Pancreatic Cancer Action Campaign: I Wish I Had Breast Cancer

Congratulations, Pancreatic Cancer Action.

Your brilliant marketing plan is working. It was a stroke of genius to have Tube ads and YouTube videos of people saying “I wish I had testicular cancer” and “I wish I had breast cancer.”

Really?

The UK-based  Pancreatic Cancer Action’s Ali Stunt  was diagnosed with pancreatic cancer age 41 in 2007.  Upon learning the disease has a 3% chance of survival and an average life expectancy of just months, she found herself  wishing she had  a cancer with a  better chance of survival. “In fact the cancer I personally wished I had was breast,” Stunt writes. “[My friend with breast cancer] was telling me how grueling her treatment was and how difficult it was to cope with the diagnosis. While I was sympathetic…I couldn’t help but think every now and then, ‘it’s alright for you, you have an 85% chance that you will still be here in five years time – while my odds are only 3%.” Cancer envy: I’d never have thought I would be envious of anyone with breast cancer, but I was.“

Oh boy. Because obviously the best way to call attention to one disease is at the expense of another.

There’s just one problem. Breast cancer is a like a fat man wearing a Hawaiian shirt: It covers a lot of ground. If you’re going to wish for breast cancer, make sure you put in a special request for the non-metastatic kind. Because in 2014, there is no cure for metastatic breast cancer. The median survival rate is surely not as good as the Pancreatic Action Network  seems to think it is. In general, breast cancer survival figures don’t necessarily represent significant gains, as they are distorted by the over diagnosis of Stage I breast cancers, which have increased five-fold since the advent of mammography in the 1980s.

Also, our research situation is much like yours: it sucks. Metastatic breast cancer is responsible for 90 percent of the morbidity and mortality, but gets less than 5 percent of the research budget.

Click here for the “I Wish” video

The New York Times said people with metastatic breast cancer “live from scan to scan, in three-month gulps, grappling with pain, fatigue, depression, crippling medical costs and debilitating side effects of treatment, hoping the current therapy will keep the disease at bay until the next breakthrough drug comes along, or at least until the family trip to Disney World.” Still want to sign up?

Perhaps most troubling is the notion of what the American Cancer Society’s Otis Brawley calls “disease Olympics,” i.e., when advocates for one disease try to increase funding for their disease by decreasing funding for another disease. “I believe the wise advocate tries to get more money for all cancer research and does not try to undermine another disease in favor of the disease that he or she is interested in,” says Brawley. “The wisest advocacy for cancer science is support for more money for cancer research in general and support for funding the best science and encouraging scientific investigators to maintain an open mind.  Scientists must look for additional applications of findings beyond just their cancer of interest.”

We are all in this together.  The reason that  testicular cancer has such an enviable cure rate can be summed up in one word: cisplatin. As Brawley notes: “Cisplatin is now the most commonly used chemotherapy in the treatment of lung cancer and ovarian cancer. It is also used in some breast cancer treatments. The drug oxalaplatin used in colon cancer therapy was developed from cisplatin.  So testicular cancer research benefited a number of other cancers.”

I’m sure  Pancreatic Cancer  Action meant well.  “Our advert is not stating that the person wishes they contract breast/cervical/testicular cancer, rather they wish they could swap pancreatic cancer for a cancer that will give them a better chance of survival,” writes Stunt. “We have selected cancers for our campaign that have a significantly better survival rate than pancreatic cancer. Plus they are ones that have benefited from the tremendous campaigning done by cancer charities to raise awareness of these cancers and increase the levels of funding over the past 10-15 years and in some cases have seen survival rates increase by over 50%!”

Well, guess again. Breast cancer is a lousy disease any way you slice it. Take a look at our numbers.

Is pancreatic cancer research underfunded? Undoubtedly. Is there a need for pancreatic cancer awareness? Certainly. Was this campaign the best way to change the status quo?

No.

