In his 2019 State of the Union address on Tuesday night, President Trump called for $500 million over the next 10 years to fund research on childhood cancers.
Such funding is crucial to continue tackling the devastating disease. However, missing from the State of the Union — and most other conversations about tackling cancer — is a focus on prevention, specifically the need to research, understand and communicate the role environmental exposures play in cancer risk.
The numbers on cancer incidence and deaths are complex. Although childhood cancer mortality rates have dropped considerably from the 1960s, data from the American Cancer Society shows that incidence rates have increased 0.6 percent per year since 1975.
In this way, childhood cancers are like several others. Between 2005 and 2014, yearly cancer incidence rates rose for several types: thyroid cancer by 4 percent; invasive breast cancer by 0.3 percent in black women; leukemia by 1.6 percent; liver cancer by 3 percent; oral and pharynx cancers by 1 percent in Caucasians; pancreatic cancer by 1 percent in Caucasians; colon cancer by 1.4 percent in individuals younger than 55 years of age; rectal cancer by 2.4 percent in individuals younger than 55; and melanoma by 3 percent in individuals aged 50 and older.
While these cancer rates have increased, overall rates of cancer deaths have started to fall. In fact, since the 1990s, improved detection and treatment, as well as decreased smoking rates, have contributed to significant reductions in cancer mortality.
Reduced deaths from cancer are a great public health victory. These statistics prove that public health interventions like educational programs designed to curb smoking can have dramatic effects.
They also suggest that investments in improved detection and diagnosis are money well spent. A focus on treatments has also improved quality of life for cancer patients and their likelihood of remission.
But where is the call for better cancer prevention? As rates of numerous cancers continue to rise, the failure to identify the causes of cancer remains a disappointment for public health officials and researchers alike.
We know that environmental factors can contribute to cancer risk. Some, like smoking, are avoidable. Others are lifestyle factors that people can change like drinking less alcohol, decreasing consumption of processed meats, using protection from the sun, and increasing exercise.
Yet, other environmental factors like exposures to chemicals in the environment, including endocrine disruptors, have received little attention. While some NIH-funded programs like the Breast Cancer and Environment Research Program have worked to identify chemicals in the environment that promote cancer, funding for cancer prevention initiatives has stagnated.
Despite the limited resources invested in studies of environmental risk factors for cancer, we know enough to take action on some chemicals of concern.
For example, communities contaminated with perfluorinated chemicals, several of which are known to cause cancer, have demanded attention from government officials in addition to asking for more research.
Individuals living in these communities have the right to know how they are being exposed, and what their risks might be – for cancer and other diseases.
It is great that cancer research was raised in the President’s State of the Union speech, and that the difficulties associated with caring for a family member with cancer was mentioned in Stacey Abrams’ rebuttal.
But a failure to focus on prevention, a failure to acknowledge the role of the environment in causing cancer, and a failure to allocate funds to prevention research, are all failures for public health.