CANCER DEATH "EXTINCTION" FEASIBLE

Cancer-related deaths in people younger than 80 years could be eliminated in the United Kingdom by 2050 if recent progress in prevention and treatment continues, claims a new report written by researchers from University College London (UCL) and King's College London in the United Kingdom.

The report, entitled Overcoming Cancer in the 21st Century, was published by the UCL School of Pharmacy on January 14.

Although 325,000 cases of cancer are diagnosed in the United Kingdom annually, death rates for the four most common cancers have decreased by 30% over the past two decades, the report points out. Furthermore, there has been a steady 1% decline in cancer death rates in the United Kingdom since 1990.

The report acknowledges, however, that effective primary prevention will require increased access to the latest tests and that cancer-awareness programs are needed to improve early detection and treatment.

Despite these caveats, Alastair J. Munro, MD, professor of radiation oncology at the University of Dundee School of Medicine, Ninewells Hospital, Scotland, said he believes that the report does not add anything to the body of knowledge on tackling cancer-related deaths.

"I am not really sure that this report warrants much attention," Dr Munro told to Medscape Medical News. "There are no new findings, no original research, and no analysis; it is simply a tour d'horizon of the current state of cancer management, accompanied by brief speculation about future prospects."

"The report appears to have been commissioned and funded by [UK pharmacy chain] Boots, and there is no evidence of any external peer review," he noted.

The report was written by Jennifer Gill, PhD, a research associate at the UCL School of Pharmacy; Richard Sullivan, MD, PhD, director of the Institute of Cancer Policy and the Kings Health Partners Integrated Cancer Centre (previously a clinical director at Cancer Research UK); and David Taylor, MD, professor emeritus of pharmaceutical and public health policy at UCL.

Collating Evidence

In the report, the three authors collated data from a series of investigations, reports, analyses, and primary studies into the incidence, prevention, diagnosis, and treatment of a wide range of cancers.

They found that cure rates for some cancers are now as high as 80%. Moreover, deaths from breast, lung, bowel, and prostate cancers decreased by 30% from 1991 to 2012. There has also been a 1% annual decline in cancer death rates since 1990 because of decreasing rates of smoking, faster diagnoses, and the introduction of more effective treatments.

If these improvements continue and gather pace in the coming years, the authors suggest that cancer-related deaths in people younger than 80 years could be eliminated by 2050.

Achieving that will, however, require improvements in treatment, earlier detection, advances in the understanding of the pathogenesis and genetic basis of cancers, and better diagnostic tests, they say.

Nevertheless, Dr Gill said she believes that, at least in part, the goals set out in the report are achievable.

"It's a minimum expectation or approximation of what we think should happen with suitable investment, based on reductions in death rates that have happened in the past 20 years and projecting them forward to think about what we think should be happening over the next 35 years," she told Medscape Medical News. "But obviously, we can't say for sure what will happen," she added.

Encouraging people to take action and visit a healthcare professional with suspected cancer symptoms will require a change in mindset about the concept of cancer.

"One of the problems just now is that the word 'cancer' instills a huge amount of fear in people," Dr Gill explained.

"We read evidence that said people delay going to the doctor because they are far too scared of what the outcome will be, because some of them said that cancer is associated with certain death," she added.

"Maybe if they were aware that more and more people are surviving cancer and that there are things that can be done, particularly if they go to the doctor sooner and get diagnosed earlier, it might trigger them to move things along a bit quicker and go earlier," she said.

One of the consequences of lower death rates from cancer will, of course, be increases in cancer survival rates, the growth of which was highlighted in a recent report by Macmillan Cancer Support, as previously reported by Medscape Medical News.

Dr Gill said she agrees: "I guess reduced death rates could have an impact on increased numbers of survivors, but hopefully we'll have something in place to help them cope with any long-lasting effects of cancer treatment."

Philosophic Objections

Commenting on goals set out in the report and the concept of 'overcoming cancer,' Dr Munro said: "I have a philosophical objection, I guess, to making the arguments seem that simple, and framing it in terms of soundbites and headlines. It is much more complicated than that, and it's much more difficult."

The report authors "make a perfectly valid point that people with cancer should have the resources they need to deal with the disease and its aftermath," he continued. "One can't argue with that. But to go the next step and say, 'If we do this, we will eliminate cancer as a cause of death in the under-80s by 2050,' is, at every level, a step way too far."

"This is simply an expression of opinion and there is no worked analysis of why the expectation might be realistic. It has as much evidential value as my own opinion that, given current knowledge and sufficient will and investment, it would be possible to land a human being on Mars by the year 2050," he added.

Addressing Health Inequalities

Dr Munro explained that some of the goals set out in the report, such as those concerning primary prevention, are theoretically possible.

"We know quite a lot about some of the things that will mitigate the risk of developing cancer and, yes, if we put everything that we know about that instantly into practice, with everybody in the country doing the right thing, then that would probably have some measurable effect on the incidence of cancer," he explained.

"But there are about six conditional statements in there," he pointed out.

"I think one of the more depressing things about the report is that it did not touch at all on the question of inequality, and the effect that socioeconomic inequalities have on cancer survival, which is important," Dr Munro continued.

"Some of those inequalities are related to health behaviors, whether it's in terms of primary prevention, of seeking advice early, or any of these good things that we're all supposed to do," he said.

He expressed doubt about putting evidence into practice, citing difficulties in convincing somebody who is "living a pretty miserable life to give up smoking and watching TV."

"Nowhere in that document that I could see was the issue of socioeconomic gradients addressed, and I see that as being a not inconsiderable barrier to progress," Dr Munro added. "Unless and until we start to address the gross inequalities in terms of health and wealth in Western society, we are not going to eliminate cancer as a health problem."

In terms of novel treatments, Dr Munro said he is skeptical that the identification of molecular targets resulting in new drug development will bring the cures that are implied in the report.

What Is a Cancer-related Death?

Moreover, he questioned some of the terms used in the report, citing the following quote: "It is realistic to expect that by 2050 nearly all cancer-related deaths in children and adults aged up to (say) 80 years will have become preventable through lifestyle changes and because of the availability of protective technologies and better pharmaceutical and other therapies."

In terms of what constitutes a cancer-related death, Dr Munro pointed out that the report, in effect, uses a cutoff of 5-year survival to define whether or not a death is related to cancer.

This is an "arbitrary criterion," he said. "There are plenty of people...who are alive 5 years beyond the diagnosis who have cancer. They may then go on to have a stroke, or be run over, or get chopped up by a jealous lover, or whatever, and they will die, because that's a certainty: We all die."

"But whether you then say their death was cancer-related or not I think can become quite a difficult problem to disentangle. If, as a long-term effect of cancer, somebody is unable to function at the level in society that they were used to functioning at, and 7 years out from the diagnosis they commit suicide, is that cancer-related?" he asked.

"Even if there is not a single cancer cell in their body, but they take their own life 7 years out, to say that their death is not cancer-related is kind of a tricky jump to make, in my view," he explained.

The report was funded by Boots UK. The authors have disclosed no relevant financial relationships.