News-Letter

"You have cancer."

Even two decades ago, those words would have been a death sentence, but with improved screening mechanisms and treatment, much has changed today.

Screening can detect cancers of the breast, colon, rectum, cervix, prostate, oral cavity and skin at early stages. For most of these cancers, early detection has been proven to reduce mortality. Cancers that can be prevented or detected earlier by screening account make up about half of all new cancer cases. The five-year survival rate for these cancers is about 86 percent, due to earlier diagnosis.

Despite these advances, the recurrences of cancer in Tony Snow, President Bush's White House press secretary, and Elizabeth Edwards, wife of Democratic presidential candidate John Edwards, demonstrate that all are susceptible to this illness, some even for the second time, despite advances in medical technology and screening mechanisms.

Snow was diagnosed with advanced colon cancer, had his colon removed in 2005 and went through six months of chemotherapy. A week ago, doctors removed a tumor and discovered additional cancer in his liver and other parts of his body.

Elizabeth Edwards' breast cancer has returned to her ribs and other areas after her prior fight with cancer in 2004. Her condition, labeled as "incurable" but "manageable," will probably lead her to face chemotherapy for the remainder of her life as she has Stage IV breast cancer.

However, Edwards has admitted that she will get a high quality of care that many others are not able to obtain, indicating the role that class plays in cancer treatment. Snow will also be assured the best treatment.

According to an American Cancer Society study, five-year survival rates were 10 percent lower for people in poorer U.S. counties that were studied compared to those one grade up.

Cancer is much more treatable when detected early. However, insurance and "means," which includes money, time and education as well as maintaining a long-term relationship with a physician, are key to getting early testing. This excludes many who do not have these resources.

The National Breast Cancer Coalition indicates on its Web site that black women have a higher breast cancer mortality rate at every age, and a lower survival rate than white women. The five-year survival rate for white women diagnosed with invasive breast cancer is 90 percent while the five-year survival rate for black women diagnosed with invasive breast cancer is only 77 percent.

These statistics demonstrate the unfortunate existence of disparities in care across racial and ethnic divides.

Cancer incidence has declined over the past two decades. Rates decreased slightly in men overall, but increased from 1987 to 2003 by 0.3 percent due to an increase in lung cancer rates. Breast cancer rates have stabilized.

According to the National Cancer Institute, there has been an overall decline in cancer death rates for all race and ethnic populations, which was first noticed during the early 1990s.

Declining rates are more pronounced among men (1.6 percent per year from 1993 to 2003) than women (0.8 percent per year from 1992 to 2003). Mortality rates are seen as the best indicators of progress against cancer.

In the NCI's recent "Annual Report to the Nation on the Status of Cancer, 1975 to 2003," the Institute suggests that the stabilization of breast cancer incidence may be related to the rapid discontinuation of hormone replacement therapy, a known risk factor for the cancer.

From 1995 to 2003, mortality rates decreased for 11 of the 15 most common cancers in men and for 10 of the 15 most common cancers for women, according to NCI reports.

Among men, the three leading causes of cancer mortality from 1993 to 2003 continued to be cancers of the lung, prostate and colon/rectum. Among women, cancers of the breast, lung and cancer/rectum take the top three spots responsible for mortality from 1993 to 2003.

Perhaps the most remarkable part of the Edwards and Snow remission situation is the media coverage. Elizabeth Edwards' situation represents a remarkable case of how even Stage IV cancer is not stopping the family from embarking on a run for the presidency in 2008.

While many have criticized John Edwards for this move, it shows an amazing change from the days before Betty Ford's breast cancer came to be public knowledge in the early 1970s when the disease was rarely mentioned in public.

These situations offer hope that even advanced cancers can be managed and that Americans will be able to lead healthy lives for many years post-treatment. At the same time, they also indicate the need to address disparities in the healthcare system which seem to hinder the treatment of cancer for many.

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