Important to note this is not an average effect across all cancers. Some cancers still have terrible outcomes eg pancreatic cancer, GBM, small cell lung cancer, stomach and esophageal cancer, certain types of breast cancer. Advanced colorectal cancer also not great.
The other aspect of this is that death can often be replaced with multiple years of a highly medicalised and sallow existence while receiving cancer therapy.
Point being, we don’t want to lose site of the ultimate goal, which is preventing cancer as much as possible.
Prostate cancer is one that men should be especially familiar with. My dad was diagnosed years ago after his PCP ignored escalating PSA levels. Although he's a "survivor" of Stage 4 his life is a shell of what it was, and has expressed a number of times he wishes he was dead. When I spoke to the oncologist after his diagnosis I remember this adage specifically: "If you did an autopsy on every man that dies over 40, you'd find the beginnings of prostate cancer in all of them. It's a question of when, not if."
I say this to highlight three things:
- Physicians routinely ignore things they shouldn't. Be your own advocate and research the things your doctor tells you, especially the things they believe are just worth watching.
- There is little to no awareness in the public over prostate cancer.
- Surviving isn't always a good metric. In my dad's case, surviving was a promise for a slow and miserable death.
You're misinterpreting the "when not if" adage. For prostate cancer it's generally used as an example of how there are cancers you die of and cancers you die with. Many prostate cancers are so nonaggressive that men will die with them and never know they were there.
And that's the problem. If you did a test and saw something & then immediately eradicated that prostate cancer, what if it was going to be one of the ones that wouldn't have caused you real harm during your natural life? In that case the likelihood of the treatment causing more damage to you than the cancer itself is high. And predicting which are which is improving but still imperfect.
I work in this field and directly am involved with the treatment of prostate cancers. What you describe is not standard of care, and I’d hesitate to say that everyone should be so alarmed of getting prostate or any cancer. It’s unfortunate that your father’s PCP wasn’t aware of such warning signs, and I’m sorry for your loss.
However, We’ve seen this before with prostate and breast cancer where early and often screening leads to not only false positives but undue stress on patients. Furthermore, catching a nonaggressive prostate cancer 2-5 years early may lead to the same outcomes as catching it when certain things like PSA are detected to be increasing. But you may drastically affect one’s quality of life. It can at times be a difficult balance.
We see more and more elderly patients being treated because they are living longer. For many though, “waitful watching” or “active surveillance” is the correct clinical decision and always is up to the patient.
Finally, while prostate cancer isn’t as publicized as breast cancer (we’re trying!). It is a well known cancer and there is awareness of it.
> Be your own advocate and research the things your doctor tells you
I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?
Generally it's about catching issues early as possible not necessarily preventing the issue from occurring. If you wait until you're experiencing impacting systems before getting things like this checked your likelihood of having the same quantity of quality adjusted years of life is much lower.
Sometimes it means asking for tests that the doctor ignores or is reluctant to order. I go to a university-run clinic and often deal with trainee doctors with my regular GP present and I have had to get into arguments with them on whether I need a given test for this year's checkup even with the test showing deviated results the prior year. I was stunned at the audacity of the trainee in question as I often go to the annual checkup not in a combative frame of mind but this dismissal of my concerns rubbed me the wrong way. I was able to prevail but I shudder to think of the damage this budding physician will wreak on their future patients with this off-handed arrogance - I hope they will get better with time and age.
There are not really any lifestyle interventions with good quality evidence for preventing cancer. This is my list:
Definitely worth doing:
- Don't smoke anything that burns or chew tobacco.
- Depending on your age and sexual experience, get the HPV vaccine.
- Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.
- If you have certain ethnicity, just get a genetic test, pay for it if you have to (Mainly for Ashkenazim)
- Avoid consuming herbs/plants which contain aristocholic acid.
Probably worth doing:
- Reduce red meat consumption (observational data and plausible mechanism)
- Reduce or eliminate alcohol (observational data and plausible mechanism)
- Make sure to get sufficient fruit and vegetables and fibre. This may offset the risk of red meat consumption.
- Take vitamin D, particularly if your levels are low or you live far from the equator. Don't take intermittent megadoses, take some every day. This seems less useful if you are overweight.
