
Cancer in America Is Way Down, for the Wealthy Anyway - sndean
https://www.bloomberg.com/news/articles/2019-01-08/cancer-in-america-is-way-down-for-the-wealthy-anyway
======
wppick
I am currently reading the book "The Hundred-Year Lie: How to Protect Yourself
from the Chemicals That Are Destroying Your Life" by Randall Fitzgerald. It
details the crazy amount of synthetic or toxic chemicals in our daily lives,
pesticides on our food, and a list of other pollutants to the body. Just from
reading that this article it doesn't surprise me, and I would be surprised if
this trend doesn't continue and accelerate. The poorest Americans are deceived
into a false sense of wealth by being able to purchase cheap, synthetic, and
toxic alternatives to quality products that only the well off can likely
afford. Everything from natural furniture, organic foods, natural material
clothing, cosmetics and care products, and medicine are much more costly than
their toxic, cheap alternatives. This will also increase the divide between
the wealth and the poor since the brain is affected by the chemicals that we
are exposed to resulting in lack of concentration, poor memory, irritability,
impulsiveness, and even the resulting gut bacteria affects the brain through
the vagus nerve. The poorest Americans also have jobs, and live in areas which
expose them to more pollutants than the wealthy, and the bigger issue is that
a lot of these people don't even realize that this is an issue. Trust in
institutions like the FDA, aggressive marketing by corporations like deceitful
labeling of foods to try and make them "sound" healthy, and general lack of
education make them super vulnerable and at the whims of the highly education,
profit-obsessed, shareholder-serving, psychology-understanding, resource-rich,
lobbying elite

~~~
nwah1
There are certainly issues of this sort. I've seen references to
"environmental racism" where poor neighborhoods like Altgeld Gardens in
Chicago are built on top of reclaimed landfills, and the water pipes are all
made of lead. And Camden, New Jersey had very similar problems being a site of
major industrial pollution.

On the other hand, the upper middle class obsession with purity and organic
stuff verges on neuroticism and New Age mysticism. Much of the panic over
chemicals involves only trace amounts. Like how formaldehyde in vaccines is
extremely tiny compared to formaldehyde in pears, yet it is used as a reason
not to vaccinate. Or how sea salt has been replacing iodized salt, even though
rates of iodine deficiency in the West are rising, and this is a major problem
for cognitive development.

~~~
wppick
One of the arguments in the book I mentioned was that yes the trace amounts
are "safe", but in some cases the body cannot detox certain synthetic
chemicals, so they build up in the body until they reach a level that begins
to cause health issues

~~~
Bartweiss
Broadly, this corresponds to the use "threshold model" and "linear no-
threshold model" in toxicology, which describe whether the risk/harm from a
substance has a safe 'cliff' or declines smoothly down to 0 dose.

It's well understood that carcinogens are LNT hazards. The old quip that "even
breathing causes cancer" is literally true, so there's no such thing as a safe
dose of a carcinogen, just an acceptable dose. (Interestingly, effectively-
safe doses decline as lifespans - and therefore cumulative risk - rise.)
Increasingly, we seem to be finding that non-carcinogenic risks which have
been filed under 'threshold' are actually LNT threats for which the low-end
risk gets lost in other noise.

I'm not particularly sold on the 'synthetic' framing here, though. Lead
exposure is almost certainly LNT at least in childhood. Copper and zinc are
linked to Alzheimer's in some uncertain-but-suspicious way. While endocrine
disruptors like BPA are synthetic, they're acting on the same pathways as
'natural' disruptors like phytoestrogens. 2.5nm particulate pollution now
appears to be not only carcinogenic but also development-inhibiting; the
primary sources are man-made but the primary agents (NOx, SO2) are naturally
occurring at much lower doses.

Very broadly, I do expect many thing we're exposed to today will eventually be
viewed as horrible errors like leaded gasoline (if hopefully less severe). But
I'm not sure 'synthetic' is a meaningful metric, and I'm not sure
bioaccumulation of the compound is actually a very common pathway relative to
accumulative damage.

------
nonbel
From the source:

> _" Population‐based cancer incidence data in the United States have been
> collected by the National Cancer Institute's (NCI's) Surveillance,
> Epidemiology, and End Results (SEER) Program since 1973 and by the Centers
> for Disease Control and Prevention's (CDC's) National Program of Cancer
> Registries (NPCR) since 1995. The SEER program is the only source for
> historic population‐based incidence data. Long‐term (1975–2015) incidence
> and survival trends were based on data from the 9 oldest SEER areas
> (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the metropolitan areas of
> Atlanta, Detroit, San Francisco–Oakland, and Seattle–Puget Sound),
> representing approximately 9% of the US population."_
> [https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551](https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21551)

So, looks like the headline chart[1] is only using data from the 9 original
SEER regions (Connecticut, Hawaii, Iowa, New Mexico, Utah, and the
metropolitan areas of Atlanta, Detroit, San Francisco–Oakland, and
Seattle–Puget Sound). Also, some new data source was added in 1995, which is
about when we see that peak in incidence/mortality. So we have some room for
systematically biasing the data here, especially when we consider the various
pitfalls of "age-adjustment".

They also say much of the mid-1990s spike in incidence for males was due to
detection of asymptomatic prostate cancer:

> _" Cancer incidence patterns reflect trends in behaviors associated with
> cancer risk and changes in medical practice, such as the use of cancer
> screening tests. The volatility in incidence for males reflects rapid
> changes in prostate cancer incidence rates, which spiked in the late 1980s
> and early 1990s (Fig. 3) due to a surge in the detection of asymptomatic
> disease as a result of widespread prostate‐specific antigen (PSA) testing
> among previously unscreened men"_

[1] [https://wol-prod-
cdn.literatumonline.com/cms/attachment/4799...](https://wol-prod-
cdn.literatumonline.com/cms/attachment/479916e1-e899-4965-a35d-7517620064cf/caac21551-fig-0002-m.jp)

------
chibg10
There is no data (or even a link to a study) in this article that gives the
the reader any sense of what the mortality gap between the wealthy and poor
is, or even how "wealthy" and "poor" are defined. I come away from this
article with a better idea of the male/female mortality gap than the
wealthy/poor gap (one of the article's two headline claims).

I've noticed that politicized headlines in non-editorials that aren't
suppprted by any facts or data are an increasing media trend in the past few
years. I saw this in another article I commented on a few days ago.

[https://news.ycombinator.com/item?id=18794757](https://news.ycombinator.com/item?id=18794757)

If it's a real problem (which I believe it probably is), journalists shouldn't
ignore "show, don't tell" in their writing.

