Take Public Health to the Moon With You, Joe Biden
In his final State of the Union address, President Obama took a page from President Kennedy’s book to make a bold assertion that—just as the United States made it to the moon in a decade—the U.S. can cure cancer for good. “For the loved ones we’ve all lost, for the family we can still save, let’s make America the country that cures cancer once and for all,” said Obama on January 12, appointing Vice President Biden as head of “Mission Control” for the effort.
It’s not the first time a president has called for a major cancer-fighting campaign from the State of the Union’s bully pulpit. In 1971, President Nixon launched what became known as the War on Cancer saying, “The time has come in America when the same kind of concentrated effort that split the atom and took man to the moon should be turned toward conquering this dread disease.” Fictional presidents have made hay out of the “moonshot” to end cancer, too, as fans of The West Wing will recall from an early draft of President Bartlet’s 2002 State of the Union address.
Now, in 2016, many people believe that the time is right for another big push to defeat cancer. But according to Mailman School scientists, a cancer moonshot will never get off the ground without public health. Since 1990, cancer mortality in the United States has dropped by a dramatic 23 percent, and research shows that prevention efforts like more and better screenings and public education around risk factors like smoking can take credit for much of that progress.
“We should be doubling down on prevention,” says Alfred Neugut, Myron M. Studner Professor of Cancer Research and professor of Epidemiology. Yet for cancer, like most diseases, the bulk of federal research dollars are directed elsewhere. “Most funding goes into either basic science or into clinical therapeutics.”
Less than 7 percent of the National Cancer Institute’s $4.9 billion budget for 2014 went to cancer prevention and control. Part of the problem is that successes in preventing cancer can take decades to see.
“Come 2040, there will be a major decline in cancer mortality thanks to smoking cessation and other public health efforts. That will be spectacular—we just haven’t seen it yet,” says Neugut. “In heart disease you can see the effects of prevention faster: hypertension control, lipid control, and smoking cessation all have an effect within a couple of years. But in cancer, it can take 20, 30, 40 years to see the effects.”
Take Your Protein Pills and Put Your Helmet On
Cancer risk is determined by a combination of genetics and environment, according to Regina Santella, professor of Environmental Health Sciences and vice dean of Faculty Affairs and Research. Mailman faculty are active in both arenas. A study of newborns by Frederica Perera at the Columbia Center for Children’s Environmental Health, for example, uncovered genetic changes from air pollution known to stack the deck for cancer. And in an ongoing project, Mary Beth Terry, professor of Epidemiology, and Santella are looking at ways to improve existing models for cancer risk, such as the Gail model, which attempts to predict a woman’s risk for breast cancer through a questionnaire that assesses risk factors, such as age and reproductive history. As it stands, says Santella, the approach, is only slightly better than flipping a coin. “By adding genetic and epigenetic factors, we can try to improve the model,” she says.
When it comes to targeted prevention or treatment around cancer, public health also plays an important role by advocating for equity. Across racial and ethnic groups, there are widening disparities in survival rates for the most treatable cancers, and as the emphasis on precision medicine grows, so does the conversation around its ethics. Genetic studies allow for more personalized care and treatment, but only for those who can afford it.
“You have some people getting fancy gene sequencing and expensive treatments,” says Santella. “Others can’t afford screenings like mammograms, let alone cancer treatments that can cost hundreds of thousands of dollars.”
As Americans join with Vice President Biden to undertake a giant leap toward cancer eradication, count on public health to bring “the right stuff.”