** This is an editorial I wrote about 2005. So some of the numbers in it may be outdated. That does not mean they have changed for the better. I am reflecting on this today as after much thought I relize how little has changed, although there have been a few bright spots. If anyone wanted to know why OCF came into being, and wanted to understand what we have improved or changed, a look at the world in which we started is in order. 

 

What does it take?

One person’s opinion.

By Brian Hill

This year cancer replaced heart disease as the number one killer of Americans. Since the official war on cancer was declared by President Nixon in 1972, progress has been made, but clearly not enough. Huge leaps in knowledge such as the mapping of the human genome, which we thought would yield the clues to scientific breakthroughs, have instead left us with the knowledge that cancer is not just a couple of pathology types, but literally hundreds of unique diseases. The more we find out, it is clearer the less we know. That does not mean that progress has not been made, just not progress that has yielded the breakthrough that will finally label cancer a manageable and survivable disease. To put this in perspective, the annual budget for cancer research in the US alone is over 5 billion dollars per year (requests of an additional 4.2 billion over the next 5 years were made this year by the NCI), in spite of this enormous expenditure and effort, one person dies of cancer every minute of every day in the US… and the disease has moved into first place.

While we continue to explore and digest the reams of new data that research is producing daily, we must look to those strategies that in the past have yielded the best immediate, tangible results. If you look at those cancers in which there have been palpable gains against the death rate, i.e. cervical, prostate, colon, etc., they all share two things in common. The first is that they have lent themselves to modes of early detection, even if that detection method is somewhat invasive such as a colonoscopy. This example in itself indicates that Americans will become engaged in early detection if public literacy and awareness are made an important part of the process. The “Katie Couric effect” in the rise of colon exams is clear evidence. They will submit to annual exams like cervical, if they believe that the benefits of opportunistic screening when they are asymptomatic, hold hope of increased survival should they be found with it. The second thing shared by all these cancers where progress can be documented is that in their early stages, they respond well to existing, conventional treatment modalities; surgery, radiation, and chemotherapy. What this clearly tells us, is that while science works on ultimate solutions, there are existing, viable mechanisms to reduce the deadly toll of cancer deaths in the US, and the proven vehicles are public awareness and early detection.

Just to pick one of these, cervical cancer, without the development of new science, but with only the adoption of an opportunistic annual screening by female members of the American population, saw during a 10 year period a drop of approximately 70% in its death rate. This is extraordinary by anyone’s standards. A motivated and informed public, serviced by a community of medical practitioners engaged in early detection yielded these results. Remember that this is an examination, which is essentially visual, tactile, and if suspect areas are found, a biopsy of those tissues is performed. I could be just as easily describing an oral cancer examination here. No difference exists.

Now the part that I find the most telling. There was no landmark study that said this would be the outcome, no study before adoption of cervical cancer screening that concluded this unprecedented saving of lives would be so dramatic. There have been many retrospective reviews of this situation, but in the late 40’s and 50’s the American public, the government, private professional medical societies, and doctors drew from what they knew to be sound clinical experience to initiate this program which has saved untold thousands of lives to date. 

Just what is that clinical experience that I refer to? Essentially two things, and they have not changed in the subsequent decades. First, the knowledge that discovery of a disease in its early progression (early staging) yields better long-term outcomes. This is not rocket science. Before a cancer has had the opportunity to spread from a localized area, or even a regional area, there resides the best statistical opportunity for cure. Secondly, the cancer in question must be one that responds well to the three established therapies mentioned before in its early stages.   Given this information, which treating oncologists find little argument with, I have this question. Of the billions of dollars spent annually by our government on bringing down cancer in the US, less that 2% of all money spent is applied to those areas that have historically yielded the best results – public literacy (awareness), and early detection programs. Why so little on what is so effective?  While I won’t belabor the point here, consider that this is mostly controlled by doctor-scientist bureaucrats, and you can understand why solutions that are not science based, (leaving socio-economic science out of that definition) get little attention. Compared to gene therapy, early detection just doesn’t seem that exciting…. But is it something that can save lives while the search for a cure continues? Most certainly. And it should be implemented now.

So what would it take to have oral cancer, arguably the one which lends itself most readily to early detection and cure at early stages (it requires no invasive procedure, is inexpensive to look for, can be detected by the naked eye or palpation even its precancerous forms in a 3 minute exam, is easy to biopsy, and as an early stage cancer responds well to conventional therapies), depart from its more than 5 decades of no change in the death rate, to a success story like that of cervical cancer? 

I began my search for an answer at the Centers for Disease Control where I have participated in the Oral Cancer Work Group for several years. After all, their charter as stated by them is: to serve as the national focus for developing and applying disease prevention and control, environmental health, health promotion and health education activities designed to improve th