Cancer Deaths Begin to Decline
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JIM LEHRER: Now a closer look at the first decline of cancer deaths for Americans in 70 year.
The latest numbers from 2003 were reported today by the American Cancer Society. Among the most common cancers, breast and colon cancer deaths dropped by more than 2 percent a year since 1990; prostate cancer by 4 percent. Lung cancer deaths down too, but just among men.
For the whys behind the numbers, we go to Dr. Larry Norton of the Memorial Sloan-Kettering Cancer Center in New York City. He’s a former president of the American Society of Clinical Oncology.
Dr. Norton, welcome.
DR. LARRY NORTON: Hi, pleasure to be here.
JIM LEHRER: The word “milestone” has been used today — excuse me — to describe these numbers. Do you agree this is a milestone?
DR. LARRY NORTON: Well, it’s clearly an important event. And we’re seeing now the consequences of things that have been in action for quite a number of years. Remember, national death statistics have always lagged behind the real impact of the things that we are doing. And I think what’s important about this to remember is that it’s not just one thing, it’s not one disease and it’s not just one intervention, it’s earlier diagnosis, it’s more access to care, it’s better therapy and it’s also smoking cessation.
JIM LEHRER: Sure.
DR. LARRY NORTON: I think the difference between men and women — in terms of lung cancer — is largely due to tobacco use.
JIM LEHRER: So there’s no single one reason that explains this, right?
DR. LARRY NORTON: Well, what we’re seeing is the process of medicine evolving. We’re seeing the natural course of learning about better methods of diagnosis, of getting more people to get earlier diagnosis, of the development of better therapies. And we’ve had dramatic advances in that regard. Everything is sort of working together in a positive direction.
But what we’re going to be seeing is much more of this. Everybody recognizes this is just the beginning. As I said, we’re seeing now the consequences of things that happened five, ten, even longer years ago, so that we’re going to see over the next few years, even bigger improvements we all expect.
And when the newer approaches to cancer, based on understanding the biology of cancer, when they really hit, we’ll see even bigger changes.
JIM LEHRER: Because this, as you say, this is not the result of any magic silver bullet.
DR. LARRY NORTON: Right.
JIM LEHRER: Some huge breakthrough. This is a combination of things that have all come together, is that right?
DR. LARRY NORTON: Exactly right. That’s exactly right, yes. That’s why it’s important to keep pushing on all fronts at once.
Certainly research is the key to everything. But we need research into better diagnosis, better prevention, better therapies, smoking cessation. The smoking story is a very real one here because people notice how can breast cancer go down and deaths in women not go down? Well, the reason is smoking. Women started smoking later than men and now we’re seeing the consequences.
JIM LEHRER: And there’s no question about the connection between smoking and breast cancer as well as lung cancer?
DR. LARRY NORTON: Well, lung cancer is absolutely clear. But there are other cancers, bladder and esophagus; the breast cancer story is not all that clear, and there’s evidence on both sides of that issue.
But, remember, that half of all smokers will die of it. And one third of all cancers are caused by cigarette smoking. And one third of deaths — if you count cancer, heart disease and stroke – one third of all deaths in the world are due to cigarette smoking. So we’re dealing with a very serious issue here. And no matter what we do we’re not going to make really true progress unless we stop that.
JIM LEHRER: All right. A couple of the other, other most common cancers, colon cancer — bring us up to date on where screening, diagnosis and treatment rests with that?
DR. LARRY NORTON: Well, colonoscopy is a great story and a great victory. If you get the colonoscopies when you’re supposed to, if polyps are found and they’re removed, there’s a dramatic, huge impact on colon cancer incidence. So that is a clear-cut prevention and probably the best demonstration of screening and prevention working hand in hand.
But even if somebody should get colon cancer, there have been improvements in the surgery and improvements in drug therapy as well; giving drugs to kill colon cancer cells that might have spread also an impact. Again, everything is all working together.
JIM LEHRER: Now the death rate, which is the percentage of people who die from the particular disease, the death rate is pretty low now, isn’t it. with colon cancer?
DR. LARRY NORTON: Well, it depends on when it’s diagnosed.
JIM LEHRER: I see.
DR. LARRY NORTON: As I said, it could be close to zero if you get the polyps out by having a colonoscopy when you’re supposed to.
JIM LEHRER: All right. Prostate cancer, what is the word on it?
DR. LARRY NORTON: Well, the jury is still out as the PSA as a screening test.
JIM LEHRER: PSA is a blood test, right?
DR. LARRY NORTON: Yeah it’s a blood test and It’s prostate specific not prostate cancer specific, so as men get older their PSA’s tend to rise, because as men get older their prostates tend to get larger, but if there’s a sudden rise in PSA, it is an indicator that there might be a cancer there. And so this is being studied now as a possible screening intervention.
