COLD OPEN
On Plugged In – over 18 million. That’s the number of people around the world diagnosed with cancer last year. Nine and a half million cancer deaths and those numbers are expected to rise to more than 27 million new cases and 16.3 million deaths by the year 2040.

What’s your risk for cancer? And what can you do to reduce it? We’ll take a look at the most promising research and the latest developments on the Global Cancer Crisis and the search for a cure.

Hello and welcome to Plugged in. I'm Mil Arcega, filling in for Greta Van Susteren.

Here’s something to think about… 
About 18-million of you will develop cancer in the next year. And more than nine million people who now have cancer will die from it in the next year.

Those numbers are not meant to frighten but to educate and give perspective to a disease that is the world's second leading cause of death behind heart disease.

While it's no longer the death sentence it used to be...
cancer remains a deadly serious problem around the world.

((NARRATOR))
 
From North Africa, across Europe and Asia - Lung cancer is the most common and the deadliest form of cancer in men, followed by prostate cancer in much of the Americas, Western Europe, Australia and parts of sub Saharan Africa.

For women, The World Health Organization says the single biggest threat is breast cancer, followed by Lung Cancer and cancers of the cervix and the female reproductive organs.
Along with colorectal and skin cancers, such cancers accounted for nearly ten million deaths in 2018.

And the human toll comes with a heavy price tag estimated at more than a trillion dollars each year.

While the burden of cancer varies from nation to nation It is often greatest in lower and middle-income countries where access to treatment options and early detection is limited.

((DR. OREM JACKSON, DIRECTOR, UGANDA CANCER INSTITUTE
“So that means we still have very high mortality and this is contributed to mainly because our patients come late when their disease is advanced.”

((NARRATOR))
The burden is especially large in Sub Saharan Africa, where cancer cases are projected to increase 85 percent by the year 2030. And in Asia – where more than half of the world’s cancer deaths occurred. 

But ongoing research and new advances in treatment is providing hope. 
Johanna Wagner at the University of Zurich is using machine learning to analyze and catalog more than 140 types of cancer tumors.

((Johanna Wagner, Researcher, University of Zurich))
“Cancer is composed of different components and our motivation, our aim was to characterize these components in detail because we know that if we know exactly how our tumors are built we might be able to better tailor therapies in a tumor-specific way."

((NARRATOR))
But researchers say new advances in cancer treatment are just part of the equation.

Some of the most common cancers are preventable through changes in lifestyle, diet and exercise.

And most experts agree that prevention is one area making significant inroads in the global cancer crisis.

(end)

Prevention and reducing cancer mortality is something our next guest feels strongly about. 
Dr. J. Leonard Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society. He was designated Master of the American College of Physicians for his professional accomplishments. He is also the creator and author of "Dr Len's Cancer Blog". 

Dr. Lichtenfeld joins us now from Atlanta, Georgia on Skype. Welcome to Plugged In!
JLL = J. Leonard Lichtenfeld
MA = Mila Arcega

JLL: Hello.

MA: This is a very important show for many of our viewers around the world and we thank you for taking part in this discussion. So we've already identified the biggest cancer threats, for men and women as lung, breast, prostate and skin cancers. Does the cancer threat differ from country to country though?
JLL: Absolutely. It really depends in large part on where one lives so for example, here in the United States, we've already talked about lung cancer or breast cancer, but if you go to Asia, some countries such as South Korea have substantial numbers of patients with stomach cancer, gastric cancer, a liver cancer which is caused through infection is also a major cause of cancer in some parts of the world, so where you live has a significant impact on what your risk may be for developing certain types of cancer. 

MA: Is there any good news on the horizon, the American Cancer Society's annual report obviously shows that cancer rates were dropping here in the United States. Are we seeing similar trends in other countries?
JLL: Well there is good news, so we reported back in January of this year, a 27% decline in cancer mortality rates from 1991 through 2016, and that's pretty remarkable due to increased awareness, better treatment, screening, a variety of things, components. We are seeing and again in economically developed countries similar results. The concern we have as mentioned in the opening discussion that you had, that you offered, the concern is that not everyone around the world benefits equally, far from it. And in addition, there are also concerns about what's going to happen around the world as some of our lifestyles, some of our products such as tobacco become more common, that will have a huge impact on the cancer burden internationally. 

