Obesity and poverty may stall 25-year decline in cancer deaths, experts warn

cancerdeathrates2018-271x300Cancer hasn’t gotten knocked out of its spot as Americans’ No. 2 killer, but health officials have delivered some good news about the disease that once was considered irreversible in its lethal course: Cancer deaths rates have fallen now for a quarter of a century.

The American Cancer Society, pointing to 1991 as a peak year, says that death rates from the disease declined by 27 percent, “meaning more than 2.6 million deaths [were] avoided between 1991 and 2016.”

Still, 1.7 million Americans likely will be diagnosed with cancer this year, and the disease will kill more than 600,000 patients — meaning 1,666 people per day in this country will die of cancer.

More patients dodged cancer because they didn’t smoke or reduced their tobacco abuse, health experts said. They emphasized that dips in smoking played a big part in sizable declines between 1990 and 2016 in lung cancers among men (a 48 percent decline) and women (down 23 percent). Their message was plain: If you don’t smoke, don’t start. If you do smoke, quit or cut back as much as you can.

While preventive steps helped reduce deaths from colorectal, breast and prostate cancers, the experts also cautioned that Americans shouldn’t subject themselves to over screening or over testing for the disease.

Still, sensible early detection and treatment has bolstered favorable outcomes, and patients should consult with doctors about ways to protect themselves without costly, invasive, painful, and unnecessary procedures that may produce as many false positives as findings of serious cancer. Medical scientists have provided new guidelines for testing for two cancers that hit women (breast) and men (prostate) hard.

Cancer experts also issued cautions on how at least three challenges could undercut or even reverse progress in combating the disease: the rise of obesity and its related cancers; the problems faced by poorer and poor Americans in accessing and affording medical care; and persistent issues with liver infections (Hepatitis C) and how these raise deaths due to cancers in this organ.

With the federal Centers for Disease Control and Prevention saying that 40 percent of Americans struggle with excess weight, obesity-related cancers should be a concern, as the Associated Press reported:

Of the most common types of cancer in the U.S., all the ones with increasing death rates are linked to obesity, including cancers of the pancreas and uterus. Another is liver cancer. Liver cancer deaths have been increasing since the 1970s, and initially most of the increase was tied to hepatitis C infections spread among people who abuse drugs. But now obesity accounts for a third of liver cancer deaths, and is more of a factor than hepatitis…

Rebecca Siegel, lead author of the American Cancer Society mortality trend report, told the news service that it can take decades to see how a factor like patients’ excess weight, identified in the 1990s as a major health issue, and so, “we may just be seeing the tip of the iceberg in terms of the effect of the obesity epidemic on cancer.”

As for poverty and the disease, the news also isn’t cheery, Bloomberg News Service reported, noting of the cancer mortality declines:

There’s a caveat, however. Those gains have been reaped mostly by the well-off. While racial disparities have begun to narrow, the impact of limited access to treatment for the poorest Americans has increased wealth-based inequality …Health insurance and access to care can be an issue in some poor and rural portions of the country, where there are higher death rates of colon, cervical and lung cancers … While poverty was … associated with lower rates of cancer mortality prior to the 1980s, that trend has since reversed, due in part to changes in diet and smoking as well as screening and treatment rates.

Indeed, in my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent medical care. This has grown truer as prescription drugs and medical therapies skyrocket in price, complexity, and uncertainty. Doctors and hospitals barrage the public and cancer patients with practices they term innovative and more, dancing on ethical lines to even call some of these “breakthroughs.” They don’t as often explain the daunting costs of the procedures and drugs, which not only can bankrupt patients and their loved ones but also impose giant strains on them even as they cope with illness and incapacity. This has become so much a part of cancer care that experts themselves describe the pressing need to deal with its “financial toxicity.”

While medical providers at some point must reckon with the consequences of soaring costs, all the rest of us must do what we can to prevent cancer and treat it early. As mentioned, cutting down or out smoking can make a big difference. So, too, can common sense and moderation in diet, exercise, weight regulation, and alcohol use.  We can start now and make healthful improvements part of our 2019.

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