- If you are female, then have children and breast feed if possible. Longer durations of breastfeeding are more effective. Having more children is also more effective. (One may balk at this, but there is a lot of supportive data about long term breast cancer risk)
- Exercise. There is only (a ton of) observational data, but exercise is so universally beneficial. Going from nothing to a bit of exercise has a bigger impact than going from a bit of exercise to a lot. Most people over do it. Do cardio and resistance training. Try to do something every day.
- Avoid supplements designed to have antioxidant properties (based on data suggesting harm from controlled trials, and no clear benefits).
Maybe:
- Move closer to the equator.
- Avoid obesity (note this is complicated... obesity itself may not be the problem. Obesity is protective for some cancers, and this varies by age).
- Get checked for Hepatitis B and C, particularly if you have risk factors or were born/grew up in an endemic country.
- If you get chronic reflux or heartburn, consider pushing for your doctor to investigate further (usually a gastroscope) and do an H pylori test. This is particularly if you were born/grew up somewhere with a higher chance of exposure. If you have it, take the eradication therapy.
- Try to maintain metabolic health. This is highly personal and hard to give general advice around. Eg. South east asian/Subcontinental people can be metabolically ill despite not being overweight. Investigations here could vary from checking for insulin resistance (eg HOMA-IR calculation from a blood test), gettinga DEXA scan to look for visceral fat, or in the extreme case continuous glucose monitoring to look for foods which really spike your blood glucose. The interventions are exercise, sleeping well, and potentially avoiding foods which spike your sugar (or scheduling exercise after eating such foods). Soon we will have a better idea if certain personalised dietary interventions may be beneficial.
> Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.
Can you elaborate on how you see this being actionable? Perhaps an increased cadence of screenings?
Yes, tailored screening is one aspect. Prophylactic surgery is another option. There are also pharmacological measures eg tamoxifen to reduce risk of breast cancer in BRCA1/2 carriers. Then there are clinical trials of preventative interventions eg denosumab in BRCA carriers.
Ashkenazim have relatively high rates of inherited BRCA1 and BRCA2 mutations. These are associated with high lifetime risk of breast and ovarian cancer, but also prostate and pancreatic cancer. If someone with Ashkenazi heritage gets one of these cancers, they are reflexively tested for BRCA1/2 mutations. There are various mitigating strategies, so it is worth finding out I think, but the right way to go about it is to see a genetic counsellor.
About the AA, it seems to be herbal supplements that are the primary concern (see https://www.accessdata.fda.gov/cms_ia/importalert_141.html). Normal ginger is fine, wild ginger is the problem. Wild ginger isn’t used in cooking as I understand it.
Or use your insurance's telemedicine portal to get a random doctor on the line and get them to order the tests.
For many people this will be out of reach but for those earning a comfortable salary, you can pay out of pocket for X-ray, CT, MRI, etc and they're "only" like $500-2,000.
Thanks for the mention runnerup. Indeed we are the easiest place to get your levels checked in-depth, hassle free. I'm the ceo over at https://www.PrivateMdLabs.com, plz email me to j@privatemdlabs dot com so I can give you a token of appreciation and discount for your next tests.
By the time my friends dad had pancreatic cancer detected, he died within 6 weeks. It’s also the fastest growing cancer in the US. Every time I read about someone dying of cancer quite often it’s pancreatic cancer and it terrifies me.
They find spots on the pancreas by accident all the time. It is incredibly common. I know, I have one: I got an abdominal CT scan while getting something unrelated checked. Some of these go on to be cancer, and sometimes they know it is precancerous. The cyst I have wasn't immediately precancerous. Now I get regular MRIs to check on it. Since I have no symptoms, there is really nothing else to do.
That lack of symptoms, though, is a real issue. If you have a little bit of cancer and no symptoms and you don't find it accidentally, it is going to be much, much harder to detect early.
If it's so deadly and widely asymptomatic until it's way too late, why don't we screen for it? Or is that problem, that we don't have a good screening test other than expensive and time consuming MRI?
Screening isn't really helpful because it isn't good enough. We find all of these lesions, but the vast majority don't result in anything that needs treated nor do they appear to have symptoms. They are just there. So right now, we just watch them. I'm guessing if we knew how common they were, could better tell between normal and cancerous, or heck, even knew why they were so common, we could do better.
But we just aren't there yet.
And unfortunately, this is the case for a number or screenings - and is a downside of some routine screenings. I keep hoping that once we understand a variety of cancer better, this will improve.
