Toward the control of cancer
Authors: Otis W. Brawley, Ted Gansler, Richard C. Wender
Journal: CA A Cancer Journal for Clinicians (2018)

Cancer is a devastating disease. It is estimated that 1.7 million Americans will be diagnosed with cancer in 2018 and approximately 610,000 will die of it.1 Cancer does not discriminate. It affects humans of all ages, races, and ethnicities. Although virtually everyone is at risk for developing and dying from cancer, the burden of this disease is not equal. Substantial disparities have been present for years. Bridging these disparities defines a central challenge for our nation's cancer control efforts. Despite a 25-year decline in the cancer mortality rate, cancer is the second leading cause of death in the United States and will surpass cardiovascular disease to become the leading cause of death in the next decade. Review of the progress to date indicates that, although much good has been done, much more good can be done. Since 1991, there has been a 26% decline in the cancer death rate age adjusted to the year 2000 standard population. There are more than 15.5 million cancer survivors in the United States.1 Given the challenge that still exists, it is appropriate to assess where the fields of cancer control and oncology have come from and where they are going, what issues must be dealt with, and what interventions must be implemented if we are to most efficiently control cancer. Over the past 5 decades, there has been an extraordinary investment in cancer research that has led to a greater understanding of the disease. Indeed, cancer is being redefined. We are literally moving from the mid-19th century definition based on histopathology to a 21st century definition of cancer that also includes genomic information. Past investments in basic research are yielding better diagnostic and screening technologies and leading to new approaches to treatment. Molecular biology provides the foundation for new treatments in precision medicine. Decades of immunology research are showing us ways to effectively harness the patient's immune system and encourage it to attack their cancer. At the same time, a better understanding of carcinogenesis is allowing for improved cancer prevention. In the next several issues of CA: A Cancer Journal for Clinicians, the American Cancer Society will publish a series of articles assessing trends in cancer mortality and issues and opportunities in cancer prevention, screening, and treatment. These articles summarize where we have come from, the current state of cancer in the United States, and how more consistent and equitable application of currently available interventions can further reduce the cancer incidence and death rates. When there are sufficient data to make a projection, estimates of the potential effect of cancer control interventions are included. Of course, we must continue to support scientific research and innovation, as the future promises even greater benefit. The foundation of a national cancer control plan to reduce the burden of cancer is a group of initiatives to ensure equal and full access to the combination of preventive and therapeutic measures that are already proven effective. We believe this is a moral imperative. These goals cannot be achieved, however, without recognizing that the roots of health care disparities are deep, reflecting fundamental determinants of health, such as poverty, conscious and unconscious racism, barriers to the availability of healthy foods, a "built environment" that limits opportunities for physical activity, and the lack of systems that ensure access to high-quality health care. Any national cancer control plan must include meaningful efforts to address these determinants of health. The forthcoming series of articles will describe the American Cancer Society's vision for how cancer prevention, screening, diagnosis, and treatment can be transformed to define the most efficient path to lower the cancer burden in the United States; these articles comprise the basis of a national cancer control plan, a blueprint toward the control of cancer and cancer mortality reduction and a mortality reduction goal for the year 2035. It is our hope that this blueprint will be a call to action for patients with cancer, their family members, professional organizations, government agencies, the medical profession, academia, and industry to work together to implement what is known about cancer control and support scientific investigation to further our knowledge.