How can public health help prevent cancer? Episode 13 of "That's Public Health"

Summary

Deboki Chakravarti, a science educator, discusses the role of public health in cancer prevention and treatment. The U.S. has spent over $100 billion on cancer research since 1971, yet cancer remains a leading cause of death. Public health focuses on primary prevention, such as HPV vaccinations and smoking cessation, and secondary prevention through early screenings. Despite these efforts, underserved populations face barriers to access. The video advocates for shifting more resources to prevention, emphasizing that stopping cancer before it starts is the most effective way to reduce deaths.

Takeaways

• 🧑‍🏫 The United States declared the 'war on cancer' in 1971, investing over $100 billion in research, but significant progress in finding cures has been limited.
• 💵 Despite the investment, cancer remains a leading cause of death in the U.S., with high death rates for breast, skin, and other cancers.
• 🛡️ Primary prevention, which includes efforts like vaccination and environmental changes, is key in reducing cancer risk before it develops.
• 💉 HPV vaccination can reduce cervical cancer cases by nearly 90%, making it an essential public health intervention.
• 🚭 Tobacco use contributes to 30% of cancer deaths, and tobacco control policies like smoking bans have significantly reduced lung cancer deaths.
• 🔍 Secondary prevention focuses on early detection of cancer through screenings, which can improve treatment outcomes and save lives.
• 🏥 Barriers like lack of insurance disproportionately affect people of color, making it harder for them to access early cancer screenings and increasing late-stage cancer diagnoses.
• 💊 Tertiary prevention involves treating cancer with surgery, radiation, and chemotherapy to prevent further damage and improve patient outcomes.
• 💸 In 2020, the U.S. spent over $200 billion on cancer treatment, which is double the amount spent on primary prevention for all diseases.
• 📈 Public health experts advocate for shifting more government spending towards primary and secondary prevention to reduce cancer rates and improve early detection for underserved populations.

Q & A

What was the 'war on cancer' launched in 1971?

The 'war on cancer' refers to an initiative launched by the United States in 1971 to find cures for common cancers. Despite spending over $100 billion on research, progress has been limited, and cancer remains a leading cause of death.

Why is primary prevention important in the fight against cancer?

Primary prevention is important because it focuses on stopping cancer before it occurs, such as through vaccinations and environmental changes. Preventive measures can drastically reduce the incidence of cancer, as seen with the HPV vaccine reducing cervical cancer cases by nearly 90%.

How does smoking contribute to cancer rates, and what public health interventions have been made to address this?

Smoking causes around 30% of all cancer deaths and contributes to heart disease. Public health interventions include tobacco control policies, such as workplace smoking bans, which have prevented almost 800,000 deaths from lung cancer between 1975 and 2000.

What are some examples of primary prevention methods for cancer?

Examples of primary prevention include vaccinations, like the HPV vaccine for cervical cancer, and environmental modifications, such as smoking bans to reduce secondhand smoke exposure, which also helps reduce cancer risk.

What is secondary prevention, and why is it crucial in cancer treatment?

Secondary prevention involves early detection of cancer, which can make treatment more effective. Routine screenings, like mammograms and skin checks, help catch cancers at early stages, improving survival rates and reducing cancer-related deaths.

What are some barriers to early cancer screening, especially for underserved populations?

Barriers to early cancer screening include lack of health insurance, high costs, and limited access to affordable healthcare. People of color and those with lower incomes are disproportionately affected, leading to later-stage cancer diagnoses and higher death rates.

How does Medicaid help reduce cancer death rates?

Medicaid provides free or low-cost health insurance, helping more people access cancer screenings and early diagnosis. Expanding Medicaid eligibility can prevent unnecessary cancer deaths by enabling underserved populations to get timely screenings.

What is tertiary prevention, and how does it relate to cancer care?

Tertiary prevention focuses on treating diseases that have already developed, aiming to prevent further damage or death. In cancer care, it includes treatments like surgery, radiation, and chemotherapy to remove or control the disease.