MA: Let's talk about tobacco, that is the single most preventable cause of lung cancer which is now, what the biggest killer around the world for cancer victims. That is declining here in the United States but we're not seeing the same declines in other countries, why is that? Is the tobacco companies, are they to blame for what is going on here? What can you tell us about that?
JLL: Well we certainly believe the tobacco companies are to blame and certainly governments around the world could do more. We've learned our lessons here in the United States, we're not perfect, far from it but we've had a substantial decline in the use of tobacco products, as have other countries that have paid attention. The problem and the concern we have is that tobacco is making inroads in other parts of the world, China, Sub-Saharan Africa, you mentioned, and it's done through what sometimes lacks government policies, sometimes farmers themselves have economic issues, they have to grow crops in order to survive and tobacco is a crop that they can grow. So, we need to pay attention to the scourge of tobacco at multiple levels and try to help folks understand how serious a problem it is, and avoid the difficulties that the United States and other countries have gone through literally for decades and millions of lives lost.

MA: You know some of that has to be economic in nature because I was just recently, well last year I was in the Philippines last year and I noticed that cigarettes were selling very cheaply there, there seemed to be a glut of it. We were able to get it for something like 50 cents US. Is that what's going on, are tobacco companies essentially shipping out a lot of the products that are unsold here in the United States and selling it in less developed countries, is that something we're seeing?
JLL: That clearly is a strategy of the part of the tobacco companies or one that we at the American Cancer Society and other organizations like UICC are very much aware of. We have been working with governments around the world to try to increase tobacco taxes which is an effective way of reducing tobacco consumption. I mentioned earlier about the economics of farming, we've been very engaged at the American Cancer Society, working with farmers, even today as I speak one of my colleagues is in Africa having those discussions, and trying to help people understand there are alternatives, that really takes a major effort by government, by individuals, by advocates, by advocacy organizations, by a number of people to understand how serious this tobacco problem is and if we don't address it, we're going to see substantial increases in cancer on not only for the immediate future but for the far future as well. 

MA: Dr Len, humans obviously are living longer, is living longer pose an increased cancer threat? 
JLL: Well, yes it does, the greatest risk factor for cancer is getting older and we recognize that certainly here in the United States and internationally. What's in a sense what's happened in some parts of the world where life is improving, economics are improving, lifespans increasing, and we're also dealing with some of the other infectious diseases that have caused early mortality. So as more people live longer, cancer becomes a much greater problem. 

MA: What's your advice to someone who is now living with cancer?
JLL: My advice is to be your own best advocate, no matter where you live and that applies to around the world, whether you're in a developed or an underdeveloped country, learn as much as you can, be your own advocate, work to get the best treatment you can, and also work with your government and advocacy organizations to make everyone aware of what we can accomplish in cancer care today, what we can do to prevent cancer, what we can do to detect it early, be an advocate to make that happen. And we will be better if we can commit to that goal. 

MA: We appreciate the work you do, Dr. J Leonard Lichtenfeld Chief Medical Scientific Officer for the American Cancer Society. Thank you. 
JLL: Thank you. 



As medical researchers look for ways to eradicate cancer and the burden it imposes on societies around the world one thing appears to be a major factor and that is ACCESS. Access to information and access to resources and treatment options.

Plugged In's Larry Lazo has our report.

((NARRATOR))
India has a population of more than 1 billion…   
And studies show that more women than men there are being diagnosed with cancer.   
Exactly WHY is a mystery. 

Information about early screening IS available in India…
Some hear it.. some don’t.

((KALPANA MEHTA, SCHOOLTEACHER (in Hindi) ))
"When I would drive to my school, it would be playing on FM, do this – do that. I would always change the channel thinking 'why listen to this? I won’t get cancer!'"

 ((REENA TRIPATHI, HOUSEWIFE (in Hindi) ))
"Everybody takes light medication every now and then, sometimes for headache or stomach ache. But such a serious disease? I had no clue about it. How could I get it?"

