An Ounce (or a Billion Dollars Worth) of Prevention: the on-going "early cancer detection" controversy
Consider a ghoulish and seemingly ridiculous hypothetical: You have been diagnosed with metastasized pancreatic cancer, and your doctor gives you a choice. You can select to be treated by a state-of-the-art chemotherapy drug, which costs about a billion dollars to develop. Or you can direct the National Institutes of Health to put a billion dollars into the research for early detection of your cancer. The former choice could increase your survival time over the average pancreatic cancer patient by 2 weeks; the latter choice, to invest in early-detection research, could benefit future generations.
The matter of early cancer detection is in the news again with the announcement yesterday of the first convincing evidence that using CT scans to screen heavy smokers could reduce their risk of lung cancer death. The study was not without its skeptics.
CT scans expose patients to radiation, and they result in unnecessary surgical procedures (to extract tumors that would never have harmed the patient). Also, CT scans are expensive, costing anywhere from $600 to $3,000. But here are some costs that are not often included in the debate over the merits of screening: First, just as in the hypothetical above, it takes a billion dollars on average to develop a new cancer drug. And many drugs in development are intended for use to only modestly extend the survival time of patients with little time. For example, when used for pancreatic cancer patients, the drug Tarceva shows a median survival increase of 14.7 days. The details in the hypothetical are beginning to look less ridiculous.
But the real kicker is that the success rate for new drug trials is only 1 out of 10. For every 1 drug that the FDA approves for market, 9 fail the monumentally expensive drug-approval process. And yet, the vast majority of cancer research money is spent not on early-detection, but rather on the development of new treatments—often on drugs for patients whose cancers have already metastasized. This is despite the fact that such treatments have barely affected the incidence of death rates among the common forms of cancer death—including both lung and pancreatic cancers--since the War on Cancer was declared in 1971.
Research for new screening methods has long been the poorer cousins of the cancer field. Perhaps with the promising results of the new study, NIH will shift its paradigm from spending the lion’s share of its funds on the development of drugs for dying patients to investing more of its money on early-detection methods.
As for the above hypothetical, many of us would choose an extra 14 days, but not for entirely selfish reasons—we might wish to buy more time for our children, for example. But that’s precisely why we have a government agency overseeing how our tax dollars are spent on cancer research: to make important decisions for the good of society, not for individuals in an unimaginable crisis. Current screening methods are so few that we can use them to cut cancer deaths only among breast, colon and cervical cancers. The only rational choice to make for all of us is to fund research on new and reliable screening methods for other common forms of cancer, such as pancreatic, ovarian and prostate cancers.