It is human nature to blame an amorphous "other" for what befalls us and diminishes our own culpability (i.e., Why me?). To that end, we are in the beginning of a media blitz to lay cancer at the feet of chemicals and our ever evolving technological world, based on the President's Cancer Panel (PCP) Report. I think we are all predisposed to blame chemicals for cancer and maybe a cell phone for brain cancer. But from my perspective, blame is a powerful hallucinogen to keep us from focusing on our own culpability. In addition, we live under the erroneous assumption that cancer is the worst thing we should fear (i.e., cancer is what kills us). In a world of limited resources, it makes sense to get the issues right.
The simple truth is that no one is doing anything to you! - Don't smoke, Watch your diet, Exercise, and Regularly see your doctor. These four simple lifestyle changes will do more for reducing your risks of disease than anything the Government or Industry can do for you. If you want to go further, then eat organic. Every EPA model that estimates risk in humans says bad things are biomagnified in eggs and animal fat. There are real studies, based on people not mice, that have validated the benefits of a number of foods and dietary supplements (e.g., Omega-3 fish oil) to reduce our risk of disease.
In an article by Nicholas D. Kristof, he stated: "41 percent of Americans will be diagnosed with cancer at some point in their lives." When I read this, all I could say was "WOW, our lifetime risk (LTR) of cancer is so high!" Like any statistician, I set out to find the basis for this number and put it into some relative context.
Major Disease Groups By the Numbers:
Pulmonary Diseases (LTR 40% women, 58% men) - are those made up of COPD (LTR 16% women, 24% men) and asthma (LTR 34%), as well as a number of other lesser LTRs. Asthma is an autoimmune disease, which usually means the root causes are genetics and a viral initiator. COPD is a horrible disease most associated with smoking. The risk of COPD is 4 times greater for a smoker. Without question, air pollution is a major, well studied, factor in exacerbating both conditions.
Coronary Heart Disease (CHD) (LTR 32% women, 49% men) - If there is anyone out there that does not know diet, exercise, and smoking cessation (i.e., lifestyle) are three things we can all do to prevent this risk, then go see a doctor. If you want to limit your risks beyond lifestyle, then see a doctor and take any of the myriad of statins, beta-blockers and ACE Inhibitors that are all efficacious in controlling cholesterol and blood pressure. Sorry, no chemicals are at the root cause of these diseases, just lifestyle and genetics.
Diabetes (LTR 39% Women, 33% men) - If you have Type I diabetes, then you already know that your disease is most likely the result of genetics and a viral initiator. For all of us out there who are worried about Type II Diabetes, which should be just about everyone over 50 years of age, controlling weight, exercise, and reducing sugar intake will do the most to lower your risks. Sorry, no chemicals at the root cause.
Cancer - The big "C," scares the heck (Huffington has rules on language) out of people. So what are the facts? The National Cancer Institute estimates that the LTR for all cancers is 38% and 44% for women and men, respectively.
Now let's take that number apart. If we are worried about chemicals, let's take out lung cancer (LTR 6% women, 8% men) since we know not smoking will reduce the incidence of lung cancer. Melanomas (LTR 2% women, 3% men) are caused by sun exposure and the loss of our ozone layer. Prostate cancer has a LTR of 16%, the largest single LTR of the cancer group. This is a cancer that has been linked to weight and intake of fats. It is also a cancer where early detection makes a big difference. The 14-year survival rate is 90% for cancers discovered 18 years ago. Medical technology has come a long way since then so logic dictates that these survival rates will increase. Breast cancer has a LTR of 13%. If a woman has inherited the BRAC1 or BRAC2 gene mutations, her LTR is 65%.
Childhood Cancer - The President's Cancer Panel Report takes special note of the chemicals found in umbilical cords and childhood cancer. Here we have an epidemiological problem. US epidemiological data is terrible. Unlike many countries, we have not developed registries that allow us to evaluate different hypotheses (e.g., We do not know the childhood cancer rate in the US excluding Downs Syndrome children who have a much higher risk of Leukemia). We do not have good statistics on how cancer rates are changing as a function of maternal and paternal age, as well as, race and ethnicity. The US is transforming itself to a predominantly multi-ethnic culture for which our historical data are ill prepared to help guide our analyses.
From my perspective, while it always feels good to blame the Chemical Industry, the call to arms for controlling disease needs to be more focused.
• EPA should issue new air pollution control limitations (i.e., MACT rule) for electric power generation (e.g., coal). Air pollution from coal is a well-studied and documented problem, as are the health effects.
• EPA should improve enforcement of drinking water systems and nonpoint source pollution (e.g., runoff from farms).
• The First Lady's "Let's Move" initiative is an important step towards trying to get our children (and parents) to eat right. Lifestyle issues (i.e., diet, exercise) are critical to long-term reduction in the major disease groups discussed above.
• We should focus more funds on early detection of cancer. Early detection may mean technology, but it is just as likely to mean finding ways to be seen by nurse practitioners instead of doctors. With very few exceptions, early detection means increasing survival.
• We should start collecting real data on the health of our citizens. It is ludicrous that insurance companies have more information on our health than the Government. The Census Bureau and the IRS have demonstrated that the US Government can protect our personal data with the added benefit that the information can be used to save our lives.
While the President's Cancer Panel Report covers many changes we can each make in our lives, it is a message that is diminshed by the large number of pages devoted to hot button issues. I doubt the take ownership message will get the same level of media coverage that chemicals, cell phones, ethanol, and endocrine disruptors receive.