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May 10, 2010

Will One in Four Americans Die of Cancer?

Maggie Mahar
A recent New York Times editorial announced that the war on cancer is reaching "a state of crisis."   Citing the Institute of Medicine (IOM), the Times called for boosting funds that support cancer trials while also raising the academic rewards to encourage researchers to run clinical trials. Appealing to readers' pre-dawn terrors, the editorial concludes by declaring that "Nearly one in four Americans are projected to die from cancer. It is vitally important to find the best treatments for them."

It's a strong "kicker "(journalese for an ending). The only catch: it's not true.  One in four Americans are not expected to die of cancer. Current projections say that one in four American men born in 1985 will die of cancer. For a woman, the odds drop to one in five. And for most Americans, the risk is much lower.

Consider that at least 30% of cancer deaths are caused by smoking. If you don't smoke, it is far less likely that you will end your life battling cancer.

Why the Risk is Lower for Most Americans

Dartmouth's Steven Woloshin, Lisa M. Schwartz and H. Gilbert Welch broke out the possibility of dying of cancer by age, sex, and smoking status in an article published in the Journal of the National Cancer Institute in 2008.   It turns out that if you are a 50-year-old man who never smoked, the chances that, over the next 10 years, you will die of one of the cancers that are most likely to kill men ( prostate cancer, lung cancer, or colon cancer) are just 4 out of 1,000.  That is  a 0.4% chance. (The odds are higher, 5 out of 1,000,  that you will die in an accident). If  he is a smoker,  the odds for  a 50-year-old man more than quadruple, to 21 out of 1,000.

For a 50-year-old woman who doesn't smoke, the chances of dying of lung, breast,ovarian or cervical cancer over the next 10 years stand at  7 out of 1,000; if you smoke the odds rise to 20 out of 1,000. The authors of the study define a  "non-smoker" as someone who has smoked less than 100 cigarettes in her life.  A "smoker" is someone who has inhaled more than 100 cigarettes and smokes now  (any amount.) If you quit smoking, your odds of dying of cancer are cut in half ten years later.

Moreover, it's worth noting that the likelihood of dying of cancer are one in four for all 25-year old men (smokers and non-smokers lumped together) born in 1985. Back in 1975, projections suggested that a man born that year had only a 18% chance of dying of cancer, while a woman had a 16% chance. By 1985, the odds for a man had risen to 25%, and for a woman to 20%.  This is because we are living longer. In the past, a person was more  likely to be killed by heart disease or an infection before cancer caught up with him or her.  (Typically cancer tumors are diagnosed at age 67.)

Another way of putting this is to say that the longer you live, the more likely it is that cancer will cause your death. If a man lives to 70, the odds are 28 out of 1,000 that this much dreaded disease will kill him over the next ten years, even if he never smoked.  On the other hand, at that age the odds that  he will die of something over the next decade are nearly 300 out of 1,000.  By contrast, the likelihood that cancer will do him in is pretty slim.

A 70-year-old women who never smoked faces the same odds: 28 out of 1,000- that , sometime over the next ten years, "cancer" will be listed as the cause of her death.. But the chances that she something will kill her over the same span are 207 out of 1,000.  For smokers who make it to 70, the risk of death by cancer is far higher: 132 out of 1,000 for men, 80 out of 1,000 for women.

Finally, low-income Americans face a much greater risk. For example, poor women are about twice as likely to die of breast cancer as wealthier women. This is because they receive less medical care, and less sophisticated care. "Where patient care is equal, treatment and outcome are equal," explains Otis Brawley, MD, associate director of the Winship Cancer Institute at Emory University. Article published in the American Cancer Society's News Center.

Brawley begins with data on African-American women which shows that they are about twice as likely to die of breast cancer as white women. But this is a relatively new phenomenon.  Until about 1980, their survival rates were equal.

And genes "didn't change around 1980," Brawley observes. In other words, there is little reason to suspect that African-American women suddenly became more susceptible to breast cancer than white women.

What changed since 1980?  Treatment for breast cancer has advanced over the past 30 years. "Improved breast surgery techniques became more common, new chemotherapy drugs improved survival times and tamoxifen began reducing recurrence rates,"  says Brawley. ut "women too poor to have insurance or adequate income to pay for those advances didn't benefit from them.  "Because there is a larger portion of low-income earners among African Americans, it can seem that race is the reason for worse cancer rates, when it mainly is poverty," he adds.

I should add that studies do suggest that skin color can add to disparities in how much care patients receive. The vast majority of doctors are white, and research suggests that African American patients and white doctors may view each other with some suspicion. At the very least, cultural differences can  make communication difficult.

But Brawley points out that among U.S. military personnel-who all have access to the same quality of care-survival rates among African American breast cancer patients and white breast cancer patients have remained the same since 1980.

Why is the New York Times Trying to  Scare Its Readers?

Just how many of the NYTs' readers are low-income, African-American men who smoke? Not many.

How many  are 30 to 55 year old middle-class or upper-middle-class women who don't smoke?  Many more. Those women face a chance of dying of cancer in the next 10 years that ranges from less than 1 out of 1000 to 13 out of 1000, depending on their age. The longer they live, the greater the risk. We all will die of something. So if a person beats heart disease, it becomes more likely that he will face cancer. But  a 75-year-old woman should not lie awake worrying about this terrible disease. There is a 1 in 3 chance that she will die before she turns turns 85. The odds that cancer will be the cause of her death are just are 33 out of 1,000.

The bottom line: New York Times readers who don't smoke do not face a one in four chance of dying of cancer at any age. I don't know why the Times would throw that  number out there. But I would guess that the person who wrote the editorial believes the statistic. Perhaps he read it in another newspaper.

Finally, let me suggest that rather than pouring more  money into chasing an elusive cure for cancer, we should be putting those dollars into two things that we KNOW will greatly reduce death by cancer: a major campaign to help Americans stop smoking -- complete with free drugs and nicotine patches --and an all-out effort  to ensure that all Americans, poor as well as rich, receive the cancer treatments that we know are most effective. (Giving more Americans health insurance is one thing ---making sure that everyone receives the same level of care, regardless of income or skin color, is something else.

The Following charts from "The Risk of Death by Age, Sex, and Smoking Status in the United States: Putting Health Risks in Context" Steven Woloshin , Lisa M. Schwartz , H . Gilbert Welch can be found here.

Riskchartformen
click on chart to enlarge

Riskchartforwomen

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