It's not customary to wish one another Happy Breast Cancer Awareness Month every October, but maybe it should be. It's our collective squeamishness (read: denial) about the Big C that keeps us so strangely passive and uninvolved.
That's understandable; we don't have a lot of control over who gets cancer or how long it will take to find its cure. As for how we diagnose and treat it, a process largely subsidized by American health insurance, in my view that's where the spotlight of awareness should shine brightest.
I recently had a lengthy phone conversation with Dr. Otis Brawley, chief medical officer and executive vice president of the American Cancer Society. His candor was both alarming and strangely reassuring. If leaders like Dr. Brawley have the guts to say the system's broken, that's a start.
Consider this snapshot of our health care system from the good doctor:
- We spend 17.3 percent of our gross domestic product on health care. By 2025, it will be 25 percent if current rates hold. The next closest country is Israel at about 12 percent.
- In 2009, we spent almost twice as much ($2.53 trillion) on health care as on food ($1.3 trillion).
- Our per-capital costs for health insurance and health care are twice as much as the runner-up, which depending on the year is either Switzerland or Norway.
- We have three times as many CT scanners per million population and five times as many MRI machines per million as Canada.
"And what most people don't realize is, our outcomes aren't any better!" Dr. Brawley says. "It's a fair statement that while people don't live longer in the United States, we are much better at taking pictures of them while they're dying."
Don't get this oncology expert started on the cost of cancer drugs like Provenge for prostate cancer ($92,000), Avastin for colon cancer ($85,000 a year) and Yervoy for melanoma ($8,000 to $9,000 a month). He considers it outrageous if not obscene.
Dr. Brawley further blames the pharmaceutical industry for intentionally developing drugs designed to keep patients on them chronically. "Many of the women who were on Avastin for breast cancer before it lost its FDA approval were on it for an average of two to two-and-a-half years," he says. You saw the price, right?
And about those recent drug shortages? Just a convenient way to pull strong sellers off the market for an FDA-mandated period in order to restock them at a higher price, says Dr. Brawley.
Those with bulletproof health insurance may get these drugs; those without often don't. But the problem runs deeper than that, to the costly over-screening that's been in the headlines lately. Dr. Brawley applauds the recent recommendation that the widely-used PSA test for prostate cancer be discontinued. He's equally opposed to HPV testing on preteens and unrestricted BRCA gene testing for breast cancer, which could lead women to unwise decisions without proper counseling.
What puts Americans most at risk for cancer today?
"The biggest cause of cancer in the United States in 2020 is not going to be tobacco, it's going to be obesity," says Dr. Brawley. "About a third of all cancers are caused by tobacco today and close to 30 percent are caused by obesity today, and obesity is on the upswing."
This month, let's honor those we've lost and those we love by focusing on improving our health insurance and health care systems to make treatment more affordable, more available and more effective.
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