News Counterpoint

Money after the fact – Why don’t we work as hard to stop cancer as we do to cure it?

When the announcement was made last month that media mogul Lowry Mays is donating $20 million to Houston’s M.D. Anderson Cancer Center, I felt deeply conflicted. Mays’ gift followed a $30 million grant from his old Clear Channel business partner, Red McCombs. Together, these two San Antonio leaders contributed half of the private monies for M.D. Anderson’s new capital campaign, which will fund the McCombs Institute, a massive outpatient-care and biomedical research facility that will focus on some of the most promising areas of cancer detection and treatment, including molecular markers and proton therapy.

Cancer is a tragic disease, and it’s understandable that many philanthropists are drawn to finding the “cure,” especially since one in three Americans will be diagnosed with cancer or know someone who has it. But it’s still frustrating that the McCombs Institute will focus almost exclusively on detection and treatment, and not on investigating the causes.

The Institute is not alone. Most “prevention” programs for breast cancer — to name one cancer that continues to increase in incidence even as deaths from the disease decline — emphasize regular self-exams, mammograms, and family history — although experts say that genetic factors are implicated in no more than 10-15 percent of breast cancers. Even more curiously, women in first-world countries continue to contract and die from breast cancer at significantly higher rates than those in the third world.

A handful of acknowledged “environmental” factors justify some of the current emphasis on lifestyle issues: Tobacco use is believed to contribute signficantly to at least 30 percent of known cancers; poor diet is implicated in between 20 and 50 percent of cancer cases.

Yet, many unanswered questions lie behind these assertions. Is it the fat itself that causes an increased risk for breast cancer (as well as several other types), or the toxins that tend to collect in fat? In the early ’90s, researchers found elevated levels of DDE, a byproduct of DDT — which still persists in the environment despite a 30-year ban in the U.S. — in the fatty mammary tissue of breast-cancer patients. According to the National Cancer Institute, Americans are exposed to more than 900 chemicals in pesticides, 20 of which have been found to be carcinogenic in animals (and not all of them have been tested). The NCI is funding an ongoing study that has found higher-than-normal cancer rates in agricultural workers that are likely linked to chemical exposure, but the estensive research required to determine whether and under what circumstances a given chemical is carcinogenic are expensive and time-consuming — although another $50 million would be a significant investment.

“My hunch is that general environmental exposures (pollutants in air and water) will be understood to be more important in the future decades,” Aaron Blair, the NCI’s Occupational Epidemiology Branch chief, said in the Institute’s June 2004 newsletter. In the public’s mind, the recent impressive advances in treatment and genetics may herald imminent victory, but until diagnoses and deaths decline, we have not won the battle. As Ronni Chozick, director of education and prevention at San Antonio’s Cancer Therapy and Research Center paraphrases the NCI, “genetics loads the gun and environment pulls the trigger.” For future generations, let’s put as much money put into disarming the trigger as we spend on those who have already been hit.

By Elaine Wolff

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