Good Morning America co-anchor Robin Roberts' recent announcement that she had been diagnosed with myelodysplastic syndrome (MDS) -- a group of conditions in which the cells in the bone marrow are damaged -- certainly came as a shock to her fans. Just five years before she had, as she has said, "beaten breast cancer" and openly discussed her experience. What's more appalling, though, is the fact that her treatment for breast cancer, presumably involving chemotherapy and radiation, are both risk factors for MDS. In other words, the medical treatment she received to "beat" breast cancer may well be responsible for the life-threatening condition she now faces.
To those of us in the medical field, this comes as no surprise. The list of drugs that can cause MDS is long -- including mechlorethamine, or nitrogen mustard, etoposide, teniposide, chlorambucil cyclophosphamide, and doxorubicin, all of which are commonly-used chemotherapeutic agents. Ionizing radiation, which may also be a part of breast cancer treatment, increases the risk for MDS. Most people, however, don't realize that cancer treatments can be as devastating and potentially deadly as the cancer itself. As actor Cynthia Nixon so aptly put it in the powerful Broadway revival of Wit, the play by Margaret Edson portraying the journey of a woman suffering from advanced ovarian cancer: "My treatment imperils my health."
Why is it that our current methods of cancer treatment consist of so many toxic drugs and radiation therapy that are capable of increasing our risk for developing second cancers? Is this the best that we can offer cancer patients in 2012?
Think of it: More than 40 years after the war on cancer was declared by President Richard Nixon in 1971, we are not much closer to preventing the disease. The National Cancer Institute has spent some $90 billion on research and treatment during that time. When have Americans ever waged such a long, drawn-out and costly war, with no end in sight?
The evidence is clear: The system designed to study, diagnose and treat cancer in the United States is broken, and it is in urgent need of reform.
The solution, I believe, lies in a critical restatement of our mission. Prevention of cancer should be a national goal. A recent study in Science Translational Medicine reported that at least 50 percent of all cancer cases are preventable. Smoking and obesity are responsible for a little over one-half of all cancers. The effect of diet, nutritional sources and physical activity levels require much more attention and public health advocacy. Environmental exposures have been inadequately investigated as cancer agents. In the case of MDS, at least 13 cancer risk factors, including organic chemicals (such as benzene, toluene, xylene), heavy metals, herbicides, pesticides, fertilizers, exhaust gases and petroleum and diesel derivatives, are listed by the National Cancer Institute.
Is there a commitment to explore these agents and determine their exact threat to our health? Unfortunately, there is a much greater emphasis, and a much more substantial financial investment, in cancer treatment than cancer prevention. The NCI's budget reflects this in its funding of basic science ($2 billion) and treatment ($1.3 billion), while dedicating only $232 million in funding altogether to prevention.
It is time for a bold new approach to the "cancer culture" as we know it. If our cancer treatment puts us at risk for the development of a second cancer, there is something fundamentally flawed about that approach. "Above all, do no harm" should always be our guiding principle in the treatment of any disease, and especially in the case of cancer. Research dedicated to effective new screening tools for cancer, and new methods of treating cancer early, before it has a chance to spread, are needed now.
Those of us who have experienced cancer as patients or as the caregivers of friends and family afflicted with cancer understand the overwhelming challenge it presents. While we cannot completely repair the physical and emotional damage inflicted by cancer, we should have higher expectations for the results of treatment.
Government leaders, researchers, physicians, the pharmaceutical industry, cancer advocates, and many other stakeholders all have a key role in promoting a safer, healthier environment, better nutrition, increased physical activity, and a new emphasis on prevention in cancer research. Working together, we will make significant strides in creating a world without cancer.
Robin Roberts has my best wishes for a full recovery to good health. I am among the many who are hoping and praying that she will win this new battle with an insidious invader. As a breast cancer survivor who has fought to remain an active participant in life, she deserves no less.
Margaret I. Cuomo, M.D., is a board-certified radiologist, much of whose practice was dedicated to the diagnosis of cancer and AIDS. She is the author of the forthcoming book A World Without Cancer (Rodale; October 2012).
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