World Cancer Day

Yesterday was World Cancer Day, a day to “fight against the disease through raising awareness, educating the public, and lobbying for change.” One of the more-quoted facts I saw during the day is that cancer kills more people than HIV/AIDS, malaria and TB combined. That blew me away. I think of cancer as a disease of the developed world, perhaps even a modern development. (I find it important that I clarify here that I have nearly no medical background – I’m learning all of this as I go along). A closer examination of the statement, though, reveals that there are, indeed, (at least) two worlds when it comes to this disease.

I’m at a place in my own understanding where the global division in access is essentially “the United States” and “sub-Saharan Africa.”  Obviously there’s more to it and that, and part of what I hope to explore in writing this blog.  It is a convenient way, however, for me to think  about the comparisons above.

Worldwide, yes – cancer kills more people than anything but heart disease, in both developing and developed nations.  In sub-Saharan Africa, however, cancer ranks as the seventh most-common cause of death.  Heart disease is slightly more common, but death from HIV/AIDS or malaria is five times more likely than death from cancer.  [Data on pages 1 & 37 of American Cancer Society’s fabulous report]

The bottom line, though, is that cancer means something different depending on where you’re from, both in terms of prognosis:

Courtesy World Cancer Day - Union for International Cancer Control

…and prevention.

As the above chart indicates, the prognosis isn’t good, particularly in developing nations.  Certainly some cancers are meaner than others, but with rare exception, someone in the developed world is much more likely than their counterpart in the Global South to survive the fight. With medical infrastructures already overburdened and under-supported, cancer is not often a priority in developing nations. Given high costs and low capacity for care, treatment is not always an option; without hope for treatment, diagnosis is delayed.

One interesting initiative is the Pink Ribbon Red Ribbon Partnership, led by the George W. Bush Institute and the newly controversial Susan G. Komen for the Cure, among others.  The Partnership will target cancers of the cervix and breast in sub-Saharan Africa – the top two cancer killers of women in that region – through “disease education, screening and treatment efforts as well as increased access to cervical cancer vaccination.” The hallmark of this program is that it will be an overlay of already existing HIV/AIDS programs, leveraging tools already created, networks already formed, and knowledge already gained to reach women with already-compromised health and to tackle diseases now rivaling maternal mortality.

Partners in Health, meanwhile, is working to build capacity for treating cancer by “twinning” local generalists with (in this case, pediatric) oncologists based in the United States. A study of  generalist practitioners working with children with cancer in Rwanda showed success in identifying and treating complicated cases

World Health Organization tells us this about decreasing the burden of cancer:

Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. Cancer can be reduced and controlled by implementing evidence-based strategies for cancer prevention, early detection of cancer and management of patients with cancer. Many cancers have a high chance of cure if detected early and treated adequately.

And the Annals of Oncology gives a different angle on the same information: “Changing lifestyles, chronic infection and increasing life spans lie at the root of the global growth in cancer. ” So from the perspective of prevention, the trends aren’t good either. This interview with Dr. David Agus on the Daily Show with Jon Stewart, I thought, captured some of the challenges ahead. Stewart says, “We’ve become a country that treats disease, but does not prevent it.”  He also asks, “Why do we have such a hard time allowing science to overcome our irrationality?” What cultural challenges will we see as the fight against cancer spreads into developing nations?

I find myself approaching the topic from a generally academic point of view, but it doesn’t hurt to take a minute to think of my own role in prevention and detection, for myself.  I’ve been working on eating more veggies and being more active, just because that’s what you’re supposed to do.  Preventing cancer seems like an extra great reason to focus on self-care, though it doesn’t really offer us instant gratification or even a finish line.  I think we like to have these things. I know I do. I’m trying to figure out my own strategies for success.

Finally, a few things I’ve considered as I write this have been more about one’s personal experience, and are themes I would like to explore more.  First, pain management is rarely part of a treatment regimen in developing nations. How much does that impact a patient’s quality of life, as well as the outlooks of patients and caretakers? I’m betting a lot! I also want to explore the meaning that these statistics all hold in our lives. My experience in my own context tells me that the odds don’t mean much when it’s happening to you or someone you love. I do wonder, though, how statistics invade lives when the odds are more damning.

Same time next year?

Great Expectations

“Andrew Jackson had a pretty clear-cut idea about America’s enemies: kill them.”

