Last week I attended a fascinating forum presented by The Atlantic magazine entitled “Cancer in the Community — Pittsburgh.” Journalist Steve Clemons, who writes for The Atlantic and moderates these events, has been traveling to regions of the country facing significant challenges related to cancer. Pittsburgh, which makes the top-10 list of America’s most polluted cities in regards to air pollution from both legacy and contemporary sources, is a place with serious cancer issues. You may be aware that the risk of developing cancer from breathing the polluted air in Allegheny County is twice — and in some parts of the county, 20 times — that of surrounding counties and significantly higher than the state and national averages for cancer risk from hazardous air pollution. Compared to all counties in the United States, Allegheny County ranks in the top 2% for cancer risk from air pollution mostly emanating from industrial point sources and mobile (especially diesel) sources.
Those who participated in the forum — physicians, nurses, therapists, cancer scientists, drug researchers, data miners, patient advocates, cancer survivors — all shared a similar sense of frustration regarding rising cancer rates at a time when so much is publicly known about cancer prevention. For example, while smoking rates have declined nationally over the last couple of decades — especially in the youth population — there are still too many people who smoke. Radon is another common cancer risk factor in this part of the country made worse from fracking operations that have exploded over the last decade in this region. Yet relatively inexpensive radon mitigation systems for homes and buildings are underused. Common cervical cancers, and less common though rising oral and throat cancers, are easily prevented with a two-shot series (three shots for those 15 and older) of human papillomavirus (HPV) vaccine. Despite reassurances of safety and efficacy from multiple peer-reviewed studies, way too many parents still refuse to protect their children from the scourge of cancer by using this immunization strategy that modern medicine has devised. The obesity epidemic continues apace in the U.S. and adds to aggregate cancer risks (as well as risks for heart disease and chronic diseases) in spite of voluminous information on how proper nutrition, physical activity, and sleep hygiene are required in order to reach and maintain a healthy body weight. Changing human behavior, it was concluded, is easier said than done, even with everything science tells us.
A case in point: We all know that smoking during pregnancy is a no-no, putting both the mother and baby at risk for a variety of dangerous health impacts, including miscarriage, prematurity, low birth weight, asthma, and SIDS. But a recent study from the CDC’s National Center for Health Statistics found that 7.2% (1 in 14) of pregnant women in the U.S. smoked during pregnancy in 2016. By location, 19 states and the District of Columbia came in below the national average (California had the lowest rate of 1.6%) and 31 states were above. West Virginia topped the list with 25% smoking during pregnancy. Pennsylvania was also above average at 11.5% (1 in 9). Jacqueline Howard notices important disparities with respect to age, race, and educational attainment:
The researchers also found that prevalence of smoking during pregnancy varied by age and race. The prevalence was highest among women 20 to 24 at 10.7%, followed by women 15 to 19 at 8.5% and 25 to 29 at 8.2%.
The prevalence also was highest among non-Hispanic American Indian or Alaska Native women at 16.7%, followed by non-Hispanic white women at 10.5%, non-Hispanic black women at 6%, Hispanic women at 1.8% and non-Hispanic Asian women at 0.6%.
“Non-Hispanic white women were almost twice as likely to smoke during pregnancy as non-Hispanic black women and about six times as likely as Hispanic women,” Drake said.
The prevalence of smoking also varied by education. Women with a high school diploma or GED had the highest prevalence at 12.2%, and the prevalence decreased with increasing education, dropping to 7.9% among those with some college or an associate’s degree.
Among those with less than a high school diploma, the prevalence was 11.7%.
Advances in cancer therapies have been proceeding at a dizzying pace in recent years. Breakthroughs in understanding cancer at a molecular level, the role genetics plays, and the brand new field of precision medicine — using the body’s own immune system via immunotherapy, for example, to fight cancer — have been met with recognizing risk factors and suggesting lifestyle strategies to at least diminish those risks.
There are some risk factors for cancer that each of us can diminish using strategies like avoiding tobacco, eating healthier, exercising more, lowering stress, getting immunized with HPV vaccine, and so forth. Other causes of cancer depend on our own unique genetic makeup, the presence of other medical conditions, and exogenous environmental factors like pollution — things we currently have less control over. But things are changing fast. Advances in early detection of cancer and new therapies, albeit expensive, have been remarkable and should continue to amaze. So, too, has been our understanding of prevention strategies, which are relatively cheap to implement.
A pediatrician will tell you that cancer prevention begins during pregnancy and continues onward through the years of childhood’s rapid growth and development and on into adulthood. As a cancer survivor myself, I can say with confidence that even though screening and treatments have greatly improved — and, thankfully, my treatment was successful — I could have done without the whole thing to begin with.