This recent piece in Scientific American, adapted from John Horgan’s talk at Stevens Institute of Technology, reviews the vast scope and questionable effectiveness of the cancer research and treatment industries.
Each year, 1.7 million Americans are diagnosed with cancer, while 600,000 Americans die from the disease annually. The annual cost of cancer treatment is estimated to reach $175 billion this year. The total amount spent on cancer research since Richard Nixon declared a “war on cancer” in 1971 has surpassed at least $250 billion.
Despite these investments, there has been little progress in reducing the mortality associated with most cancers. The age-adjusted mortality rate from cancer — that is, the rate of cancer deaths in the population adjusted for the fact that older people are more likely to develop the disease — is the same that it was in 1930. While cancer mortality has decreased 30% from the early ’90s, this only occurred after decades of increasing cancer mortality; more importantly, analyses have suggested both this decrease and the prior increase can be almost entirely attributed to changes in smoking rates over time.
Cancer-related clinical trials have the highest failure rate of any therapeutic area, and various hypotheses to explain the causes of cancer — hormones, viruses, genetics, carcinogens, etc. — have generally failed to yield effective treatments. Drugs approved by the FDA between 2004 and 2014 extended survival by an average of only 2.1 months, and patients’ annual treatment costs exceed $100,000. Immunotherapy, despite substantial press coverage and patient interest, can benefit fewer than 10% of patients and costs more than $1,000,000. More than 40% of those receiving a cancer diagnosis in the United States will lose their life savings within two years.
The benefits of cancer screening are similarly questionable. Research over the past decade has shown our bodies regularly develop and treat cancers without any clinical intervention. Repeated analyses of mammography, prostate-specific antigen (PSA) screening, and other forms of early cancer detection have clearly shown they do little to reduce cancer mortality. More importantly, many cancer screening procedures have a high rate of false positives and subject healthy patients to potentially harmful treatments, including surgery, chemotherapy, and radiotherapy. This has led to widespread calls to discontinue screening programs, as some claim the programs’ high costs, harmful effects, and tendency to lead to overtreatment outweigh any benefits of early detection.
The size of the cancer industry has also fostered corruption and conflicts of interest. The 1,200 cancer centers in the United States spend $173 million annually on advertising, often leveraging emotional appeals that provide patients with unrealistic expectations about the effectiveness of treatment while entirely suppressing the associated costs. Cancer specialists can be paid by drug companies to prescribe certain drugs, which incentivizes them to describe these drugs in the terminology we often see in cancer therapy: “breakthrough,” “miracle,” “game-changer,” etc. The massive commercial incentives have led to cancer research’s own reproducibility crisis, with multiple analyses finding the majority of highly cited cancer trials fail to replicate when independently tested.
In sum, the article describes a massive treatment and research infrastructure that, despite its size, public prominence, and supposed importance, has demonstrably failed to deliver meaningful benefits to patients. The author notes this has led some doctors to begin practicing “conservative medicine,” acknowledging the limited impact novel pharmacology has had on the course of disease and instead relying on fewer, simpler treatment methodologies.
The Cost of Cancer: Systemic Issues
This 2016 analysis charts the rapid growth of spending on cancer treatment alongside a shift to more personalized and complex therapeutics.
This 2019 analysis estimates significant federal cancer research funding is supplemented by $6 billion per year in additional funding from nonprofits. Cancer research funding does not track disease burden well, with some of the deadliest cancers receiving relatively little funding and vice versa.
This 2016 blog post estimates the total funding since Nixon’s “war on cancer” declaration exceeds $250 billion.
The Cost of Cancer Care: Individual Issues
This 2017 analysis finds “the average price of a novel anticancer drug routinely exceeds US$100,000 per year or course of treatment” and estimates the worldwide financial burden of cancer treatment will exceed $150 billion by 2020.
This 2018 analysis found 42.4% of those 50 years or older diagnosed with cancer had depleted their entire life’s assets within two years of treatment.
This 2018 article argues the heavy marketing of cancer immunotherapy distorts the fact that very few patients can benefit from it and ignores the incredibly high costs (both financial and health-related) associated with the treatment.
