Where the cancer fight goes next

Most media outlets are celebrating the latest American Cancer Society annual report, showing that cancer rates, and deaths from cancer, continue to fall.

But a close look at the numbers reveals a more inconvenient truth. The low-hanging fruit in the cancer fight has been picked. Further progress will require some dramatic changes.

The report put this as gently as possible:

Further progress can be accelerated by applying existing cancer control knowledge across all segments of the population and by supporting new discoveries in cancer prevention, early detection, and treatment. 

The first part of that sentence is the most inconvenient. Poor people aren't getting the cancer prevention message.

The fight is far from won. About 1.5 million people will get the news "you have cancer" this year (not counting those with easily-removed skin cancers), and the odds of later death by cancer are one-in-three.

The most common cancers remain lung, colon, and prostate cancer for men, or breast cancer for women. Lung cancer is the deadliest form, killing two-thirds of victims.

That's where the big progress has been made, especially among men. Deaths from lung cancer among males are down over 25% since their 1995 peak, and prostate cancer deaths have been cut nearly in half. Women have had steady progress in cutting colon and breast cancer deaths.

The reason for that is smoking. There is a multi-decade delay between lower rates of smoking and lower rates of lung cancer. Guys quit, women didn't, although it should also be said men once had Mad Men-sized smoking habits. (The show's cast is mostly smoking clove, by the way.)

What needs to happen now, the report says, is a concentrated effort toward reaching poorer people, especially black folks. From the press release:

African-American men have a 14% higher cancer incidence rate and a 34% higher overall cancer death rate compared to white men, according to the report. African-American women are less likely than white women to get cancer, but when they do get it, they're more likely to die from it. 

This becomes especially clear when you isolate to prostate cancer. In Alabama, for instance, whites have about a 1 in 1,000 shot at getting a prostate cancer diagnosis, and about one-fifth die of it. For blacks the incidence rate is twice as high, and the rate of death three times higher.

While it was easy to get support for programs aimed at the mass market, which cut the smoking rate and increased the rate of early detection, programs aimed at specific groups will be much harder to fund and implement.

The cancer fight is about to get very political.

This post was originally published on Smartplanet.com