Running Head: The Realities of Cancer 1

The Realities of Cancer in the United States: A Summary

Matthew DeVlieger

University of San Diego

1 May 2017
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Abstract

With cancer being the second leading cause of death in the United States, increasing emphasis

needs to be placed on maximizing the effectiveness of treatment and prevention techniques.

Cancer is responsible for about 25% of all deaths in America, and approximately 40% of people

will develop the disease at some point in their lifetimes, assuming no change. Risk factors

include obesity, radiation exposure, excessive alcohol consumption, and the number one cause:

smoking. Due to medical research and technological advances, treatment options for cancer

have been improving. The most common treatments are surgery, chemotherapy, and radiation.

Tens of billions of dollars are spent by the American government on direct costs from cancer, and

this drives the national health care expenditures up significantly. The individuals with cancer

also face drastic financial hardships due to the disease, as well as experience reduced

productivity and disability. The American Cancer Society provides many services that assist with

cancer treatment, support, and follow-up. However, prevention is the best option, and more

emphasis needs to occur on educating the public about ways to reduce development of the

disease.
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The purpose of this paper is to document the harsh realities of cancer and its treatment in

the United States. Cancer is one of the leading causes of death annually, and is also one of the

most costly diseases to treat. In the U.S., cancer is second only to cardiovascular disease as the

leading cause of death, and in the U.K., it is the leading cause (Jemal et al., 2008). Cancer is

responsible for about 25% of all deaths in the United States, and 30% of those are from lung

cancer. Smoking is the leading cause of lung cancer, and significantly reducing this activity

nationwide will dramatically improve the health of Americans. In men, prostate cancer is the

most prevalent, and in women, breast cancer, with each about 25% of new cases. In 2016, an

estimated 1.7 million new cancer cases were diagnosed and 600,000 people died from the

disease. Also, approximately 40% of men and women will be diagnosed with cancer at some

point during their lifetimes, based on 2010-2012 data. In 2014, an estimated 15,780 children and

adolescents up to age 19 were diagnosed, and close to 2,000 died from the disease (American

Cancer Society [ACS], 2015).

About half of those patients receiving treatment for invasive cancer die from that cancer

or its treatment (Jemal et al., 2011). Survival is worse in the developing world, as the types of

cancer most common there are more difficult to treat. Those survivors of cancer treatment

develop a second primary cancer at about twice the rate of those never diagnosed in the first

place (Rheingold, Neugut, & Meadows, 2003). This is projected to be due to the same risk

factors still present, which include obesity, smoking, excessive alcohol consumption, and

radiation/chemotherapy from the first cancer treatment. Therefore, even those “cured” of the

disease need to be consistent and thorough with cancer screening and prevention. Short or long-

term survival depends on many factors, but some of the most prominent include the cancer type,
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the patient’s age, and overall quality of health. Those with other health issues have significantly

lower survival rates than otherwise healthy people. The older one becomes tends to reduce

likelihood of survival when diagnosed. This is concerning because the American population is

living longer, and thus more will be diagnosed at an older age. Also, those who report a higher

quality of life tend to survive cancer more than others (Montazeri, 2009).

Further, cancer care and treatment takes a significant toll on the national health care

budget. In 2010, national expenditures for cancer care totaled nearly $125 billion. In 2020,

estimates have projected expenses could reach $156 billion based on the increased costs of care

(National Cancer Institute [NCI], 2017). Increasingly more focus has been on cancer prevention

and screening, which should reduce cancer treatment costs in the long term. The further cancer

progresses, the more expensive treatment becomes, so early detection and prevention has become

a priority. In order to reduce national health care expenditures, techniques need to be produced

and maintained which will lower the American cancer incidence rate.

Background

Cancer can form in any area of the body. It occurs when abnormal cells start growing out

of control and crowd out normal cells. Cancer is not just one disease--there are over 100

different types. Cancer can start in one area of the body and spread to another. When it spreads,

it is called metastasis. The type of cancer is named from where in the body it originated, so if

lung cancer spreads to the bones, it is still called lung cancer. Tumors are often associated with

the presentation of cancer, and when cancer is inside the tumor, it is called a malignant (as

opposed to benign) (ACS, 2015).