Why does the U.S. spend more on tertiary prevention than on primary prevention?

In 2020, the U.S. spent over $200 billion on cancer treatment, compared to much less on primary prevention. This focus on treatment rather than prevention contributes to higher cancer death rates, especially among underserved populations.

What shift in public health spending do experts advocate for to reduce cancer rates?

Public health experts support shifting government spending towards primary and secondary prevention to focus on preventing diseases or diagnosing them early. This would help lower cancer rates and improve health outcomes for all populations.

Outlines

00:00

🎓 Introduction to Cancer and Public Health

Deboki Chakravarti introduces the topic of cancer and its connection to public health. She provides a brief history, mentioning the 'war on cancer' initiated in 1971 by the U.S., which aimed to find cures for common cancers. Despite significant financial investment in research, limited progress has been made in reducing cancer deaths, and cancer remains a leading cause of death in the U.S. The focus now shifts to public health interventions as the best defense.

🛡️ The Role of Primary Prevention

Primary prevention is emphasized as one of the best ways to address cancer, aiming to stop the disease before it begins. Vaccinations, such as HPV vaccines, have significantly reduced cervical cancer cases by 90%. Primary prevention also involves environmental changes like reducing tobacco use, which is responsible for 30% of cancer deaths. Public health programs have helped people quit smoking, while smoking bans in workplaces reduced secondhand smoke exposure and encouraged smokers to quit.

🚭 Impact of Tobacco Control Policies

Tobacco control policies, like smoking bans implemented in the 1970s, have significantly impacted cancer prevention. By reducing secondhand smoke exposure, these policies helped prevent almost 800,000 lung cancer deaths between 1975 and 2000. Additionally, these measures encouraged recreational smokers to reduce their smoking, leading many to quit altogether, showcasing the long-term benefits of public health interventions in reducing cancer risks.

🔍 Secondary Prevention: Early Detection

When cancer prevention is not possible, secondary prevention, focusing on early detection, becomes critical. Routine screenings, such as mammograms and skin checks, can identify cancers before symptoms appear. However, access to these screenings is often limited by income and insurance disparities, particularly affecting people of color. Public health experts advocate for expanding Medicaid to increase access to affordable screenings, which could reduce deaths from advanced-stage cancers.

⚕️ Tertiary Prevention: Managing Cancer

Tertiary prevention focuses on treating cancer after diagnosis to prevent further damage, typically through surgery, radiation, or chemotherapy. While this aspect of care is primarily in the hands of clinicians, it still falls under public health’s broader mission. The U.S. spends most of its health budget on cancer treatment, with over $200 billion spent in 2020 alone. This focus on treatment rather than prevention highlights the need for a shift in spending towards early interventions.

💡 Shifting Focus to Prevention

Public health workers argue for a reallocation of government resources towards primary and secondary prevention, as this approach could help reduce cancer deaths among underserved populations. By preventing disease or diagnosing it early, public health can make a significant impact on cancer outcomes. Shifting from treatment to early intervention, such as vaccination and screening, would help prevent severe health outcomes and stop people from getting sick in the first place.

🔬 Conclusion: The Role of Public Health in Cancer Prevention

The video concludes by summarizing the roles of primary, secondary, and tertiary prevention in the fight against cancer. Deboki emphasizes the importance of early intervention to shift the focus from treatment to prevention, ultimately reducing cancer incidence and deaths. The video is part of a series by Complexly and the American Public Health Association, aiming to highlight the significant role of public health in disease prevention.

Keywords

💡War on Cancer

The 'War on Cancer' refers to the U.S. initiative launched in 1971 to find cures for common cancers. It symbolizes the nation's large-scale effort, particularly in research funding, to combat cancer. Despite spending over $100 billion, the results have been limited, and cancer remains one of the leading causes of death in the U.S.

💡Primary Prevention

Primary prevention focuses on stopping cancer before it starts by addressing the root causes. This includes strategies such as vaccinations (like HPV vaccines to prevent cervical cancer) and lifestyle modifications, such as anti-smoking policies. In the video, it is highlighted as the most effective way to reduce cancer incidence.

