Health Wanted: Cancer

The Episode 

The Topic: How is our nation doing in the fight against cancer? News reports suggest the United States is riddled with cancer, and that people are receiving diagnoses at younger ages. What is the reality?

This week on Health Wanted, host Laurel Bristow and Otis Brawley, MD, practicing physician and professor of oncology at Johns Hopkins School of Medicine, provide context for cancer statistics, discuss the importance of cancer screening strategies, and dive into the ways health inequities are impacting cancer rates. 
 

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The Takeaways:

• Our cancer mortality rates are improving. The 5 year survival rate (so the likelihood someone with cancer will be alive 5 years from their diagnosis compared to someone without cancer) has increased from 49% for diagnoses during the mid 1970s, to 69% for diagnoses made between 2014 and 2020.
• The improvements are driven by better diagnostics, screening, and imaging, which can detect cancer at earlier stages when it’s easier to treat, as well as improved therapies. It’s also been significantly impacted by reduction in smoking (though smoking remains the No.1 cause of preventable death.)
• The cancer burden is still high. In 2025 there’s expected to be over 2 million new cancer diagnoses in the U.S. and over 600,000 deaths a year - an average of about 1,700 deaths a day.
• Causes of cancer vary, and in some cases are still unknown. Genetic factors predispose people to certain cancers. Researchers are investigating the role things like microplastics, ultraprocessed foods, environmental exposrues, lifestyle factors (drinking, sedentary lifestyle), and more may have on cancer development.
• There has been a rise in cancer incidences in people under 50, but cancer largely remains a disease of aging. 
  Cancer screening is an important tool for preventing advanced cancer. The HPV vaccine is incredibly effective.
• Racial disparities can impact cancer detection and survival rates. The (now illegal) practice of redlining has been found to be associated with a later cancer diagnosis, lower likelihood of receiving recommended treatment, and higher likelihood of dying.
• Women who live in residential areas that were previously “redlined” are more likely to die within 5 years of a breast cancer diagnosis compared to women who do not live in a redlined area.
• Black people are less likely to have early detection of any cancer that has screening recommendations (like breast, cervix or lung cancer). Cancer death rates are highest in the South and Appalachian regions of the U.S.

The Interview

The guest: Otis Brawley, MD

The Key Takeaways: 

• The death rate in the United States from all cancers combined has gone down by 34% from 1991 to 2022. The risk of the average America dying from cancer today is two thirds of what it was for the average American in 1991.
• Obesity may be linked to cancer rates. Fifteen percent of Americans were obese in 1970. Today it's well over 40%. The second leading cause of cancer in the entire population is energy imbalance.
• The best way to cure cancer is to find it and treat it early. Cancer is asymptomatic by definition, so people who are feeling healthy still need to get screened.

The Listener Questions

Is the COVID shot no longer available to everyone?. What’s going on?

There’s a couple of different things that are happening here. What happened first was talk that the ACIP, which is a committee at the CDC who make vaccine recommendations, might suggest that going forward COVID vaccines be actively recommended for certain groups, rather than everyone. It’s not totally clear who that would include, but likely people over 65, pregnant people, and people with certain medical conditions that put them at higher risk of hospitalization or severe outcomes, and young kids who haven’t had COVID exposure before.

These recommendations would put us in line with other countries like Canada, Australia and the UK, who all recommend vaccines for people over 65 but don’t push otherwise healthy adults under 65 to get an annual shot.

Compared to those countries we are also the only country to recommend annual shots for otherwise healthy adults and kids under a certain age.

My questions are if people who fall outside of this group could get annual vaccines if they want, if insurance would pay for those people, and would we still recommend vaccinating children under a certain age (infants have the second highest risk from COVID).

But now, the FDA has announced that they will be limiting access to COVID vaccines to people over 65 and those under 65 with certain health conditions that make them more vulnerable to severe outcomes.

Despite acknowledging that children under 4 have an increased risk of severe outcomes from COVID infections, the new framework does not include vaccinations for infants who have never been exposed to COVID.

Plus,  people who don’t have any of the eligible conditions but want an annual vaccine likely won’t be able to get one. This could be people who live with an immunocompromised person, people who work in healthcare, people who live with elderly adults, or just people who want to lower their own risk of severe outcomes, long COVID or COVID transmission.

The other issue that came in the announcement, is that the FDA wants placebo controlled trials to show benefit if the vaccines are to be allowed in people between 50-64 years old with no medical conditions.

But not just any trials. Trials with extremely high confidence that COVID vaccines reduce symptomatic disease. But these vaccines have been promoted over the last several years as a highly effective tool to reduce severe disease, hospitalization, and death…

The real question is if positive results from these clinical trials (which would cost millions of dollars to conduct)  would increase the proportion of people under 65 who get vaccinated. I don’t know that it would. And I simply do not foresee companies taking on the cost of conducting these studies to be able to provide vaccines to a small portion of the population.

Also, to make this decision, from a regulatory agency, without getting input from actually qualified experts, really shows that this isn’t actually an evidence based decision.

Relatedly, NovaVax was finally granted full approval, but with these same restrictions, before this announcement was made. Now it’s been approved, but only for people 65 and over or people 12 and over with at least one condition that would make them more susceptible to severe illness.

We are putting in hybrid vinyl flooring throughout our home and removing tiles. And when I was having a look at it I was wondering if it is going to result in more microplastics being introduced into my and my families bodies, or if it is really only an issue if it is heated and with food substances? 

Anything that’s made out of plastic, like vinyl or PVC or laminate, is going to produce microplastics. Microplastics are more plentiful when things are heated, but UV exposure from sunlight and just general wear and tear will also create microplastics.

The real question is if this is a significant contributor to your overall risk from microplastics, and I had a hard time finding any solid research about that. I think it’s more important you focus on making sure whatever your flooring is made out of has a lower risk of harmful chemicals. So you want it to be non-toxic, low VOC (volatile organic compound), phthalate-free etc to reduce the risk of exposure to those chemicals either directly or via any microplastics that might be produced.