This 2016 analysis reviews the dangers associated with cancer immunotherapy, which often must nearly kill the patient to kill the cancer.
This 2017 analysis found only 8% of patients can be expected to benefit from immunotherapy.
Siddhartha Mukherjee, author of The Emperor of All Maladies, writes in The New Yorker that the cost of a course of cancer immunotherapy often exceeds $1,000,000. He argues it would bankrupt the health-care system if used broadly.
Cancer Advertising and Promotion
This 2017 story by Kaiser Health News finds patients and caregivers are regularly misled by doctors and treatment facilities, which frame new therapies using terms such as “breakthrough,” “game-changer,” “miracle,” etc. These terms obscure the low probability of effectiveness for new therapies.
This 2018 analysis by TruthInAdvertising found cancer centers spent $173 million on advertising in 2014, often leveraging patient testimonials to promote a sense of hope and suppress consideration of costs, even when the probability of successfully treating a given cancer was relatively low.
This 2014 analysis similarly found most cancer center advertisements leverage emotional appeals and rarely provide realistic presentations of expected treatment effectiveness or costs.
Vinay Prasad argues financial incentives push doctors to exaggerate the likely benefits and downplay the harms and costs of the cancer treatments they recommend to patients.
Cancer Treatment Failures
- How much of the decrease in cancer death rates in the United States is attributable to reductions in tobacco smoking?
This 2006 analysis finds the majority of the decrease in cancer mortality observed since the early 1990s can be attributed to decreased smoking rates.
C. Glenn Begley and Lee Ellis argue the failure rate in clinical oncology research is sufficiently high to require dramatic change in the field. They found 47 of 53 “landmark” cancer studies could not be successfully replicated.
The Reproducibility Project found only five of 14 highly cited cancer studies could be replicated.
John Horgan reviews Azra Raza’s 2019 book, The First Cell: And the Human Costs of Pursuing Cancer to the Last. Raza argues little progress has been made in the “war on cancer,” with the exception of a few, specific diagnoses (e.g., blood, bone marrow, and lymph cancers).
Issues With Cancer Screening
This 2015 article argues a focus on survival rate has inflated the clinical benefit of cancer screening. Cancer screening has merely allowed patients to live longer with a diagnosis of cancer by catching the disease earlier; mortality data indicates patients’ overall lifespans have not been extended by early detection.
This 2010 analysis found 25% breast cancers detected by mammography and 60% of prostate cancers detected via PSA are “overdiagnoses” and the conditions either were not present or would have resolved themselves without clinical intervention. This suggests any treatment of these overdiagnoses had no clinical benefit.
This 2019 article summarizes the misplaced enthusiasm for screening, arguing the past belief that widespread cancer screening will reduce mortality is not supported by the data.
This 2013 Cochrane analysis finds that for every 2,000 women screened for breast cancer using mammography, one death will be averted, 10 women will be unnecessarily treated, and another 200 women will receive false positives that are caught before treatment begins.
An additional 2013 Cochrane analysis finds prostate cancer screening has not led to a decrease in prostate cancer mortality and likely has led to significant harm due to the treatment of false positives.
The NNT finds there is no net benefit to breast cancer mammography, with the harms of overdiagnosis and overtreatment exceeding any benefits of early detection.
The NNT similarly finds the benefits of early detection of prostate cancer are negligible and do not offset the harm associated with the treatment of false-positive diagnoses.
This 2017 article notes estimates that each prostate cancer diagnosis successfully caught early by PSA screening is offset by 240 false positives.
- Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials
In this 2015 analysis, John Ioannidis argues cancer screening has negligible or nonexistent benefits for all-cause mortality.
John Ioannidis goes further in this 2018 editorial, arguing evidence of the ineffectiveness of screening programs is sufficiently strong to encourage the abandonment of these programs.
Michael Baum, who helped found the U.K.’s breast cancer screening program, argues the overall harm associated with overtreatment of breast cancer outweighs any benefits that may be associated with early detection, and as such, screening programs should be abandoned.
Richard Ablin, who discovered the prostate-specific antigen (PSA), describes the test as a “profit-driven public health disaster” with substantial clinical and financial costs and limited evidence of benefit.