I’m always surprised that war is a free rein to kill, and saddened that murder is an acceptable recourse for murder. I was also unsettled by the nearly universal glee that followed the death of Osama bin Laden.  Beliefs about war and justice run long and deep, and are as personal as they are historical, but the fact that death as a political action can be discussed calmly, publicly, and proudly  is worth some pause.

Meanwhile, there’s this:

Image

The reaction to this incident was both emotional and tactical.  Certainly there are taboos against the desecration of bodies – I once had a professor who said the only universal across cultures is the care that is taken with corpses.  The same issues of justice and war and, in this case, those of race and religion and otherness, are present here. Political responses condemn the incident as reprehensible, surely on an emotional level, but also one concerned for the ripples it may cause worldwide – its affect on sentiment, bargaining power, and violence. How odd, indeed, that the killing was not the problem, so much as what happened after.

In wartime, is the idea of life worth more than the lives themselves?

Finding My Way

I was excited to read last week that India has passed one year with no presence of polio. I take it for granted, frankly, that other parts of the world continue to suffer the slings and arrows of ailments that are merely, to my culture and context, passing fancies.  My only association with polio, which I now learn is a dubious one, is Franklin Delano Roosevelt. A friend who served in the Peace Corps married the man who journeyed into the city to fetch her medication for malaria. My great-grandmother died of tuberculosis in the ‘30s, and I’m warned that prairie dogs carry the plague. I am fortunate to live in a time and place and slice of society where these illnesses in particular, and this kind of suffering in general, are more abstract notions.

A quick search, however, revealed that eradication is not simple….of course.  I have so much to learn about disease eradication, and epidemiology, and, really, the entire science of medicine. It’s hard to know what to say, and I’m starting by noticing connections and contradictions. This quote, however, struck me as a bit of what I’m after:

“From the first, Roosevelt seemed to understand that rehabilitation of the polio patient was a social problem with medical aspects. It was not a medical problem with social aspects.”

-Hugh G. Gallagher, 1998

I have a hunch that these medical and social problems will fall into a predictable spectrum and sequence. Let’s find out.

An Introduction

I have seen a significant proportion of my loved ones saved by medical science – some in the truest mortal sense of the word, and others in ways that have allowed them to continue their lives with minimal interruption, to continue their pursuit of happiness unfettered.  On much rarer occasions, I’ve seen the anguish of those who were unable to be saved, and the ones who survived them.  Seeing the phenomenal impact that reliable access to quality health care has made in my communities, and considering that such a thing is but a dream in many others, made me wonder about what other impacts such access has had in my life.   Is “life expectancy” more than just a number, but a way of life?I suspect that the way I live my life is deeply influenced by my expectation that it will be long and I will be healthy.  I anticipate that my relationships will generally end if I say they will and not before, and that the flow of my day-to-day life will not be interrupted by disappearances. Any illness I experience, even a serious one, will likely be a blip, and not a sentence, and thus my goals are perhaps loftier.  I have had the luxury of being a late bloomer.

The flip side is that I am living with the illusion of control.  I feel I can and must steer the course of my own life, which is a pressure perhaps new and unique in history.  Some of the impacts of that pressure are positive – in fact, it is basis of the American Way.  On the other hand, it is grossly deceptive, and we are perhaps unprepared when the inevitable does in fact befall us.

Questions of what is asked of or available to us add up to a dangerous possibility: that perhaps some human lives are worth more than others.  This horrifying notion encompasses not simply the grand injustice of child mortality or the fatal persistence of malaria in some regions – a disease eradicated in the US halfway through the twentieth century.  Some health crises aren’t coincidental, but rather systemic.  Some aren’t intentional, but allowed to continue through neglect.  Such experiences are deeply personal, but also affect families, communities, and societies.  Anywhere that resources are limited, from individuals to international aid groups, priorities must be determined.  How do we determine those priorities?  What is important?  What is even visible? The answers aren’t always pretty, or even palatable.

Why admit such disturbing notions without providing some solutions, some hope?  That goal, too, has birthed more questions, questions about human nature and the path of least resistance and what inspires us to act differently.

The questions wrap around each other, and some disguise themselves as answers.  I’d like to use this blog to explore things as they are, things as they should be, and how to get from here to there.  I’m scared to explore this on my own, and I hope you will help me in this – please clarify, and add, and challenge.  Maybe together we can get somewhere.