 

“All too often, when people think about breast cancer, they think about it as a problem, it’s solved, and you lead a long and normal life; it’s a blip on the curve. While that’s true for many people, each year approximately 40,000 people die of breast cancer — and they all die of metastatic disease. You can see why patients with metastatic disease may feel invisible within the advocacy community.” —Dr. Eric P. Winer, director of the breast oncology center at the Dana-Farber Cancer Institute in Boston

Can’t See the Metastatic Forest for the Breast Cancer Screening Trees

Others can speak far more knowledgeably and eloquently about the recent pink ribbon funding controversy. My concern is that we are missing the forest for the trees. Setting aside the funding issue, let’s consider the truth worth of these exams. Screening and self exams can be helpful. But let’s not kid ourselves. These tests are frankly not that great.

“Women are regularly told that screening mammograms save lives,” says the National Breast Cancer Coalition. “Evidence of actual mortality reduction is, in fact, conflicting and continues to be questioned by scientists, policy makers and members of the public. Since evidence does not currently significantly support, nor disprove the effectiveness of this test, receiving a screening mammogram should be a personal choice, not a medical mandate.”*

Essentially, we have better imaging technologies. The  average size lump found by first mammogram is about the size of a dime (~1.5 cm) but even tumors as small as pencil erasers can be seen.

The real problem is we don’t know WHAT we are looking at.

We don’t know  WHY some tumors spread beyond the breast.

We don’t know HOW to stop metastatic growth.

We are seeing more and more breast cancers earlier and earlier. In some cases, people are overtreated: It’s the oncological equivalent of using a shotgun to kill an ant. Many women may be diagnosed and treated for a cancer growing so slowly it might never have caused any symptoms or threatened their lives.

As surgeon/scientist/blogger David Gorski, explains, “… for mammographically-detected small tumors, almost always those detected by screening mammography, it’s not so clear whether all of these need to be treated. Overdiagnosis is being increasingly appreciated as a significant problem, and, indeed, may account for as many as 1 in 3 breast cancers detected by screening mammography (although more common estimates are on the order of 20%). There is even evidence–not bulletproof by any means, but intriguing evidence–that as many as 20% of mammographically detected tumors may actually spontaneously regress.”

Screening is just one tool. We need to look at the bigger picture. Unfortunately, the under treated are always with us:

“If we did what we already know, at least 37% of cancer deaths in people between the ages of 27 and 64 could be avoided right now,” writes ACS’s Dr. Len Lichtenfeld. “Where is the national conversation about the fact that poverty is a carcinogen? Are you talking about it? Is the media talking about it? If the silence is deafening, then perhaps you have your answer. “

Finally, as much as I have a vested interest in breast cancer research, it shouldn’t come at the expense of addressing other diseases. I concur with ACS’s Dr. Otis Brawley:  “The wisest advocacy for cancer science is support for more money for cancer research in general and support for funding the best science and encouraging scientific investigators to maintain an open mind,” says Brawley.  “Scientists must look for additional applications of findings beyond just their cancer of interest.”

You’ve probably heard of the chemotherapy drug Herceptin, which is used to treat about 25% of breast cancer patients. It was developed to treat neuroblastomas and gliomas, both cancers of the nervous system, but it didn’t work for those cancers.
Another example, cisplatin, was first developed as a treatment for testicular cancer.  It is now the most commonly used chemotherapy in the treatment of lung cancer and ovarian cancer. It is also used in some breast cancer treatments. The drug oxalaplatin used in colon cancer therapy was developed from cisplatin.  So testicular cancer research benefited a number of other cancers.
Similarly, the drug leuprolide was developed in the mid-1980s as a hormonal treatment for metastatic prostate cancer. This drug has since been FDA-approved for not only treatment of metastatic prostate cancer, but also premenopausal breast cancer, endometriosis, and precocious puberty.

The number of drugs that were developed for one disease but ended up being useful in others  is legendary and goes beyond cancer.

*Women age 40 and older should have mammograms every 1 to 2 years. Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.