~~~
Bartweiss
I agree that this is common and troubling.

I ended up on this soapbox after a recent study showing academic-performance
harm from fine particulate matter in the air. The article had no numbers, so
the HN thread was full of (weirdly politicized) speculation about American
intelligence. Meanwhile, the underlying study showed modest effects in parts
of China where daily particulate levels average 10x higher than the very worst
"stay indoors" days in America. It was an interesting study, but the headlines
it produced were actively making people less informed.

It's a particularly damning problem in this article because there are so many
different ways to read this result. It could be that rich people get better or
more intensive care after diagnosis. Or that they're more likely to get
regular checkups and so are on average treated at an earlier stage. Or that
with HPV vaccine not on the scheduled list, many insurers won't cover it and
so the rich face less cervical cancer. Or simply that rich people are less
likely to smoke and live with smokers. Or, especially since the long-term data
here comes from a small set of disproportionately-urban regions, wealth is
acting as a strong proxy for environmental exposure.

And even lay readers can discern those things! If rich people have lower
incidence, that's different than lower mortality per incidence. Major risk
factors like smoking can be adjusted for. We're told that wealth used to
correlate with cancer, but the only summary of the change is the vague "in
part to changes in diet and smoking as well as screening and treatment rates".
This article needed, at minimum, a graph of incidence and mortality by income.

------
kolinko
Wow, the disparity in male vs female incidence and mortality is astonishing -
almost twice as many men as women get and die of cancer every year.

~~~
hylaride
I wonder if it's because men are much more likely to smoke and drink
heavily...

~~~
RmDen
Probably also because unlike women..men will wait a long time to go to the
doctor

~~~
redbone
More likely it's due to the fact that men are more likely to work in fields
that force them into contact with carcinogens. Road workers, oil rig workers,
construction workers, etc.

------
AnimalMuppet
Hypothesis: Some significant fraction of the wealthy/poor disparity is because
the poor now smoke significantly more than the rich.

~~~
babyslothzoo
And statistically speaking, the poor are overwhelmingly very obese, whereas
the wealthy are fit/thin. Fitness is a new class indicator.

Over 80% of Americans are obese or overweight, largely due to lifestyle
choice, food addiction, and food abuse. Obesity and related disease are by far
the leading cause of death and illness in the USA, it's an extraordinarily
costly epidemic that nobody wants to acknowledge.

~~~
djohnston
can i get a citation on that 80%? i know we're fat but..

~~~
dagw
The numbers I can find are closer to 70 than 80%, but still. The really scary
number is that the obesity rate is closing in on 40%. So the majority of
people who are overweight or obese are in fact obese!

[https://www.niddk.nih.gov/health-information/health-
statisti...](https://www.niddk.nih.gov/health-information/health-
statistics/overweight-obesity)

[https://www.cdc.gov/nchs/data/databriefs/db288.pdf](https://www.cdc.gov/nchs/data/databriefs/db288.pdf)

------
renholder
For those of you who just want main point:

 _There’s a caveat, however: Those gains have been reaped mostly by the well-
off. While racial disparities have begun to narrow, the impact of limited
access to treatment for the poorest Americans has increased wealth-based
inequality, according to the American Cancer Society’s annual update on trends
and statistics._

~~~
andrenth
Metal cutlery was only available to the wealthy in the middle ages. At some
point they became widely available for everyone.

Such is the way with most technological advances, where the high price
initially payed by the rich is turned into more productivity and lower
production costs, resulting in greater availability.

~~~
fjp
Ah yes, the past 40 years of wealth gains will trickle down on us any day now!

~~~
djohnston
that's been the pattern for all of our industrialized history, there's no
reason to be skeptical that it will suddenly stop happening

