Hi. This is Dr. Kathy Miller from Indiana University in Indianapolis, Indiana. Medscape editors recently asked the regular oncology bloggers to consider a very simple question: If we had the power to do it, which single "calcified" feature of the oncology culture would we change? In other words, which change would lead to the biggest improvement in outcomes?
I have a very simple answer. We need to forget about treatment and focus on prevention.
My reason for saying this is simple. Every patient who does not develop cancer, who does not come to my clinic for treatment, is a patient who will not die from cancer. No matter how effective or how targeted our treatments become, it is unlikely that they will be 100% effective for everyone, and they will have costs and toxicities that will continue to be a problem.
Prevention may seem like a tough task. But we already know how to prevent at least half of the malignancies we see in a general adult oncology clinic. We need to eliminate tobacco, both inhaled and chewing tobacco. We need to get our patients off their butts and get them moving, and get them to return to healthier diets that include real food and less processed foods with excess fats, sugars, and all the additives.
We need to get our patients to avail themselves of screening procedures, particularly those that can be used for prevention. I am talking about mammography and colonoscopy. Colonoscopy can identify early malignancies, but it also prevents them by identifying and removing the polyps that give rise to malignancies.
We need to increase the use of vaccination for hepatitis B worldwide, as this is the leading cause of hepatocellular carcinoma, and of vaccines for human papillomavirus, a major cause of cervical cancer for us in the United States and those in the developing world.
We need to encourage our primary care colleagues to assume that preventing cancer is a major role for them. The cardiologists are light-years ahead of us as a community in this regard.
Cardiologists have made preventive cardiology -- treating hypertension, treating hypercholesterolemia, managing diabetes -- the bread and butter of the general internal medicine family practice setting. We have treated preventive oncology as if it were something special -- as if it required a referral to a specialized clinic to even consider using tamoxifen or raloxifene in a high-risk postmenopausal woman, or genetic testing for a woman at high risk of developing breast or ovarian cancer. We have separate clinics for smoking cessation, as it if takes that special expertise.
When you make me "Queen for a Day" or when the Medscape Oncology editors give us a chance, I propose that our focus needs to be on prevention rather than treatment.
For those who believe we are already focused on prevention, let me challenge you on that. Consider the amount of money the National Cancer Institute spends on prevention vs treatment. ASCO, the annual meeting of the American Society of Clinical Oncology, is coming up. Take a gander at the oral sessions on cancer prevention. Check out the empty seats, and then think again whether we have really given prevention the focus it deserves.