|Interview with Dr. Brenda Edwards, NCI|
Schmalfeldt: I'm chatting with Dr. Brenda Edwards, Associate Director of the Surveillance Research Program, Division of Cancer Control and Population Sciences at the National Cancer Institute. Thank you for joining us on NIH Research Radio today.
Edwards: Thank you.
Schmalfeldt: Well, there's been a lot of good news lately about cancer research and treatment - decline in the overall number of cancer deaths. That's a recent report from the American Cancer Society. Second straight year.
Edwards: That's correct.
Schmalfeldt: Is this because we're getting better at treating cancer, diagnosing it, or is this a combination thereof?
Edwards: Many factors, because as you know cancer is many diseases. So we really have to look at almost every type of cancer to give an answer as to what's happening. So, bottom line is total number of cancers for the second straight year declined. That actually is a report from 2004.
Schmalfeldt: What can we, as laypeople, do to continue this very happy trend?
Edwards: Well, as I said, cancer is many diseases so we need to look at each one. First and foremost, the leading cause of cancer deaths in men and women is lung cancer. Tobacco use, historically, has been the leading risk factor that's impacted the occurrence of cancer. So men, when we saw a peak in the mid-60s through the Surgeon General's report, we've had a long term effort to get men to quit smoking as well as women. So that turned around in the early 90s - that is, lung cancer deaths in men. So, with that decline we started seeing about 1990-91 an overall decline in the rate at which cancer was occurring. So that was actually our measure of progress. But in terms of total numbers, it's taken awhile before we've seen the actual numbers come down.
Schmalfeldt: Is it in some cancer we're doing better than in others?
Edwards: Yes. I mean there are some cancers for which we really don't know that much about what causes them, what we can do to find them early or even, in some cases, how to treat them. The top four typically are, in addition to lung, colorectal cancer which is, again, the second leading cause of cancer death in men and women. And for that one, we've actually started seeing a decline in the overall rates for women, even before we started reporting them routinely. For men, we saw a turnaround in the 80s. What's happening there? Many things. Diet, physical activity, the way we prepare food, early detection - a lot of screening has been going on although its uptake is not widespread. Screening with colonoscopy, actually finding polyps, removing them. So in a sense it's kind of preventing them as well as early detection. For others like breast cancer, we probably know about half of the risk factors, but not all of them. We started seeing a decline in breast cancer for women - the leading cancer diagnosed in women. So we saw that again in the early 90s. There, it's a whole range of things - hormone use, reproductive factors. Prostate cancer's a little more challenging. We're not fully sure what's going on there, but that's the leading cause of cancer diagnosed in men, but not necessarily in terms of dying from cancer. So it depends and I could go on. There's some others for which we don't have a good way of finding them. Pancreatic cancer actually causes quite a number of deaths. We don't exactly know how to find it early or how to treat it, so we still have a ways to go on some cancers.
Schmalfeldt: Usually, with pancreatic cancer, by the time symptoms show up it's already too late.
Edwards: That's right. So, for cancer we're looking at lifestyles, the risk factors, can you modify those, change some - smoking, diet, physical activity. For others it's early detection. Again, for breast cancer we have screening that's there. Cervical cancer, we have screening also there.
Schmalfeldt: One area in which we seem to be lagging in the good news we're talking about today is in cancer deaths among African Americans. In fact, that rate has increased. What are some of the reasons for that?
Edwards: It's complicated. First of all just their rate of getting cancer has been higher for many of the cancers - many of the leading ones. Higher smoking rates for the lung cancer factors for men, not necessarily for women. Breast cancer - you're going to have to take a look at both pre- and post-menopausal. In fact, we have more white women diagnosed with breast cancer than African Americans. Once diagnosed, advanced disease, issues of treatment, a whole range of things. And other situations, we don't really know. Prostate cancer - much more common in African American men than in other men. Their death rate is substantially higher. So, again, you really have to go back and look at each of the cancers affecting the population. But it covers a wide range of higher rates, higher risk factors, some access questions, access relating to screening, early detection and treatment.
Schmalfeldt: Right. That's one area I wanted to touch on. In the African American population. The access issues. The barriers to getting health care. How do we overcome that?
Edwards: Again, that's a challenge. One, education and information. There's some information from our health surveys that would suggest that in the African American population they've seen a lot of their family and friends get the cancer, die of it. There's actually a concern that cancer is highly fatal, so there's sort of this fatalistic view.
Schmalfeldt: If I don't go to the doctor, he won't tell me I have cancer.
Edwards: Partially that, or "I don't want to know because there's nothing you can do about it." That's actually contrary because for many of the cancers there are things you can do to find it early and it is highly treatable. So, it is complicated. It is the access question and lifestyle. African Americans on average have much higher obesity rates. So, the diet issue. Also, the people that they trust with regard to delivering information. So outreach has occurred in a number of ways, including the churches, barber shops. You have to have people that are believable and you actually have more people engaged in delivering a message that there's something you actually can do about it. But again, the access, insurance, cost of care - that's still an important factor.
Schmalfeldt: So, education is vital in reducing the rates of cancer deaths among the entire spectrum of the population?
Schmalfeldt: What is NCI doing to educate the public about these risks, the treatment, and ways of avoiding this disease altogether?
Edwards: Well, we have an Office of Cancer Communication. They're very much engaged in the education effort. Actually, I come from the Division of Cancer Control and Population Sciences. One of our whole areas of research is "how do you intervene in the community? How do you change behavior? How do you deliver the message? How do you tailor it? How do you make it, if you will, locally relevant?" So we actually are engaged in a number of activities that are looking at "how do you deliver that message"?
Schmalfeldt: Excellent. Our guest on NIH Research Radio, Dr. Brenda Edwards, Associate Director of the Surveillance Research Program, Division of Cancer Control and Population Sciences at the National Cancer Institute. Keep up the good work and hopefully we'll have more good news next year.
Edwards: Looking forward to it.