The Past, Current, and Future.

According to Edgar Rice Burroughs [1], BWe are, all of us, creatures of habit,^ and I am foremost among this group. My days at work invariably begin with the brewing of the first of many pots of coffee, followed by a bowl of cereal while simultaneously reviewing overnight emails and submissions to the Journal of Cancer Education. My daily inbox is, I imagine much like yours, filled with urgent and not so urgent requests, anticipated responses, SPAM, updates of varying importance, and a ragtag collection of posts from various news organizations. One such post from the last category recently caught my attention. It was a story citing an IMS Health report that global cancer drug spending crossed the $100 billion threshold in 2014 [2]. (NB: this report is only concerned with cost of cancer medicines and does not include total treatment costs such as direct patient care, radiation, surgery, etc.) This represented an increase of 10.3 % from 2013 and up from $75 billion five years earlier. (NB: for thoughts on what is driving these costs, I refer you to a recent NEJM article by Avorn [3]). Spending on cancer drugs represents nearly 11 % of all drug spending globally. IMS forecast is that this will grow to $147 billion in 2018. According to GLOBOCAN [4], approximately 11 % of all cancer cases occur in the USA, yet the IMS reports that the USA accounted for 42.2 % of total spending. While I have no doubt that many of these drugs will significantly improve both the quality and length of patient lives, it does give one pause to consider whether given this level of spending on medications we are spending anywhere near enough on cancer education including training, public education, and direct patient/family educational services. The Agency for Healthcare Research and Quality (AHRQ) estimates that the direct medical costs (total of all health care costs) for cancer in the USA in 2011 were $88.7 billion (11 % due to drugs) [5]. Thus, estimated total care costs for 2013 would approach $180 billion. Benjamin Franklin is credited with saying BIf an ounce of prevention is worth a pound of cure....^ Then, if my calculator is trustworthy and you will permit me some editorial license in my application of some less than rigorous mathematics, it would appear that in the USA, we should be spending approximately $11 billion on cancer education/prevention. So reader it is up to you to consider which is the better cost value and which is more palatable, to prevent or to cure? The reality is that at the present time, we need both. I look forward to the day when we have effective prevention strategies for the majority of cancers. When that time comes, we will be challenged with convincing the public to adopt these behaviors. Another email which recently crossed my computer screen was a report in the CDCP Morbidity and Mortality Weekly Report [6] which presented results of a review of 2013 screening rates in the USA. Data demonstrate that B...around 1 in 5 women are not up-to-date with cervical cancer screening, 1 in 4 women are not up-todate with breast cancer screening, and 2 in 5 adults are not upto-date with colorectal cancer screening.^ So even when we have effective means of early detection, we will be challenged with engaging the public. As our colleagues in smoking cessation can attest, it takes more than data to change behavior. The need for cancer education and training will then be never more urgently needed. This past April, I had the privilege to represent the Journal of Cancer Education (JCE) at the annual European Association for Cancer Education (EACE) meeting in Heidelberg, Germany. This wasmy third EACEmeeting, and it only served to reinforce * Arthur Michael Michalek amm3@buffalo.edu