Download LESSON 5.6 WORKBOOK So what about the 'War on

LESSON 5.6 WORKBOOK
So what about the 'War on
Cancer'?
This module has provided a broad perspective to cancer as a disease, switching
focus among the DNA, cellular, organ, and systemic levels. As described in Unit
1, our understanding of cancer has changed over time, and will likely continue to
change as we learn more about the disease itself. This lesson is intended to take
a step back and examine everything we know about cancer currently, to gain
perspective on where we have come over the last several year, and where we still
need to go.
The ‘War on Cancer’
Wo r k b o o k
Lesson 5.6
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1. 1. What was the first organization to
begin the 'War on Cancer'?
aa. American Cancer Society.
bb. American Society for Control of
Cancer.
cc. Susan G. Komen Foundation.
dd. National Cancer Institute.
The popular media often describes people with cancer as ‘battling’,
‘fighting’, or ‘struggling with’ cancer. People that are in cancer remission are often described as ‘survivors’. Why is cancer in particular
treated so emotionally?
In the early 20th century, a cancer diagnosis was a death sentence.
Patients were usually in denial of their diagnosis or fearful of their
death. For this reason, doctors often did not tell their patients
they had cancer, nor did patients tell their loved ones. Cancer was
rarely mentioned in public. Then in 1913, 10 doctors and 5 other
concerned citizens founded the American Society for the Control
of Cancer (ASCC) to raise awareness of cancer as a disease.
The ASCC believed that the best way to defeat cancer is through
education. They wrote articles in magazines and professional
journals to educate the public about cancer. In 1936, Marjorie G.
Illig, an ASCC volunteer went one stage further. She created a
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Figure 1: Original poster
for the ASCC.
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LESSON READINGS
legion of volunteers whose purpose was to wage ‘war on cancer’ The Women’s Field Army wore khaki
uniforms, complete with insignia of rank and achievement and went out into the streets to raise money
and educate the public about cancer. Within 2 years their numbers swelled from 15,000 to 150,000
members. The Women’s Field Army moved the ASCC, which was eventually renamed the American
Cancer Society (ACS), to the forefront of cancer charities. Funding education, prevention, and research
projects with the goal of defeating cancer by improving cancer prevention and treatment . It made a major
contribution to cancer education in 1971 when lobbied President Nixon to pass the National Cancer
Act, which established a ‘War on Cancer’. The Act expanded the National Cancer Institute (NCI) and
increased federal funding for cancer research. Since 1971 it has spent nearly $90 billion dollars on its goal
to cure cancer within 30 years.
Cancer advocacy: pros and cons
Other charitable organizations have since joined the ACS and
the government’s ‘War on Cancer’. Some, such as the Jimmy
Fund of the Dana Farber and St. Jude’s Children’s Research
Hospital have arisen from hospitals that focus on cancer care,
and raise money to support research into treatments. Others
such as the Susan G. Komen Foundation and Livestrong have
been formed by cancer patients, survivors or their families with
the goal of ‘raising cancer awareness’.
Figure 2: Breast cancer
awareness poster. Awareness
campaigns promote early
detection without educating
individuals on what cancer
diagnosis means – leading to overdiagnosis and
overtreatment.
While research into cancer biology, prevention and treatment
is concrete and has clear goals, the notion of raising cancer
‘awareness’ is rather more vague, and recently, patient
advocates and activists have called into question whether
encouraging the population to wear pink ribbons and buy pink
merchandise or to grow moustaches in ‘Movember’ raises
awareness effectively. At issue is these cancer charities’
focus on making early screening universally available. Cancer
charities cite the 5-year survival rates for breast cancer and prostate cancer, which are among the highest
for all forms of cancer within the US population, as evidence for the success of their approach. Yet activists are concerned that these numbers are misleading and serve to divert resources from more critical
problems in cancer treatment and care.
Wo r k b o o k
Lesson 5.6
We have learned that while mass screening can indeed dramatically increase the number of early stage
tumors and cancers that are detected, neither screening alone nor follow-up biopsies can accurately
predict which of these tumors will give rise to severe disease. Because of this we currently treat all of
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2. What was the major goal of the ACS?
aa. Developing new therapies for
cancer treatment;
bb. Educating the public about
cancer;
cc. Increasing funding for research;
dd. Organizing boycotts of tobacco
companies.
3. What is Breast Cancer Awareness
Month hoping to achieve?
aa. Build support for women who
are terminally ill;
bb. Encourage more people to have
breast cancer screens;
cc. Educate people on the biology of
breast cancer;
dd. Inform people on the causes of
breast cancer.
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LESSON READINGS
breast tumors as though they will, which as we have learned leads to overtreatment that can be extremely problematic. In fact in cases, such as prostate cancer, where we now have a better handle on which
tumors will progress to severe disease, recommendations for screening have been significantly reduced.