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Cancer is caused by changes in a cell’s DNA. Some of these changes could be inherited

from parents, but most are due to environmental factors. These factors include outside exposures

to many different stimuli. Anything that is thought to cause cancer is called a carcinogen.

According to medical research, one such factor that contributes to cancer is the type of lifestyle

one lives. For example, those who eat more nutritiously with fruits and vegetables tend to

develop cancer to a lesser extent. This is likely due to the antioxidants and polyphenols that will

prevent cancer from taking place. Tobacco use also is a major contributor to the development of

cancer, especially of the lung. Additionally, alcoholic beverages have been identified as

carcinogenic agents. Further, those who are more physically sedentary typically have a higher

risk of developing cancer. Obesity is a leading risk factor as well. Other carcinogens include

ultraviolet light, radon gas, infectious agents, pollution, and medical treatments, such as hormone

drugs and those that suppress the immune system (ACS, 2016). Carcinogens, however, do not

cause cancer every time one is exposed. Some may simply cause cells to divide at a faster rate,

which increases the likelihood of DNA mutation. Others may only be dangerous after prolonged,

high levels of exposure. Also, the type of exposure and each individual’s genetic makeup are

important in determining whether cancer is likely to develop (ACS, 2016).

Treatment for cancer is usually one of three different modalities: surgery, chemotherapy,

or radiation. The surgical approach would physically remove the cancer, along with any body

parts in which it metastasized. For example, breast cancer patients might remove the entire

breast or just the section the cancer was localized in. However, surgeries can’t treat all types of

cancers, like leukemia, where the cancer is in the blood. Drugs more effectively treat this type.

Chemotherapy is the usage of drugs that either kill cancer cells or impede their growth (ACS,

2015). The drugs can be administered through an IV or pills taken orally. This is one of the best
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treatment options for Stage 3 and 4 cancers, which are the final stages after it has spread

throughout the body. The third common treatment option is radiation, which also slows cancer’s

growth. It can be given in combination with the chemo and surgery, or can be a stand-alone

treatment. The procedure is similar to getting an X-ray (ACS, 2015).

Social and Economic Impact

The effects of cancer reach far and wide. From an individual perspective, it takes a

significant toll on those diagnosed, both from a social and financial aspect. American cancer

survivors are facing larger burdens of medical costs treating cancer, missed work, and reduced

productivity overall. In the next ten years, the percentage of American cancer survivors is

projected to increase by more than 30 percent, resulting in more than 18 million more Americans

facing the realities of cancer treatment (Centers for Disease Control and Prevention [CDC],

2014). Most of these survivors will be above the age of 65, since medical science is helping

America live longer. Researchers studied data from the Agency for Healthcare Research and

Quality’s Survey to estimate annual medical costs and productivity losses among adult cancer

survivors and those without a cancer diagnosis. The study findings indicate that male cancer

survivors had annual medical costs of more than $8,000 per person, and productivity losses of

$3,700, compared to males without cancer at $3,900 and $2,300 respectively. Female survivors

of cancer had more than $3,200 in additional medical costs and $1,300 in productivity losses

compared to those not diagnosed with cancer. The study also indicated that about 25% of

employed cancer survivors felt less productive at work. Employment disability accounted for

75% of lost productivity among survivors. Additionally, the researchers found that 32% of

cancer survivors experienced limitations in their activities of daily living outside of work, and

42% had to make changes to their work hours and duties due to cancer (CDC, 2014).
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Cancer also takes a significant toll on the American health care system as a whole. Since

it is the second largest cause of death in the United States, the system has deemed it permissible

to spend tens of billions of dollars on cancer research and treatment. The Agency for Healthcare

Research and Quality estimates that the direct medical costs for cancer in the U.S. in 2014 were

$87.7 billion. Of these costs, about 60% were for hospital outpatient or doctor’s office visits,

and 27% were for inpatient hospital stays (ACS, 2017a). One of the most significant financial

impacts of cancer is the cost of treatment. However, lack of health insurance and other

socioeconomic barriers prevent many Americans from receiving optimal cancer prevention/

treatment. According to the U.S. Census Bureau, about 30 million people (10% of the American

population) were uninsured in 2015. The percentage was up to 17% in Texas (ACS, 2017a).