💡HPV Vaccination

The HPV vaccination prevents infection with the human papillomavirus, which can cause cervical cancer. In the video, it’s noted as a primary prevention method that reduces cervical cancer cases by nearly 90%, showcasing its significant impact on cancer prevention.

💡Smoking and Tobacco Control

Smoking causes about 30% of all cancer deaths, with tobacco control policies like smoking bans serving as primary prevention strategies. These efforts have reduced lung cancer deaths by preventing secondhand smoke exposure and encouraging smokers to quit. The video stresses the importance of these policies in reducing cancer risks.

💡Secondary Prevention

Secondary prevention involves early detection of cancer through screenings, such as mammograms and skin checks. Early diagnosis can prevent cancer from progressing to more dangerous stages. In the video, this is shown as a critical approach for reducing cancer deaths, particularly when primary prevention isn’t enough.

💡Screening Barriers

Barriers to screening, such as lack of insurance or low income, prevent timely detection of cancer, particularly among underserved populations. The video emphasizes that people of color often face these barriers, resulting in later-stage diagnoses and higher death rates from cancers like skin cancer.

💡Tertiary Prevention

Tertiary prevention aims to manage and mitigate the effects of cancer after it has developed, using treatments like surgery, chemotherapy, and radiation. The video highlights how this type of care seeks to reduce further damage or death, and it is where most healthcare spending occurs in the U.S.

💡Cancer Treatment Spending

In 2020, over $200 billion was spent on cancer treatment in the U.S., with a focus on tertiary prevention. The video contrasts this with the much lower spending on primary prevention, stressing that this imbalance contributes to higher cancer death rates, especially in underserved populations.

💡Public Health Interventions

Public health interventions refer to strategies employed to prevent disease and improve population health. In the context of cancer, these include promoting vaccinations, smoking cessation programs, and expanding access to screenings. The video discusses how these interventions are crucial for reducing cancer-related deaths.

💡Medicaid Expansion

Medicaid expansion is suggested in the video as a way to increase access to healthcare services, including cancer screenings, for low-income populations. By extending health coverage through Medicaid, public health experts believe more people could benefit from early detection, reducing the disparities in cancer outcomes.

Highlights

In 1971, the United States launched the 'war on cancer,' spending over 100 billion dollars on research with limited progress in finding a cure.

Despite extensive research, cancer remains one of the leading causes of death in the U.S.

Public health interventions are the best defense against cancer deaths until a surefire cure is discovered.

Primary prevention focuses on preventing cancer before it starts, such as through HPV vaccinations that reduce cervical cancer by nearly 90%.

Smoking causes about 30% of all cancer deaths, making smoking cessation programs a crucial public health intervention.

Secondhand smoke increases lung cancer risk by as much as 32%, leading to smoking bans in workplaces starting in the 1970s.

Tobacco control policies, including smoking bans, prevented almost 800,000 lung cancer deaths between 1975 and 2000.

Secondary prevention involves early cancer detection through screenings, which can identify cancers before symptoms appear.

Barriers to cancer screenings, like income and insurance access, disproportionately affect people of color, leading to later-stage cancer diagnoses and higher death rates.

Expanding Medicaid eligibility is advocated by public health experts to increase access to screenings for lower-income individuals.

Tertiary prevention focuses on treating cancer through surgery, radiation, and chemotherapy, aiming to prevent further damage and death.

In 2020, over $200 billion was spent on cancer treatment in the U.S., more than double the amount spent on all primary prevention efforts.

The higher focus on treatment rather than early prevention contributes to increased cancer death rates in underserved populations.

Public health advocates for a shift in spending toward primary and secondary prevention to reduce cancer deaths.

Early interventions through tools like screening and vaccination can shift the focus from treating severe outcomes to preventing cancer in the first place.