Hence labeling those individuals who have been diagnosed with early stage tumors that would never
have progressed to severe disease as ‘survivors’ gives a misleading impression of the effectiveness of the
screen, since the principal thing they may have survived is the unnecessary treatment they have received
as a result of the screen. On the other hand these same screening programs are not effective in reducing
the death rate from fast-growing metastatic cancers, if the tumor has spread before the screen has detected it. Activists argue that resources would be more effectively used by figuring out how to tie screening
results to prediction of outcome at the individual level – which is the hope of personalized medicine as we
learned in the last lesson. Moreover patient advocates consider that labeling patients who would never
have developed serious disease as ‘survivors’ while labeling patients who cannot be helped ‘losers’ in the
war on cancer is divisive and counterproductive.
Few of the prominent cancer charities focus on
awareness of cancers that are still essentially death
sentences, such as lung, stomach, liver and pancreas.
In this case activists argue that even though we may not
yet have screens to detect early stage tumors or viable
treatment options awareness campaigns should prioritize
education into minimizing risk. For example, lung cancer
is one of the highest causes of death in the US population
and is most frequently associated with smoking. In
fact smoking is one of the leading causes of all forms
of cancer, and is estimated to be responsible for about
30% of all cancers, yet cancer organizations focus little
attention on raising awareness of the dangers of smoking,
and smoking prevention campaigns have declined in the
last several years
Wo r k b o o k
Lesson 5.6
Figure 3: Smoking is one of
the most preventable causes of
cancer. It is believed at around
30% of all cancers are caused by
smoking tobacco products.
We now understand that unbalanced diets and obesity are other major risk factors for cancer. We learned
in Unit 3 that not only does obesity give rise to chronic inflammation that in turn can promote cell transformation, but it also reduces the ability of the immune system to handle cancers. Knowing this it is particularly puzzling that cancer awareness organizations have actually promoted the consumption of unhealthy
foods in order to raise money. For instance in a campaign to raise money for breast cancer awareness,
the Susan G. Komen Foundation partnered with KFC so that KFC would donate 50 cents for every bucket
of fried chicken it sold. Fried chicken, particularly from fast food restaurants like KFC, is generally high in
the calories fat and salt known to promote risk for obesity and potentially cancer. Once the media began
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4. Which of the following would be a
useful awareness program from a
cancer charity? (Circle all correct)
aa. Advertisements encouraging
people to stop smoking.
bb. Partnership with McDonalds to
sell fried chicken to raise money
for research.
cc. Labels on foods that contribute
to obesity.
dd. Education materials explaining
what mammogram diagnoses
mean.
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LESSON READINGS
reporting on this contradiction the Susan G. Komen foundation cut its ties with KFC, but the event raised
questions about the extent to which other corporations were using connections to the cancer awareness
promotions run by charities like Susan G. Komen, to deflect attention from their involvement in increasing
the risk for cancer.
Defeating cancer
In the 40 years since the passage of the National Cancer
Act that started the ‘War on Cancer’ it is estimated
that $90 billion has been spent in the US on research
and treatment of cancer. Yet, major questions about
cancer – what causes it and how can we predict
whether a cancer will spread and cause disease – not
only remain unanswered but are a minor target of our
research dollars: It is estimated that of the $2 billion that
the ACS and NCI spent last year on the war on cancer
only ~$300 million was spent on research that focuses
on metastasis. Likewise only $233 million is spent on
education on cancer prevention. Activists ask whether
patient advocates are dictating where money is spent and
impeding progress.
Figure 4: The KFC Buckets
For The Cure partnership with
Susan G. Komen was criticized
by many patient advocates
for raising money for cancer
research and awareness while
also promoting obesity and
increasing cancer risk.
Will we ever be able to prevent cancer. Unlikely. Random
DNA mutations accumulate no matter what we do so
preventing the random DNA mutations that mutate protooncogenes or tumor suppressor genes to drive cell transformation is an impossible task. Accumulation
of random mutations increases with age, which is why cancer is more frequent in the elderly. So while
we cannot prevent all random DNA mutations, it is likely we will be able to reduce the extent to which
they occur by minimizing exposure to environmental carcinogens particularly cigarette smoke, diet, and
pathogens that increase the frequency of mutation.
Wo r k b o o k
Lesson 5.6
Will we ever be able to cure cancer? Research funded by the ‘War on Cancer’ has taught us so much
about how cells behave, much of it so completely unexpected that it is not surprising we have not yet
solved the problem. But as we learn more we move further towards treating individuals diagnosed with
cancer so they can lead long healthy lives. While cancer may be inevitable for the very old, we may
indeed be able to eradicate it in the young. Understanding metastasis is one key, another is the choices
we ourselves make to reduce risk.
Notes:
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STUDENT RESPONSES
Why have concerns been expressed about cancer awareness campaigns?
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Remember to identify your
sources
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Lesson 5.6
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