SAN FRANCISCO—America must take a more logical approach to healthcare, or the whole system for providing it will collapse, warned Otis W. Brawley, MD, chief medicine and science officer at the American Cancer Society.
“I spend a lot of time talking about the rational use of healthcare, not the rationing,” said Brawley, who also serves as an Emory University professor of oncology, hematology, and medicine.
He treated his audience at a plenary session of the sixth annual Oncology Congress to a blizzard of statistics suggesting that awareness and prevention could dramatically reduce suffering and death.
The United States spent $2.53 trillion for healthcare in 2009, twice as much per capita as Switzerland, the next-biggest spender, he said. Yet the United States is only 29th in life expectancy.
And healthcare expenditures are growing at a rapid rate, he warned. Currently they account for 17.3% of gross domestic product, but they are expected to reach 25% by 2025. “We’re not getting what we pay for,” he said.
“Our life expectancy is starting to go down in this country.”
Much of the money that goes to cancer treatment could be saved, he said. Part of the problem is that increased screening is leading to cancer diagnoses in patients who would otherwise be untroubled by the disease. For example, many prostate cancers progress so slowly they will never bother the patient. “We are curing cancer we don’t need to cure,” he said.
He called for more support for genetic and genomic studies aimed at identifying the types of cancer most likely to metastasize.
Worldwide, the number of cancers diagnosed (currently about 11 million new cases per year) is increasing due to three factors, said Brawley: better detection, the adoption of a Western lifestyle, and the increasing size and age of the population.
More attention needs to be focused on lifestyle factors, he said. “Many people don’t realize that obesity, a high caloric intake, and lack of physical activity causes cancer.” The United States faces a “tsunami” of disease be cause of the obesity epidemic, which is particularly alarming among children. “One in five kids aged 6 to 11 is obese,” he said. “This is so important because obese kids hardly ever lose weight.”
As an example of how well prevention can work, Brawley cited lung cancer. About half of all men smoked in the 1960s, and now the rate has dropped to about a quarter (women’s smoking rates increased with women’s liberation in the 1960s and 1970s), as a result, mortality from lung cancer has declined 14.3% since 1992.
The incidence of melanoma is increasing, but sun avoidance and widebrimmed hats could cut it in half, Brawley said. He called for caution about sunscreen, however, because it may only prevent sunburn and not cancer.
The incidence of colorectal cancer is declining. Fecal adult blood testing is the most important test for this cancer, said Brawley. Stool blood testing decreases the risk of death by 35%, he said, but very few people are getting this test. Still, people should get whatever kind of screening they can for this cancer.
Surprising factors have affected other disease. For example, refrigeration has lowered stomach cancer rates because Americans are eating less meat preserved with salt, he said.
Liver cancer, however, is increasing because one of 20 US men who served in Vietnam ended up positive for hepatitis B, said Brawley.
Breast cancer deaths are also decreasing because better screening is catching this cancer earlier, and because treatments have improved, he said.
He stepped into the controversy over mammography, arguing in favor of the cancer society’s recommendation of screening all women older than 40. Women should be informed about the problem of false positives, but still get screened, he said. “If a third of women in their 40s don’t get screened, that means 4100 lives will be lost needlessly,” he said.
He noted, however, that “breast self-exams will save more lives than mammography.”
He pointed out that the disparity in survival rates between blacks and whites with both breast cancer and colon cancer had only emerged in the 1980s when better treatments became available. “This disparity is heavily driven by a disparity in treatment,” he said.
So how can we wring the illogic out of healthcare? “I think we need to stress awareness,” Brawley said. “It’s a whole transformation of how we view healthcare.”