Transcripts

Hi, I’m Deboki Chakravarti, I’m a science  educator, and today we’re going to talk about  

cancer and what public health does about it. In  1971, the United States launched an effort to find  

cures for common cancers. We called this “the  war on cancer.” But after spending well over  

100 billion dollars on research, we’ve made only  limited progress on finding a cure, and the number  

of deaths from breast cancer, skin cancer and more  is still high. Overall, cancer remains one of the  

leading causes of death in the U.S. So until  we have a surefire cure or a medical miracle,  

our best line of defense against cancer deaths  are public health interventions. Now, according  

to public health experts, one of the best ways  to address cancer is to prevent it in the first  

place. That’s what we call primary prevention.   Primary prevention could mean vaccinations. Like,  

cervical cancer is usually caused by a sexually  transmitted infection called human papillomavirus,  

or HPV. But HPV vaccination has been shown to cut  down the number of people who get cervical cancer  

by nearly 90%. Primary prevention can also mean  modifying our environment to make it safer and  

healthier. Take smoking, for example. We know that  smoking tobacco causes about 30% of all cancer   

deaths and contributes to other common causes  of death, like heart disease. That’s why public   

health experts have created programs to help  people quit smoking. But non-smokers can still  

be exposed to secondhand smoke, increasing their  odds of developing lung cancer by as much as 32%.   

So starting in the 70s, many workplaces and  businesses banned smoking on their premises, as   

a way to cut down on secondhand smoke exposure and  keep everyone healthy. And as an added benefit,  

recreational smokers who could no longer light up  at work ended up smoking fewer cigarettes per day,  

and many found it easier to quit entirely.   Researchers from the National Institutes of Health  

estimated that between 1975 and 2000, tobacco  control policies like smoking bans prevented  

almost 800,000 deaths from lung cancer. Now, we  can’t always prevent cancer before it happens.  

So the next best thing is to diagnose it early,  aka secondary prevention. Identifying cancer  

in the late stages can make the disease  harder to treat, so timely detection can  

mean the difference between life and an early  death. This is where routine screenings like  

full-body skin checks or mammograms  come in. They can reveal tumors so tiny,  

they haven’t even caused symptoms yet. But there  are barriers to getting screened, like income  

and insurance. People of color are often less  likely to have health insurance and affordable  

access to screenings. So they’re more likely to  be diagnosed with skin cancer at a later stage,  

and more likely to die from various advanced-stage  cancers. That’s why public health experts advocate  

for expanding the number of people eligible for   Medicaid, a government program that provides  

free or low cost health insurance. So more people  with lower incomes will be able to get screened,  

preventing unnecessary deaths. Sometimes, though,  a disease has already taken hold. At that point,  

clinicians try to prevent the condition from  causing further damage, like disability or death.  

We call this tertiary prevention. And although  tertiary prevention is more the work of doctors  

than public health experts, it’s still a part of  public health. For cancer, tertiary prevention can  

include some combination of surgery, radiation  and chemotherapy, to try and remove the disease  

from the body and prevent it from coming back.   Tertiary prevention is also where the U.S. spends  

most of its health budget. In the year 2020 alone,  the government, private insurance and patients  

collectively spent over $200 billion on cancer  treatment. To put that into perspective, the  

federal government spent about half that amount on  primary prevention – not just for cancer, but for  

all diseases and public health problems. And this  focus on treatment rather than early prevention  

is part of what contributes to the higher rates  of cancer deaths among underserved populations.  

Because if you can’t afford to get screened,  you probably can’t afford the best treatment  

either. That’s why public health workers support a  shift in government spending towards primary and   

secondary prevention, so everyone has a better  shot of preventing diseases – or diagnosing   

them early. So primary, secondary and tertiary  prevention are all important in the fight against  

cancer. But when we lean on early intervention –  through tools like screening and vaccination – we  

shift the focus from preventing the worst health  outcomes, to stopping people from getting sick in  

the first place. And that’s how public health can  truly prevent cancer. Thanks for watching! This  

video is part of a series created by Complexly  and the American Public Health Association  

to shed a little light on the important work that  public health does. To learn more, visit APHA.org.