FWIW, mine was found on a CT scan and all the monitoring was on an MRI - and both expensive (thankfully the out of pocket costs for healthcare here are low) and uncomfortable for some folks.
In general the worst cancers are the ones that are difficult to detect early enough before they metastasize. As the article says, this death rate has dropped mostly because of preventative care and early screening.
Cancer rates have exploded since 1970. I told this to someone and they arrogantly corrected me. But I just looked it up right there and they had confused death rates with cancer rates. Thanks be to god for smartphones.
Diabetes, obesity, cancer, depression rates all exploded in unison starting around 1970. Why does everyone ignore the massive implications of this? It means there’s something we’re doing that is killing millions of people but everyone brushes that aside and supports treatments rather than figuring out what happened in 1970 that is actually causing it.
There are a trillion pet theories but nobody wants to do research to figure out. Nobody advocates for this research. What the hell
This is already well-known and understood in science: cancer rates exploding is not because of an external force causing more cancer, but a sign that we addressed other things that kill you before you get cancer. And we also got far better at screening, including being able to identify benign tumors.
This sort of hyperbole- "killing millions", "trillion pet theories"- is needlessly alarmist.
It's one of those things were effects are so far ahead in time you don't really realise they're there until you're 60 and cancer kills you. And then it's "oh well, old people die" or "he had too many beers"
I was striving to be vegetarian for more than a decade (avoid red meat, low fat diet) because of the "science", before I started developing issues.
Good luck in finding research to back this up, the trend seems to be going all towards vegan highly processed food.
I was impressed when mainstream science recently reluctantly backtracked on animal fat and meat.
The USDA is still to update recommendations of course.
And obesity skyrocketed because nobody knew the difference between a fat person and a skinny person before 1970? We knew what cancer was before 1970. We certainly knew what diabetes was. The simple fact is that people started getting sicker in the 70s.
For a very long time people have been going to the doctor when they feel sick. Oliver Cromwell consulted with doctors and was convinced that he was very ill. Later on we understand that he had bipolar disorder. When people feel sick they consult doctors and have been doing this for hundreds of years. An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer. And even mental illnesses as I have pointed out were recognized as medical ailments by people for hundreds of years. It wasn’t that we suddenly started diagnosing these things.
Also, there are communities of people who do not develop heart disease or insulin resistance or depression or cancer. The common thread between every community like this is that they live outside of the modern world and do not eat modern foods. They live in an old way. This is well documented. Yet another insane data point that people somehow ignore. There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this, people like you who leave snide comments and contribute nothing. A worthless parasite.
So there are communities that live in the old way and do not get any of these diseases. We see that these diseases exploded for us around 1970. It couldn’t be more obvious.
> An illness like diabetes presents very specific symptoms and doctors have been aware of diabetes for a very long time. The same is true for many kinds of cancer
You can have diabetes and high blood pressure and cancer and not have symptoms. That's why we screen for them. If you have symptoms, it is no longer screening, it's diagnosing. A lot more screening is happening now than before the 70s so we are obviously finding a lot more disease.
I'm not arguing against the fact that lifestyle and environment play a significant role in increasing cancer, but that doesn't change the fact that dramatically increased screening rates have contributed to dramatically increased disease diagnoses.
> There are literally people out there who basically do not get cancer heart disease or diabetes and nobody seems to think it’s important to get to the bottom of this
I think there is probably more research these days into causes of cancer than ever before.
> people like you who leave snide comments and contribute nothing. A worthless parasite.
I don’t buy it. Cancer that is screened eventually will present. It doesn’t change the amount of cancer that presents. Again, this changes survival but not diagnoses. People who abstain from living in the modern way almost never get cancer or diabetes. Is this because they aren’t being screened? The explosion doesn’t correlate to change in screening methodology. Yes, people who ignore the simple facts are parasites. Like with the recent breakthrough in epigenetic aging, for decades the theory of mutation based aging dominated despite the clear and simple fact that there was contradictory evidence. For decades we had to put up with the amyloid theory of Alzheimer’s even though the plain and simple fact was that there were people without Alzheimer’s who had plaques and there were people with Alzheimer’s who didn’t have plaques. The reason why billions of dollars were spent on the wrong solutions and the reason why millions of people have suffered and died prematurely for no good reason is people like you who glom onto whatever is the least painful thing to believe. Whatever liberates you the most from accountability. No, it’s not anything we are doing, it’s just data anomalies and we are totally helpless. The same doom worship that is responsible for every global warming advocate getting really glassy eyed and avoidant whenever you start to discuss actual solutions rather than just rave about how utterly screwed we are. People don’t want solutions they want to resign to their helplessness. So yeah you are part of the problem in my opinion. You just want to resign to the fact that cancer is totally beyond our ability to comprehend or do anything about it. And you ignore these insane data points that demand to be scrutinized and made sense of because it would interrupt your world view.
