The United States Program on Cancer, 1975-2003: A Dismal Failure by:Anthony and Ipatia Apostolides
It seems to us that we are living in a cancer epidemic in the United States. Both of us have lost parents to cancer, and we have been losing more and more relatives and friends to cancer. Based on our own sad experience, we were driven to carry out research on the impacts of cancer in the U.S. over the period 1975 to 2003. This study assesses the U.S. cancer program, as guided by the National Cancer Institute, by examining three basic measures of that program: 1) the cancer incidence rate; 2) the cancer mortality rate; and 3) the probability of getting cancer for an American male or female in their lifetime. The basic data series were obtained from NCI's SEER (Surveillance, Epidemiology, and End Results) program. The result of our research was a paper (52 pages), and this is a synopsis of that paper. The paper in its entirety is available on the web: http://www.geocities.com/cancer_paper
The findings of our research on the impacts of cancer on Americans are grim and shocking. Since 1975, the effects of cancer on people has been continuously and steadily worsening - with the following dismal outcomes of the three measures:
The reported age-adjusted cancer incidence rate of Americans getting cancer in 2003 was 460 people per 100,000. This was in stark contrast to 400 people per 100,000 in 1975. This reveals a significant worsening of cancer incidence in the U.S. over time. In actual numbers, this means that 1.3 million Americans got cancer in 2003 as compared to 864,540 in 1975. This bleak situation is even worse because of the delays in the reporting of cancer cases (Clegg et.al., 2002). As a result of these delays, the reported cancer incidence in 2003 is an underestimate of the correct incidence, which we have calculated to be 494 per 100,000 people getting cancer; and the total number of Americans getting cancer now increases to 1.4 million people.
Over the period of analysis, 1975-2003, the reported cancer incidence rate increased at an average annual rate of 0.5 percent. This positive growth rate means that the number of people diagnosed with cancer every year was increasing faster than the population of the country. Moreover, this rate will be higher with the adjusted incidence numbers for the delayed reporting of cancer cases (particularly for 1993 to 2003). In addition, the total number of Americans affected by cancer increased every year (1975-2003) by 1.6 percent (also an underestimate).
During each of the 25 years since 1975 - until 2001 - more Americans died from cancer, per 100,000, than in 1975. Also, many more Americans died from cancer in 2003 - 553,244 - than in 1975 - 430,002. Furthermore, we surmise that the number of cancer mortality rates reported by SEER/NCI are underestimates due to the likely misses of cancer death cases when they are marked in the IMMEDIATE CAUSE section of the death certificate rather than the UNDERLYING CAUSE section; this shortcoming can be a substantial one.
It is a very disturbing fact that the number of Americans who have been losing their lives to cancer, in the 1990s and the 2000s - on a daily basis - reached the count of a World Trade Center tower at 1,500 people. This number translates into 63 Americans dying from cancer every hour of the day - which means 1 American dies from cancer every minute. These are indeed grim statistics, attributable to the failure of the cancer program.
The total number of people in the U.S. who lost their lives to cancer also increased annually at a rate of 0.9 percent (1975-2003). The dismal result of these increases was that at the end of the period, 2003, many more people were dying from cancer than died in 1975.
Over the period of analysis (1975-2003), a total of 33 million Americans were afflicted by cancer. Even this is an underestimate, due to delayed reporting of cancer cases, and the actual number would be considerably higher. During the same period, a total of 15 million Americans lost their lives to cancer. The ratio between these two numbers provides an approximation of those who die in relation to those afflicted by cancer - at 45 percent. Almost half of those who get cancer will eventually die from it.
Probability of Getting Cancer
With regard to one's chances of getting cancer, as of 2002, American males faced a staggering probability that is close to 50 percent of contracting cancer in their lifetime, while American females were facing a 42 percent probability of getting cancer in their lifetime. Moreover, these probabilities have been getting worse over time. By contrast, the probability in 1975-1977 for an American man or woman of contracting cancer was 34 percent. This was already a high number - which became even higher over time. Furthermore, the probabilities - particularly in the 1990s and 2000s - are underestimates since cancer probabilities are calculated from cancer incidence rates and these rates are underestimates as a result of reporting delays.
Cancer in the News
Despite data shortcomings that result in significant underestimates of cancer statistics, the existing cancer data show a dismal situation with respect to cancer prevention and cancer treatment. The grim statistics are typically not depicted in the news media. Over the years, the media has focused on news portraying small numbers of deaths, from diseases like the bird flu, and have ignored the horrendous fact that millions of Americans with cancer have died, and continue to die, from cancer. In addition, they have focused on short periods of time that give misleading results.
Conclusions and Recommendations
If the cancer program worked, positive benefits to Americans would have been shown by a decrease in the cancer incidence rate and the mortality rate, from their levels in 1975. In addition, the probability of getting cancer in one's lifetime would have decreased. That did not happen; on the contrary, the numbers increased across all measures. Even a rudimentary evaluation of the costs of the NCI compared to the benefits obtained by the American people would conclude that it has been a horribly inefficient use of national funds.
A single main recommendation arises from the big and continuing failure of the NCI cancer program: The National Cancer Institute to be drastically restructured and its programs to be significantly changed, in order to develop and make effective programs of prevention and programs of treatment of cancer. The American people have been paying too high a price - with their lives - for an extremely misguided and ineffective cancer program.
Clegg, L.X., et.al., "Impact of Reporting Delay and Reporting Error on Cancer Incidence Rates and Trends." Journal of the National Cancer Institute. Vol. 94, No. 20, Oct. 16, 2002, pp. 1537-1545.
National Cancer Institute (NCI). Surveillance, Epidemiology and End Results (SEER), 1975-2002. http://canques.seer.cancer.gov/
United States Bureau of the Census. Statistical Abstract of the United States, 2006; section on Population.
Clifton Leaf's article on the War on Cancer: http://money.cnn.com/magazines/fortune/fortune_archive/2004/03/22/365076/index.htm
Dr. Samuel Epstein's website on the War on Cancer:
About the author
Anthony Apostolides, Ph.D. has been engaged in research and teaching on health care and other areas of public sector economics. He taught in universities/colleges, and has published articles in peer-reviewed journals. He received a doctoral degree in Economics from the University of Oxford, United Kingdom.
Ipatia Apostolides, B.A. has more than fifteen years experience working in the cancer field. She has co-authored several medical articles related to cancer. She has a Bachelor's degree from Case Western Reserve University, and several years of post-graduate coursework.
2006 Copyright. All rights reserved. Permission is granted to use/copy this article as long as credit is given to the authors Anthony Apostolides and Ipatia Apostolides.