Jan 22, 2014 — The latest numbers were released from The American Cancer Society on the battle against cancer. In this episode of The Scope, Dr. John Sweetenham from Huntsman Cancer Institute tells us what the numbers mean. He discusses where the most progress has been made, the opportunities for future victories and whether survival rates are the best metric for measuring success.

Interview

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Host: The battle against cancer. How's it going? The American Cancer Society recently released some statistics that indicate it's going pretty well. We're here with Dr. John Sweetenham, Huntsman Cancer Institute, who hopefully can shed a little light on what all these numbers mean when it comes to the battle against cancer.

Dr. John Sweetenham: Sure. I think a couple of important take home messages. Number one, if you look over the last 30 or 40 years since the battle on cancer was declared in the 1970s there has been really remarkable progress in the early diagnosis, detection, screening, and death rates for a number of common cancers. The death rates from several of the very common cancers including breast cancer, lung cancer, and colon cancer have fallen pretty dramatically over that time.

Host: Like significantly?

Dr. John Sweetenham: Absolutely.

Host: When you look at these numbers you go wow, this is pretty great.

Dr. John Sweetenham: Absolutely. As a good example, in 1971 in the U.S. there were about one and a half million cancer survivors. At the moment in the U.S. there are about 20 million cancer survivors.

Host: Wow.

Dr. John Sweetenham: Very extraordinary improvements in outcomes. The downside is that the burden of cancer on the community as a whole still continues to go up. The primary reason for that is that cancer is a disease predominantly affecting people in their later years. As the population gets older we are simply seeing more folks with cancer.

Host: Was there any interesting stories within the number of survivors? Was it a specific group of people that are surviving more now, or a specific cancer?

Dr. John Sweetenham: Specific cancers where there have been big advances include breast cancer, lung cancer, prostate cancer, and colorectal cancer. Particularly, there has been a significant decline in the black community in a number of cancers including prostate cancer.

Host: What would you attribute that to?

Dr. John Sweetenham: Interestingly, the American Cancer Society doesn't attribute that, I think because we don't really know for sure. I think the assumption has to be that this has really been an educational effort, because there have been more awareness and more efforts in that community to make sure that they are aware of the availability of early diagnosis, of screening, and so on. In diseases such as prostate cancer it is true for sure that early detection and diagnosis is the key to cure.

Host: Is there a lesson to be learned there as far as you're concerned?

Dr. John Sweetenham: I think the lesson is surrounding the power of education, that the more public awareness there is of these screening and preventive measures for cancer the more impressive the results can be.

Host: The advances in the specific cancers that you mentioned, breast cancer being one of them, what would you attribute that to, or there again, are they not attributing it to anything?

Dr. John Sweetenham: I think breast cancer is a good example of where research into this disease combined with real efforts at early detection have made a huge difference. Screening mammography in particular and the early detection of breast cancer has had a major impact on the outcome. Like all cancers, the early detection is the key. These diseases are all more curable if they're caught very early on.
In addition to that, in cancers like breast cancer there has been a huge explosion in the number of new drugs driven by our understanding of what goes wrong in cancer cells and why they start to grow out of control. We've seen a big explosion in the number of available treatments in breast cancer and in many other types of treatment.
Again, a combination of early detection, making sure that as many people as possible have the diagnosis when the disease is at its most curable, and that's being coupled with major advances in treatment for those folks who actually need treatment beyond surgery.

Host: Survivors, is that a good metric to judge how well the war on cancer is going, or is there a better metric - quality of life maybe being one of them?

Dr. John Sweetenham: Quality of life, of course, is major. I think that there is no doubt now that we're seeing big changes in the way that we think about what represents a successful outcome in cancer. If you go back 20 years it was all about cure, so all of our metrics of success around cancer treatments were based around whether or not we could cure the cancer.
I think what we're now starting to see that with a number of the newer treatments which are coming along, they may not totally eradicate the cancer but they have the ability to keep it under control often for many, many years. What we're starting to see now is a shift away from this idea that good quality cure is the only meaningful end point to good quality of life with control of the disease as a major end point.
We're starting to think about managing cancer in the same way that we might manage diabetes or heart disease as a chronic condition which may need management over 20 years or 30 years to maintain somebody in good quality healthy life for as long as possible.

Host: You had mentioned that we're going to have an increasing older population moving up which is going to mean more incidents of cancer. What are the challenges associated with that from your perspective?

Dr. John Sweetenham: Two-fold really. Number one simply is a numbers thing. We are going to have more folks coming through the door who are going to need to be treated. And, we are going to have to look at ways that we can effectively do that not just within big centers like Huntsman Cancer Institute but across the whole community. Because many of these folks are not going to find places like Huntsman Cancer Institute readily accessible. Our challenge is going to be how to extend our Huntsman Cancer Institute care out in the community so that we can reach those people where they are rather than having them come to us.

Host: When the American Cancer Society releases their next report in ten years, what do you foresee that report saying?

Dr. John Sweetenham: I think in many ways it will be very similar to the report that we've seen this time around. What it's going to show is further progress in reducing the number of deaths from cancer and probably further increase in the number of people who develop this disease just because the population is getting older. I think that if in another ten years we see that there's been a further decline, hopefully across the whole spectrum of cancers, in death rates then I think that will be great news and very encouraging.

Host: Where are the best opportunities to make those gains do you feel?

Dr. John Sweetenham: I think that the best opportunities in many respects are probably in those cancers where we've already made good progress. I think what we'll most likely see is continuing improvements in the treatment of conditions like breast cancer, prostate cancer, lymphomas, leukemias, those kind of diseases.
Some of the more challenging conditions, diseases like pancreatic cancer will be a good example, we need more research. I think our efforts over the next five to ten years need to be in getting a deeper understanding of the biology of those types of cancer and what it is within the cells themselves that's driving them. Because it's that knowledge that we gain through research which has enabled a lot of progress we've seen over the last 20 or 30 years.

Host: Any final thoughts, anything that I've left out, anything that you would like the audience to know?

Dr. John Sweetenham: The best way to avoid cancer is prevention. There's a lot of stuff out there in all kinds of media as to what you can do. I think my take home message in that regard would be don't smoke, eat a good balanced diet, and get plenty of exercise. Those are probably the three most powerful things that you can do to avoid being affected by this disease in the first place.

Host: I might add get your screenings if there's a history and that sort of thing as well.

Dr. John Sweetenham: Get all of your screenings even if there isn't a history, particularly as you get into your 40s and 50s. Make sure, ladies, get your mammography. Men, get your prostate cancer screening. Ladies, do your cervix cancer screening. Prevention, prevention, prevention.

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