President Obama has pledged to reform the national health care system. Central to this, as the President has stressed, is containing the spiraling costs of health care -- costs which are soaring at about six percent each year. Most experts agree that this is not possible without any plan to prevent Americans from getting cancer in the first place. This year, 1.5 million people will be diagnosed with cancer. Of them, 562,000 people, over 1,500 every day, will die.

The cancer epidemic now strikes as many as one in three Americans and takes the life of one in four. After nearly 40 years of losing the war against cancer, a war that President Nixon declared in December 1971, we are taking grossly inadequate action to protect us from this menace.

Based on recent estimates by the National Institutes of Health, the total costs of cancer are $219 billion a year. The annual costs to taxpayers of diagnosis and treatment amount to $89 billion; the annual costs of premature death are conservatively estimated at $112 billion; and the annual costs due to lost productivity are conservatively estimated at $18 billion. And these are the quantifiable, inflationary costs. The human costs surely are of far greater magnitude.

The connection between our losing the cancer war and the need to control ITS costs through prevention is clear. Cancer is not only one of the most costly and sometimes deadly diseases in America, it is also one of the most avoidable.

To be sure, smoking remains the best-known and single largest cause of cancer, particularly lung cancer. While incidence rates of lung cancer in men have declined by 20 percent over the past three decades, rates in women increased by 111 percent. But more importantly, non-smoking cancers - due to known chemical and physical carcinogens - have increased substantially since 1975. Some of the more startling realities in the failure to prevent cancer are illustrated by their soaring rates. These include:
  • Malignant melanoma of the skin in adults has increased by 170 percent, mainly due to the use of sunscreens in childhood that fail to block long wave ultraviolet light.
  • Thyroid cancer has increased by 116 percent due in large part to ionizing radiation.
  • Non-Hodgkin's lymphoma has increased by 80 percent due mostly to phenoxy herbicides, and phenylenediamine black hair dyes.
  • Testicular cancer has increased by 60 percent due to pesticides, hormonal ingredients in cosmetics and personal care products; and estrogen residues in meat.
  • Childhood leukemia has increased by 55 percent due to ionizing radiation; domestic pesticides; nitrite preservatives in meats, particularly hot dogs; and parental exposures to occupational carcinogens.
  • Ovary cancer (mortality) for women over the age of 65 has increased by 47 percent in African American women, and by 13 percent in Caucasian women due to genital use of talc powder.
Breast cancer has increased by 17 percent due to a wide range of causes. These include: birth control pills, estrogen replacement therapy, toxic hormonal ingredients in cosmetics and personal care products, diagnostic radiation and routine premenopausal mammography, with a cumulative breast dose exposure of up to about five rads over 10 years.

It is now beyond scientific dispute that environmental and occupational exposures to carcinogens are the primary cause of non-smoking related cancers. An October 2007 publication on environmental and occupational causes of cancer by one of us (Dr. Richard Clapp) further emphasized that the increasing incidence of cancer is due to preventable exposures to carcinogens in workplace and environment.

This publication summarizes extensive scientific evidence on cancers resulting from environmental exposures to formaldehyde, chlorinated organic pesticides, and organic solvents. It also details evidence attributing the increasing incidence of lung cancers to preventable occupational exposures to a wide range of carcinogens. These include asbestos, formaldehyde, methylene chloride, benzene, and ethylene oxide.

The National Cancer Institute (NCI) is the primary federal agency devoted exclusively to fighting cancer. Paradoxically, the escalating incidence of cancer over the last 30 years parallels its sharply escalating annual budget -- from $690 million in 1975 to $6 billion this year. Of this a mere $131 million, 2.2 percent, is allocated to NCI's mission on Prevention and Early Detection. However, in spite of well-documented evidence relating the escalating incidence of cancer to a wide range of avoidable carcinogenic exposures, the NCI remains "asleep at the wheel," and has stubbornly refused to devote significant resources or even attention to prevention.

Major policy changes in the NCI are overdue. These include the appointment of a new Deputy Director for Cancer Prevention, and the allocation of at least 4 percent of the NCI budget to prevention programs for fiscal year 2011.

Furthermore, the NCI has touted the imminent success of new cancer treatments promises that have seldom borne out, and which have been widely questioned by the independent scientific community. For instance, in 2004, Nobelist Leland Hartwell, President of the Fred Hutchinson Cancer Control Center, warned that Congress and the public are paying NCI $4.7 billion a year, most of which is spent on "promoting ineffective drugs" for terminal disease. In fact, the costs of these new biotech drugs has increased over 100-fold over the last decade without any evidence supporting their effectiveness in improving survival rates.

Congress now has an epochal opportunity to reform our health care system and prevent diseases, particularly cancer, from occurring in the first place. By taking some simple steps, Congress should enact prompt and aggressive reforms to prevent cancer.

As members of the independent scientific community, we welcome the Obama Administration's goal of health care reform. But while the Administration has put forward a cancer plan, mistakenly it focuses exclusively on the diagnosis and treatment of cancer, rather than on its prevention. In the past, Congress has also misdirected its attention to cancer relief. The simple truth is that the more cancer is prevented, the less there is to treat. That will also save lives and money.

About the author

Samuel S. Epstein, MD Chairman, Cancer Prevention Coalition, Professor emeritus Environmental & Occupational Medicine, University of Illinois at Chicago School of Public Health