Uninsured patients are much more likely to be diagnosed with cancer at a later, more deadly

stage, where treatment is more extensive, expensive, and less effective. This will drive up health

care costs on a national scale. However, the Affordable Care Act (ACA) should help provide

more screening and prevention of cancer progression due to its provision of more health care

insurance coverage to Americans.

Emerging Trends in Management

There are many modalities and techniques to treat cancer. Besides the most common,

surgery, chemotherapy, and radiation therapy previously discussed, immunotherapy has been

giving people hope. It is a biological therapy, which uses substances made from living

organisms as treatment. This technique utilizes your immune system to eradicate cancer cells.

The goal is to strengthen the system so that it naturally fights off the cancerous parts of the body,

such as malignant tumors. White blood cells, called T cells, are grown from your body and

reintroduced via an IV. The influx of these cells will help reduce malignant tumor size, since
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they attack cancer cells. Research is also ongoing to cause the immune system to identify tumors

if they ever resurface, and cause them to diminish and eventually die off. (NCI, 2015). Another

emerging trend in cancer treatment is called targeted therapy, utilizing certain drugs. This

treatment is the foundation of precision medicine, and seeks to block the changes in cancer cells

that help them grow, divide, and spread. Cancer cells thrive because they are able to mask

themselves from the immune system. Some targeted therapies put markers on cancer cells, thus

permitting the immune cells to more easily identify and destroy them. Other therapies cause

cancer cells to undergo cell death. Still other techniques cause blood vessels to shrink which had

previously supplied the tumors with blood supply, or cause hormones feeding cancer cells to stop

being released (NCI, 2014).

Federal or State Programs

In addition to consulting with health care practitioners, those diagnosed with cancer have

many opportunities to further network and educate themselves about the disease. Obviously,

reputable sites on the Internet will contain a wealth of information. The American Cancer

Society (ACS), a national organization, also has many ways to stay connected, help loved ones

understand cancer, and find the emotional support they need. The ACS is affiliated with the

National Cancer Information Center, which provides free information and advice 24 hours a day,

365 days a year, in 12 different languages. Trained cancer experts are available via phone or

online live chat, providing accurate and up-to-date information to patients and caregivers, as well

as connecting them with valuable resources and services within their communities. They can

advise about many different topics, including specific cancers, treatment options, coping skills,

prevention, cooking, screening, medical equipment, financial assistance, insurance, and much

more. They provide a service that matches volunteers who will give cancer patients a ride to the
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hospital/treatment facility at no cost. They also can assist in finding lodging if cancer treatment

is far from home at little to no charge. The society also has free online support groups, and often

assigns a personal cancer care navigator who will direct and help individuals through the cancer

treatment process (ACS, 2017b).

Conclusion

As seen, cancer can and does take a devastating toll on the American population. As the

second leading cause of death in the United States (Jemal et al., 2008), it is very important that it

be researched and treated effectively. Understanding has progressed by leaps and bounds in the

recent years, and headway is being made on the disease. Early detection has increased and

treatment has improved, with state-of-the-art medical technology and surgical techniques being

implemented. Thus, many more diagnosed will have a better chance at survival. However,

prevention is the best treatment, and education needs to continue at a national level about causes

and ways to reduce the likelihood of development. For example, smoking is the leading cause of

lung cancer, and this activity should be minimized across America, especially in public spaces

where many can be affected through second-hand smoke. With approximately 40 percent of

Americans likely to be diagnosed with cancer at some point (ACS, 2015), obviously we need to

conduct more research and implement more educational programs for the American public to

curb this statistic. With tens of billions of dollars spent on treating the disease (ACS, 2017a),

reducing its incidence by prevention and education will also significantly reduce this increasing

trend.
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References

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https://www.cancer.org/cancer/cancer-basics/economic-impact-of-cancer.html

American Cancer Society (2017b). Finding support programs and services in your area.

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carcinogens.html

American Cancer Society (2015). What is cancer. Retrieved from

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Centers for Disease Control and Prevention (2014). U.S. cancer survivors face significant

economic burden. Retrieved from https://www.cdc.gov/media/releases/2014/p0612

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