The documentary “sugar coated” details this period when the sugar industry got everyone believing excessive sugar was fine and fat wasn’t healthy. Leading to a wave of low-fat sugar-fortified food in the late 70s on. Obesity exploded in response and related outcomes.
Thank you for your comment.
I studied anthropology, an imperfect field, but one thing was obvious right away and it is that point you are making here.
Please keep telling people.
- the American Cancer Society didn't start promoting cervical cancer screening until the 1960s [1]
- mammography was first recommended officialy in 1976 [1]
Screening was just coming of age 50 years ago so it's no surprise we started to find something once we started looking for it.
Cancer is ultimately a numbers game & you roll the dice every single day. Life expectancy in the US today is ten years longer than it was in 1970. All those extra dice rolls add up. Ideally you could correct for this effect, but it’s not clear we know enough about how cancer risk accumulates over time to do this correctly.
Cancer rates for each age have exploded, not just total cancer rates. Cancer rates for cancers that were known and diagnosed well before 1970 have exploded.
Looks like they went from 400 to 500 then back to 450 since 1975. It's trending down.
And you'd need to correct for age distribution to make sure it's not just the population having older people and thus higher chance of cancer in a given year.
Could it be that people started living long enough to develop these problems, or that the problems were just previously undercounted? There are a lot of fairly boring theories that are more likely than anything extravagant.
There have been some wonderful advances in cancer therapy, such as immunotherapy. For example, Rituxan (rituximab) only dates to 1997, but it's already in a number of chemotherapy protocols, leading to a clear improvement in survival rates in previously difficult-to-treat cancers such as aggressive non-Hodgkin's lymphoma.
Flashier, and something I've already talked about, is CAR T-cell therapy, the first generations of which were approved in 2017. This therapy has definite risks of severe side-effects, but it can result in complete remission of cancers that have survived multiple lines of chemotherapy, as happened with me.
Immunotherapy isn't just promising, it's here, and, because of it, so am I, but even more exciting is that it gives us more avenues of research to build off of known-useful therapies.
> For example, Rituxan (rituximab) only dates to 1997
It is kind of scary to me that drugs these days have such long regulatory lead times that a drug developed in 1997 is just now being entered into treatment regimens.
I understand why that is (the Thalidomide tragedy stuff and like that), but I also clearly remember reading an article ~10 years back that asked why cancer treatment seemingly hadn’t made any leapfrogs since the ~70s, and the answer was back then they could aggressively iterate on treatments.
I get what you're saying: it's a bit of an apples-to-oranges comparison since better screening means we're comparing cancers of different severities. I don't necessarily see that as a problem, though, since a lot of these earlier screened cancers would have become more advanced cancers down the line. If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?
The "US Cancer Death Rate" talked about in the article is measured in deaths per 100,000 population, not deaths per detected cancer. So we are comparing apples to apples, but finding and treating cancers earlier could be helping to result in fewer deaths.
> Or it could simply mean that another cause of death has increased. Like heart disease/diabetes from ever increasing obesity rates.
You could hardly have picked a worse counterexample. Deaths from heart disease have fallen dramatically over that time period, even faster than cancer deaths have dropped.
Deaths from strokes - which at one point equalled deaths from all cancers combined - have fallen as well, although much of that drop occurred before the time period in question.
Deaths from diabetes are actually quite few in number compared to heart disease and cancer. They've sort of plateaued over this time interval, which isn't good news, but hardly the alternate explanation for the reduction in cancer deaths.
Now, there is one big cause of death which we haven't addressed: COVID-19, which causes about 3x the number of deaths as diabetes, and over half the number of deaths as all cancers combined. But that only began in 2020, and this data shows a decrease across the entire interval, so it's not relevant here.
Diabetes is almost never the direct cause of death, but it’s damn hard in the body. Hurts circulation, hurts your nerves, hurts your organs… and it can flare badly in reaction to some medications.
