Issues, priorities, and political implications for cancer: An organization’s perspective

bviously we are making great strides in advanced scientific approaches to curing cancer and the genomic revolution promises much more to come. Less obvious to the nation as a whole and key policy makers at all levels are the enormous opportunity costs of not implementing what we know about prevention, in a vigorous manner. By prevention, I refer to both primary prevention, such as proper diet, preventing the uptake of tobacco use, and the use of vaccines; as well as secondary prevention, including early cancer screening for breast, cervical, and colon cancers and tobacco cessation efforts. An estimated and two-thirds of cancer deaths can be prevented by dietary changes, exercise and prevention approaches such as sun screen use, clinical screening, and the elimination of tobacco use. Yet as a nation we put an exceedingly small proportion of our overall health budget into reducing the incidence of disease. We are a health care society in which 45 million are still disenfranchised by not having access to health care–a health society in which all are covered for prevention and for health care. We pay significantly for this imbalance with soaring health care costs and high incidences of preventable death and disease. We rank far below most other industrialized nations in infant mortality rates and life expectancy. Indeed, despite our high gross domestic product (GDP) and very large per capita health expenditure, we rank 44th in infant mortality and 50th in life expectancy. It is also crucial that we recognize the disproportionate negative impact of cancer on lower income groups and minorities. The greater impact stems from lower access to prevention and screening services, resulting in higher rates of fully preventable cancers and later diagnosis of curable cancers. Finally the impact of millions of Americans having no insurance coverage or being underinsured curbs access to prevention, screenings, routine cancer care and trials that involve copayment.