The war on cancer: A public health triumph

In the war on cancer, the American Cancer Society announced in a yearly report by Stacy Simon that over the last 20 years, 22% fewer people have died from cancer, representing 1.5 million avoided deaths.  The biggest single reduction occurred in lung cancer, according to the Society’s Vice President for Surveillance and Health Services Research, Ahmedin Jemal.  There are fewer smokers, as millions quit, and millions of others never started smoking.

This was not primarily the result of medical care, though doctors certainly advised many of their patients to quit.  Rather, quitters used a variety of methods over multiple attempts to quit, including advice from doctors and others, smoking cessation products like patches, gums, etc., reading generic or individualized materials, quitting cold turkey, etc.  So this wasn’t “patient engagement” by the medical system per se, as quitters were not primarily benefiting from their doctors’ active medical management of their smoking.  They weren’t patients; for most quitters, cancer had not developed to the point where they required treatment for cancer.  Rather, in most cases the successful quits came from multiple self-initiated efforts by the “worried well,” often with nudging by family members.

There is much credit to share for all the lives saved, e.g., for doctors who advised patients to quit.  Yet this victory seems due more to public health efforts than to the medical system. 

Efforts to meliorate the toxic effects of other lifestyle choices about alcohol, drugs, overeating, inactivity, etc., might also benefit from focusing on public health efforts addressed to the worried well, in similar ways. 

Advice:  Have a happy New Year!   Give a hug to your public health friends, and let’s celebrate!   

My annual physical was a lifesaver

David Evett's letter to the editor:

Stephen Smith's article: "The annual physical gets a checkup" (Health/Science, Oct. 22) questions the value of the yearly visit to the doctor. I am an active, energetic 71-year-old. Between Christmas and New Year’s 2005-2006, I had a mild case of pneumonia, which yielded promptly to antibiotics. When I went in for my annual checkup the following April, I seemed to be in excellent general health. My conscientious doctor, however, ordered a chest X-ray to see whether the pulmonary infection had done any permanent damage. This was not an official follow-up: had I not come in for the exam, he would not have ordered the X-ray. It revealed no ill effects from the pneumonia. The alert radiologist, however, noticed a suspicious shadow in the other lung. It was cancer. Early detection meant early surgery and the strong likelihood that it would not recur. I need hardly say that I am glad – as are my family, friends, and professional associates – that I schedule that exam every spring.

Advice to elderly pneumonia survivors: Pneumonia can be dangerous for older people, so make sure the doctor follows up to ensure the infection has completely cleared up.

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