But one of the really important things is seeing the doctor, getting the digital examination, the rectal examination, and the proper therapy if it’s diagnosed. And there, too, we’re going to see very dramatic improvements as some of the more modern therapies really have their impact nationwide.
JIM LEHRER: You mentioned breast cancer. What else do we need to know about where matters stand with it?
DR. LARRY NORTON: Breast cancer is one of the areas where we have had really dramatic changes. We have a long way to go, there’s no question, but we’re seeing the light at the end of the tunnel, which doesn’t mean we’re at the end of the tunnel but we know we’re moving in the right direction.
JIM LEHRER: Light at the end of — excuse me, light at the end of the tunnel, there’s not going to be any more breast cancer?
DR. LARRY NORTON: I think that that — I’m willing to stick my neck out –
JIM LEHRER: Wow!
DR. LARRY NORTON: — and say, as I’ve said before, that a little girl born this week is probably not going to have to worry about breast cancer in her future, and that may be true for a lot of other diseases as well.
JIM LEHRER: And the reasons on breast cancers are these many things — go ahead, I’m sorry, I interrupted you.
DR. LARRY NORTON: Sure of course. Mammography obviously has a very clear impact; we’re working on other ways that may augment mammography in terms of diagnosis — diagnosing cancer when it’s small in the breast is clearly important. We have much less mutilating surgery. We have breast conservation surgery now, and better methods of radiation for controlling the cancer in the breast.
We have got better ways of using drugs to kill any cancer cells that might have strayed, and that’s both chemotherapy-type drugs and hormone therapy-type drugs.
And we’re working on a lot of prevention strategies, as well, some involving hormones, and some involving vaccines, so that everything, again, is working together in a very positive direction.
JIM LEHRER: Now, what about lung cancer? That’s still a deadly one, is it not?
DR. LARRY NORTON: Well, that’s where the smoking comes in. I think it’s very unlikely that we’re going to have a huge impact until we get people to smoke less. And even after diagnosis of lung cancer, if you stop smoking, you improve your prognosis. That’s how noxious the cigarette smoke is. But we’re also learning about the biology of lung cancer, learning a lot about what changes in DNA are associated with lung cancer. And this is leading to improved drug treatments, improved therapies, based on that biology. So even with a tough disease like that, we still have some promising things to look forward to.
JIM LEHRER: But the death rate for lung cancer is still comparatively very high, is it not?
DR. LARRY NORTON: It’s the smoking.
JIM LEHRER: No, but what I mean is, whatever the cause is, if you get lung cancer your chances of dying are higher than if you get some of these other cancers.
DR. LARRY NORTON: Absolutely. And cancers that tend to be caused by known factors like radiation, like cigarette smoke, tend to be the worst because the exposure to the chemicals, is constantly causing changes in the DNA. So these cells, the DNA is the molecule that is the instruction sector of the cell, so these cells really have very aberrant instructions, and, therefore, they’re behaving so abnormally it’s very hard to kill them.
JIM LEHRER: Dr. Norton, just in a general way, once somebody is diagnosed with cancer, and I know it varies from one cancer to another, but in general terms, once a person is diagnosed, are they living longer?
DR. LARRY NORTON: Oh, yes, absolutely, in many, many of the cancers. First of all, we do have what is tantamount to cure rates on many cancers. Most women with breast cancer, for example, will be cured by modern therapy as an example.
But even people who have the cancer coming back we have improved methods of treating them that can extend their life and extend the quality of their life. The quality of life they have can be extended, so, unquestionably, people with recurring cancer, with many types of recurring cancer can live very high quality lives because of the treatments we give. But that’s just a step in the right direction.
When you’re able to convert an acute disease that can kill you quickly to a chronic disease that you can live with for a long time that shows you’re moving in the right direction.
And the history of medicine has always been that if you can get the movement from an acute disease to a chronic disease, then you know that you can get even further and convert that disease into a curable disease and even a preventable disease. And we’ve seen it with testicular cancer, is an example, is one very clear example of that, and there are many other examples.
So, again, we see the light at the end of the tunnel. This doesn’t mean we’re at the end of the tunnel but we’re moving in the right direction and we have to move even faster.
JIM LEHRER: And if we have this conversation a year from now, the results will continue to be along the line we’ve talked about, right?
DR. LARRY NORTON: That –
JIM LEHRER: That’s your prediction?
DR. LARRY NORTON: That is our expectation, right.
JIM LEHRER: Dr. Norton, thank you very much.
DR. LARRY NORTON: My pleasure, thank you so much sir.