, we are, quite frankly, headed in the wrong direction.

Conclusions

• Prevention, early detection and therapy are all important. The drop in lung cancer incidence and deaths is due largely to a reduction in tobacco use (Prevention).   Much of the reduction in death from breast cancer is likely due to our ability to detect breast cancers when it is small and more curable (Early detection).  Improvements in deaths from leukemia and lymphoma in recent years are due to new drugs and regimens (Therapy). The drop in colorectal cancer deaths is likely due to a combination of factors including improved diets, screening to remove precancerous polyps and early cancers and better therapy.

• Lifestyle choices impact on cancer burden. Some changes in lifestyle have reduced the burden of cancer, most notably reduced use of tobacco. Some changes have the opposite effect. The dramatic increase in melanoma cases is in large part due to increased exposure to sun and artificial sources of UV light that damage the skin.

• Early detection is important, but has a dark side. Early detection of potentially fatal cancers when they are at a curable state is of obvious importance. However, improved technology can also increase our ability to detect cancers that may never be a threat to the health of the patient. The increase in the incidence of thyroid and kidney cancer with no change in death rates may be due, at least in part, due to increased diagnosis of asymptomatic cancers.

Lessons as we move forward

• Yes to prevention, early detection and therapy. We must invest in all three areas if we are to continue to reduce the burden of cancer for our fellow Iowans in the years ahead.

• We need persistence and patience. We need to take the long view. Real change takes time. Long term investment and commitment is vital.

• Apply what we know - expand what we know. The burden of cancer in Iowa will be reduced by applying what we already know about life-style and being sure all Iowans have access to top notch medical care. There is also a need to expand our knowledge so we can develop better approaches to cancer prevention, early detection and therapy through research. One opportunity highlighted by this data is the need to improve our ability to determine whether a cancer detected in an individual patient needs to be treated or not.

I will finish with another Twain quote  – “Twenty years from now you will be more disappointed by the things you didn’t do than why the ones you did do”. We must respond to these cancer facts in a way that will NOT result in disappointment twenty years from now. We need to invest in delivery of care and research focused on cancer prevention, early detection and therapy. Only that way, can we reduce the burden of cancer for those we serve.

OK – one last Twain quote  - “Always do right. This will gratify some people and astonish the rest.”