Regardless of the length of time I have been in medicine, losing a patient to cancer is still extremely painful and heartbreaking. Male, female, black, white, young or old, my sorrow is the same. Cancer’s unpredictable nature can wreak havoc on not only the affected individual but the immediate and extended families, co-workers, caregivers, and even the healthcare professionals. A New Testament scripture in Matthew 5: 45 states that “it rains on the just and the unjust.”
Many years ago in medical school, I recall when I lost my very first patient to cancer. Let’s just call him A.W. A. W. was an elderly gentleman with bladder cancer who was being cared for by the VA hospital in Iowa City, Iowa. He was as cantankerous as all the other veterans, but he and I got along marvelously. I’m sure I peaked his curiosity since I was this young black girl from the south with hair like he had never seen and a dialect that included words and phrases like “yawl and fixin’ to.” I often had to redirect him to the business at hand, because he loved to talk and wanted to know every detail of my life.
I saw A.W. every day and we developed such a great relationship that he made me promise that when the rotation was over that I would write to him occasionally. Of course I said I would. A few months later when I was busy with the next major medical clerkship, I remembered A. W. and my promise. I wrote him a letter describing my current hospital service and I shared with him how much I learned from my experiences with him.
About a week or so after that, I received a letter from A. W.’s son explaining that his father had died not too long after his hospitalization. His son wrote in the letter that A. W. talked about me often and that he appreciated the care I gave. As a student, those words helped shape my future career in medicine. A. W. taught me the cruel reality of cancer: it robs you of precious time with your friends and loved ones.
However, scientists are learning some patterns of cancer that can help predict a person’s likelihood of developing this life-ravishing disease. For instance, 1 in 5 cancer deaths can be attributed to cigarette use. In 1982, the United States Surgeon General, C. Everett Koop, stated that “Cigarette smoking is the major single cause of mortality in the United States” and his words remain true even today. Cigarette smoking is linked to an increased risk of cancer in lung, bladder, esophagus, ovaries, colorectal and a host of other cancers.
Although the association of cigarette smoking and cancer risk is well-documented and studied, a large percentage of our society continues to smoke. Almost 50 million adults smoke. Fifty-four percent of children between the ages of 3 and 11 are exposed to second-hand smoke. Some groups, such as people with a lower educational level, smoke more. Only 6% of people with a graduate degree smoke. Cigarette manufacturers are also aware of these statistics and that is the reason for the prevalence of nicotine advertisements in poor neighborhoods.
With all of the debate surrounding the implementation of the Affordable Care Act and the decision of several states not to expand Medicaid, have we lost sight about the commonalities of our discussions: making healthcare affordable for all and reducing the cost of healthcare? I am no economist by any means but I do understand that preventing a disease is cheaper any day than treating one. So with everything we know about cigarette use and its link to cancer, why do states such as Missouri, Louisiana, Alabama, and Georgia have some of the lowest taxes on cigarettes? The state of Missouri has the distinct honor of having the lowest tax in the nation at $.17 per pack. These are questions I encourage you to ask yourselves when electing the next wave of legislators.
Another major area of cancer disparity is in preventative screening. For instance, black and white women get mammograms at about the same rate. However, if the mammogram is abnormal, black women receive the necessary follow up at a slower pace than white women. Timely screening is important since the cancers found in black women are more aggressive and are found at more advanced stages.
Although colorectal screening has increased in the US, 22 million people are not up-to-date on screening recommendations. Per the CDC, black people had the highest rate of getting colon cancer in 2010 but significantly lagged behind whites in regards to screening. Some theorize that the low rates of colon cancer screening in the black community may be due to a lack of knowledge or a lack of access.
Though we have much further to go in our understanding of cancer, its treatment, and the lofty goal of eradication, we do have some general basic information that could potentially save lives and that is in the area of prevention. If you want to reduce the likelihood of developing cancer, don’t smoke, get the recommended screening tests, exercise regularly, and eat a healthy diet.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
