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By Matthew Rees

Food and Health Fact #196:

The cancer conundrum

Cancer kills about 600,000 people in the United States annually, according to the National Cancer Institute, and about 10 million people globally. In the U.S., and throughout the world, it’s the second leading cause of death, after heart disease. The title of celebrated book about cancer published a few years ago – “The Emperor of All Maladies” – captures the haunting nature of the disease.

Optimism about cancer can be a recipe for disappointment. But a long article published recently in The New York Times carried a seemingly hopeful headline: “Is a Revolution in Cancer Treatment Within Reach?” Here’s the answer, from journalist Kate Pickert:

Rather than a single breakthrough therapy or discovery, a variety of scientific advances are exerting downward pressure on cancer mortality in new ways and at the same time. As a result, the landscape for many cancer patients has changed tremendously in just the past five years. The Cancer Moonshot, a multibillion-dollar initiative championed by President Biden, aims to cut the cancer death rate by 50 percent in the next quarter century. The goal is lofty, but recent progress against cancer means it’s now less far-fetched than it might have once seemed. 

Pickert cited access to new drugs, but also a wide variety of treatment options that can be tried, with patients “changing course whenever their cancer becomes resistant to a drug, always staying ahead of their disease.” Progress, she wrote, “depends on our ability to combine new cutting-edge science and drugs with a system that allows all patients to benefit from them equally.”

But there’s one cancer-fighting tool Pickert never mentioned: prevention. It’s a striking omission given that 40 percent of cancer cases “are associated with preventable risk factors,” points out the American Association for Cancer Research. The article also made no mention of detection, even though if most cancers are caught early, the survival rate over 5 to 10 years is 95 percent. But few people have their cancer detected early – most cancer is caught at stage 3 or 4.

The author’s perspective is emblematic of a mindset that’s prevalent throughout the biomedical community: accept that widespread cancer is a given and focus on treating it and/or finding therapies – all while giving short shrift to trying to prevent it or detect it. In fairness, funding levels are fundamental to the disparity: only about 10 percent of the money invested in research goes to prevention and just 5 percent to detection.

And let’s remember two data points that often get overlooked in cancer discussions. First, just 10 percent of cancer stems from inherited genes, according to the National Cancer Institute. Second, curing cancer would be an extraordinary achievement, but the societal gains in life expectancy – about three years – would be less than many people think. (Switching to a plant-based diet can deliver a bigger boost to life expectancy, according to a study published last year.)

Set against the hopeful (albeit flawed) outlook in the Times was a starkly different perspective published a few days later in the Financial Times. That article featured data on the dramatic rise in cancer rates among young people throughout the G-20 group of nations, which have a total population exceeding 4.5 billion.

From 1990-2019, cancer rates in these nations, among people aged 25-29, increased 22 percent (the highest percentage in any age group). And cancer rates among those 20-34 years are higher than at any point since 1990. There was also a 70 percent increase in cases of colorectal cancer, among those 15-39, compared to a 24 percent increase in all cancers. (The data come from the University of Washington’s Institute for Health Metrics and Evaluation.)

The explanation? “The diet and lifestyle to which children are exposed in early life is likely to be a factor in the rise,” according to the FT, summarizing the views of a Mayo Clinic physician and noting the rise in childhood obesity.

And why the rise starting in 1990? Keeping in mind that cancer can take decades to develop, the FT points out that, “People born in the 1960s belonged to the first generation exposed from infancy to modernized diets and lifestyle [as well as] lifestyle and environmental changes that started to become the rich-world norm in the 1950s.”

Strengthening the diet-cancer hypothesis are the types of cancer increasing the fastest: colorectal, esophagus, stomach, pancreas, bile duct, liver, and gallbladder. The common denominator? They are all linked to the gastrointestinal tract, which functions in the digestion and processing of food.

This sad state of affairs is not a given. While cancer is a global phenomenon, its incidence varies widely among countries, with developed countries faring the worst.

The highest cancer rates are found in Australia, New Zealand, Ireland, the United States, and Denmark. While many countries’ low cancer rates are a function of poor monitoring, we also know that those rates in some countries are a product of low smoking rates and diets low in ultra-processed food consumption.

Getting the medical establishment to invest more in improving diets, and less on pills and procedures, is going to deliver the greatest improvements in health and lifespan. Because the best way to survive cancer is to detect it early – or not to get it at all.