So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that.
Similar to AIDS in that it doesn’t kill you directly (not that we know that juvenile diabetes is a thing, and we routinely test for it), it just makes any other health challenge much dicier.
> Diabetes is almost never the direct cause of death, but it’s damn hard in the body. Hurts circulation, hurts your nerves, hurts your organs… and it can flare badly in reaction to some medications. So, the cause of death won’t be “diabetes”, it’ll be heart attack, stroke, chronic infection, something like that.
It's not like the CDC doesn't know this. They understand how diabetes works; that's reflected in the tabulation of data. It's still incorrect to say that the drop in cancer deaths is explainable by the increase in diabetes deaths, not the least because age-adjusted diabetes deaths decreased during most of that interval.
> If our testing were perfect such that we could detect all cancers early enough to stop, that would functionally be a cure, no?
no. being able to detect cancer doesn't mean people are getting tested twice a year for their whole life. for example, you wouldn't have routine cancer screenings for children, but sometimes they get cancer, and on those occasions it'd be nice to have better treatment options.
No disagreement with you there. By "perfect screening" I assumed a "perfect" patient set where problems brought up at annual checkups lead directly to tests which lead to detection, but perhaps that's a naïve assumption to the point of uselessness.
Still, I think it's easy to write off screening advances as skewing the data set vs. actually saving lives, when they do in fact help people that otherwise could have been much sicker.
We wouldn’t normally even consider talking about these things as if they’re in any way mutually exclusive, would we? Like normally we would all understand that it’s good for cars to get safer and for trauma care to get better.
if cancer screenings for children were painless, lower risk than the cancer, and cost five dollars, you would totally have routine cancer screenings for children
The thing we don't know is which early cancers actually progress to advanced cancer. It's possible that we detect more things that look like cancer, but that would not have ever progressed into full blown metastatic cancer (at least, not before the patient died of something else). So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.
> So that could artificially make it look like we've gotten better at treating cancer, when actually we've just gotten better at detecting non-life-threatening cancer.
No, because the death rate is measured at the population level, not at the incidence level. Fewer people are dying today of cancer than 30 years ago.
The only way that detection bias could impact that outcome is if you make the argument that a large number of terminal cancer cases were going undetected in 1991 at the time of death.
"problem" is a bit of a strong word, but when someone says "Cancer Death Rate Dropped" dropping people assume "Cancer Rate Dropped", which is not at all the same thing
The article provides no numbers about cancer rate dropping. Yet the false association between the two ideas is so strong that even the authors themselves seem to theorize that the cancer rate itself is dropping because people don't smoke as often now.
Conflating those two concepts seems like a Very Bad Idea
The % of the US population that dies every year from cancer has dramatically reduced. The % the US population that is detected to have cancer is up dramatically.
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991, the report said, averting an estimated 3.8 million cancer deaths in that time.
Yes. I expected to find that the decline in smoking has also lead to the decline in fatal cancer — and there it is. Still a good thing.
I think this would only matter if some of the additional detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible.
It's different for e.g. Flu, where more testing = more detection of an illness that would not necessarily have become serious, had it gone undetected.
>detected cancer would have gone away on its own. Correct me if I'm wrong, but I think that's impossible.
What if they detect a slow growing cancer that wouldn't have become a problem before you hit the age of 150? Not every cancer is aggressively trying to eat its host whole.
Avoiding cancer in the first place matters too. Lung cancer is a lot less common, now that nobody smokes any more. The rate of lung cancer deaths for men has halved since 1991, which itself accounts for half of the overall decline.
It's mostly due to the reduction in smoking, not screening. Screening helps, but it often extends lifespan and healthspan rather than preventing a death.
I wouldn't use the word "problem" but to explain it better, cancer rate itself has not dropped necessarily but due to early detection, number of deaths from cancer has dropped. We still have a long way to go to actual be able to cure cancers especially in advanced stages. Still a good win but more work to do.
Screening, the HPV vaccine and dropping rates of smoking.
It would be nice if we could stop advanced cancers but at least we're getting better at prevention.
I lost my dad to cancer last year. It's a horrible disease. I really had no idea how horrific it is. My dad had a year longer than his initial prognosis thanks to new immunotherapy drugs.
