Public Health Experts Say Cancer Moonshot Ignores Prevention

By focusing on a cure for cancer, the $1 billion "Cancer Moonshot" initiative announced earlier this year by President Obama is ignoring the impact that has already been made on cancer mortality and incidence from public health and prevention initiatives, including screening, say public health experts.

"Developing cancer cures is essential, but controlling cancer is also a policy and public health challenge. We must operate on both fronts," they add.

The comments come from a letter signed by 70 deans of schools of public health from across the United States, coordinated by the Association of Schools and Programs of Public Health.

The letter was sent today to Vice President Joe Biden, who was given responsibility for the project in February 2016. Last week, Biden appointed Greg Simon, a former pharma executive and recent cancer patient, as executive director of the Cancer Moonshot task force.

In their letter, the public heath deans say that they "strongly support the goals of the Cancer Moonshot initiative, to find cures for cancer and to reduce cancer mortality in the United States."

"We are concerned, however, that the initiative may be undervaluing the vital role that public health and prevention have played — and must continue to play — in reducing cancer incidence and mortality," they continue.

"Since the beginning of the 'War on Cancer,' the most notable cancer successes have been due to the power and efficacy of prevention. The massive reductions in lung, cervical, colorectal, and gastric cancer mortality rates are almost entirely due to a focus on public health and prevention approaches (including screening)," they point out.

The letter urges the politicians to "pay careful attention to the balance between treatment and prevention-related investments."

"The development of new and innovative therapeutic cancer interventions is vital, but history has shown that the greatest impact in reducing cancer mortality rates has come from preventing cancers," they comment.

The comments in the letter echo those reported by Medscape Medical News when the news of the Cancer Moonshot initiative first broke, in January 2016. In an interview at that time, Robin T. Zon, MD, a practicing oncologist at Michiana Hematology–Oncology PC in South Bend, Indiana, said the commitment to increase funding of cancer research is laudable, but added: "there is a lot that we can already be doing with what we know." Rather than aiming to "cure" cancer, she suggested that more realistic aims are reducing the incidence of cancer — by public health measures to reduce smoking and obesity — and controlling cancer by improving use of the treatments that are already available — by acting on clinical information collected in big data initiatives such as CancerLinQ, in which her practice is participating.

Two-thirds of cancers are due to lifestyle — smoking, obesity, alcohol, etc. — so putting money into public health initiatives would give a "bigger bang for your buck," Dr Zon told Medscape Medical News.

Otis Brawley, MD, chief medical officer at the American Cancer Society, also emphasized prevention in his reaction to the news. "Just as important as continuing to explore new science is a concerted effort to gather what we already know about cancer and find ways to apply these tools more effectively to save lives," he said in a statement.

"If we applied what we already know about cancer prevention, early detection, and treatment, we could prevent a substantial proportion of the nearly 600,000 cancer deaths in the US each year. These remarkable tools mean nothing if they sit unused, unavailable to those in need because of gaps in care caused by poverty and other factors."

The American Institute for Cancer Research (AICR) also highlighted prevention, pointing out that "AICR research has shown that we can prevent nearly one-third of the cancers that occur every year in the US if Americans made healthier choices, including moving more and eating smart." In addition, if smoking stopped, approximately half the cancers in the United States would be prevented.

It is not just cancer that would be reduced — such lifestyle changes would also reduce the risk for heart disease, diabetes, and other chronic diseases, the AICR pointed out.

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