Yes it is a theoretical mess. The article manages to conflate in the same sentence:
> The decline in smoking rates in the U.S., better early detection and innovative treatments including immunotherapy drugs have driven a drop in death rates since 1991
which mixes all meanings together (smoke → cases ; detection → fatality ...). So it's just "decreased number of deaths".
(Well, on the other hand, it makes sense that more factors impact such "final" result.)
From the CDC:
> In the past 20 years, from 2001 to 2020, cancer death rates went down 27%, from 196.5 to 144.1 deaths per 100,000 population
More vaccines seems like one of the most straightforward future mitigations since viruses like Hepatitis/HPV/mono/HIV/herpes/etc cause almost a fifth of cancer cases:
That is a dubious claim. While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative. Also, Hep C, HIV and herpes have no vaccine, so unclear what your statement is referring to anyway? What has contributed to a drop in cancer mortality would be advances in treatment (like targeted therapies and immunoncology), better image/blood/genetic screening practices, and certainly the decreased popularity of smoking.
This particular virus has a solid link to various forms of cancer:
"[Epstein–Barr virus] has also been implicated in several other diseases, including Burkitt's lymphoma, hemophagocytic lymphohistiocytosis, Hodgkin's lymphoma, stomach cancer, nasopharyngeal carcinoma, multiple sclerosis, and lymphomatoid granulomatosis.".
The word "implicated" in science normally means "correlated with" and can't really be considered a "solid link".
Some of the articles cited in that section have sentences like "1 out 2 (50%) adult analyzed cases was positive, with 50% of stained tumor cells (this patient was a 22 years old female, coming from Napoli);" that don't follow the necessary standard of evidence. I continued to skim the linked articles and they are all clearly correlative.
It's a lot more subtle than that. First off let me say that historically, demonstrating that a virus causes cancer has been a major bit of work, and many times people have mistakenly seen associations and falsely believed they were causal. second, I don't deny there are some cancers which are caused by viruses. But, you're referencing extremely rare cancers, not the cancers that make up the bulk of US (or world) deaths from cancer. My complaint is about taking these relatively rare situations and implying there's some sort of general underlying well-understood cause, when the reality is, in many situations, the virus itself did not specifically "cause" the cancer, but for complex biological reasons, it's "associated" with the cancer (which could manifest as increased susceptibility to getting particular types, or worse prognosis, or even possibly better outcome).
> While links between HPV and cervical cancer are quite strong and well-defined, the associations with the other viruses you cite are only correlative.
HPV is merely correlative, as well. That's basically how all endogenous cancers work. With Epstein-Barr Virus the association is quite strong, though the incidence of EBV-induced cancers doesn't seem to be quite as large as HPV--~1% vs 2-3%.
HPV isn't correlative, it's causative. Additional co-transformation factors may be required, but it is well understood that E6 and E7 proteins directly lead to tumorigenesis. EBV pathogenic mechanisms are more autocrine and therefore a muddier picture, hence correlative.
> Also, Hep C, HIV and herpes have no vaccine, so unclear what your statement is referring to anyway?
OP is talking about more vaccines as possible future mitigations - more vaccines as in new vaccines, not more vaccinations using existing ones (though that wouldn't hurt either.)
Out of curiosity, I chose one cancer from the article: breast cancer. Deaths declined from a peak of 33 to 19.1 per 100k women, whereas smoking only seems to increase your risk modestly: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698948/
> The HR (reference group was never smokers) was 1.14 (95% CI 1.03–1.25; P = 0.010) for ever smokers, 1.24 (95% CI 1.08–1.43; P = 0.002) for starting smoking at ages < 17 years, and 1.23 (1.07–1.41; P = 0.004) for starting smoking 1–4 years after menarche.
However smoking rates have gone down massively since the '50s:
> Ever/never chest X-ray exposure increases BC risk 2-fold regardless of age at first exposure and, by up to 5-fold when carrying 3 or more rare variants in a DNA repair gene.
Digital x-rays have largely replaced film, and they can reduce radiation exposure by 80-90%.
I did a ride with the Fireflies West (http://www.fireflieswest.com) cycling/fundraiser group this past year, and that was our motto. Indeed, fuck cancer.
Screening is more widespread and so is general awareness for symptoms. This leads to earlier diagnosis which generally has a better outlook than later stages. Then there's also general progress in terms of surgical procedures as well as medication for treatment