((NARRATOR))
What these women have in common is that they both have an aggressive form of breast cancer. Compounding the high number of cancer cases in India is a lack of treatment options.

A similar story in Africa where Uganda is struggling with a high cancer rate.. and limited resources to combat it.    

((DR OREM JACKSON, EXECUTIVE DIRECTOR, UGANDA CANCER INSTITUTE))
 “we don’t have the infrastructure. We don’t have the facilities to quickly make diagnosis and treat them effectively.”  

((NARRATOR))
THE COST OF SOME CANCER-FIGHTING DRUGS IN UGANDA HAVE BEEN LOWERED.. BUT MANY OF THE MEDICATIONS REMAIN TOO EXPENSIVE FOR MOST PATIENTS.

(( BAMBAIHA FRANCIS, CANCER PATIENT))
“I came here and they operated me. After the operation, some drugs were not in the [government] pharmacy. I had to go to a [private] pharmacy to buy them. But they were very expensive. So I had to go back to the village, sell part of my land, so that I buy those drugs.”

((NARRATOR))
THE COMMON THREAD AMONG MANY NATIONS IS A LACK OF EARLY SCREENING…
PATIENTS THAT WAIT TOO LONG TO BE DIAGNOSED.
AND HAVING ACCESS TO THE NEEDED MEDICATIONS AND TREATMENT OPTIONS TO HAVE A CHANCE OF BEATING THEIR SPECIFIC TYPE OF CANCER.

((Larry Lazo, VOA NEWS, WASHINGTON))


So how can people in developing countries beat the odds? What's being done to make diagnosis and timely cancer treatment available to them?

For more on efforts to reduce the cancer burden 
around the globe we are joined by Cary Adams. He is Chief Executive at the Union for International Cancer Control the UICC where he coordinates global advocacy to address cancer issues.

He was formerly the chair for the Non-Communicable Disease Alliance, the NCDA. That's a coalition of about 2000 organizations working to limit the spread of non-communicable diseases.

He's received numerous awards for his work. He joins us now on Skype from Geneva, in Switzerland where he is based.

Mr. Adams, thank you for taking time to speak with us.
CA = Cary Adams
MA = Mil Arcega

CA: It's a pleasure to be with you. 
MA: Now your organization works with 170 different countries to develop and implement cancer treatment strategies around the world. Is there any sense of urgency right now in the work that you're doing?
CA:  Well, there is and I think we're probably at the best time we've ever seen with regard to engagement from the governments around the world to put cancer as a priority within their health plans, and this is off of 10 years of global advocacy to make sure that there are various commitments made at a global level, which are signed off by each of the members states or countries around the world, and we're seeing progress in the way that they develop and implement National cancer control plans which cover many of the areas that your previous speaker was covering and was talking about. 
MA: Now in that previous report too, one of the men interviewed there he said he had to sell parcels of land so that he could pay for the cancer medication that he needed. Now, some of us here in the news were taken back by that is. Is that something that happens often? Is that something that you see?
CA: That is very common unfortunately. Yes, the health infrastructure in many of the lower middle income countries do not have the benefits of being part of like the American system or the Swiss system or the English system, and that sort of out of pocket payments for all treatments, whether that's cancer or any other disease, which before was a family and it often falls onto the family. So, we have to recognize that in solving the problem of cancer in low middle income countries, we've got to take a holistic approach involving governments who need to look at the whole health infrastructure, not just about the price of drugs or the price of technology, but also educating people about the signs and symptoms of cancer, so they can get into a health system that provide the various essential medicines and treatment that's required to deal with that which we know we can treat successfully. 
MA: But any way you look at it, cost has to be a big part of the equation. I know there have been a lot of efforts towards preventing, but for those who already have cancer, it can be a death sentence if you can't afford it. It's very difficult here in the United States, even with insurance. I can imagine what it would be like for someone who is suffering from stage three or stage four lung cancer in Haiti. 
CA: Yeah, you're absolutely right. In fact, stage three or stage four of any cancer is very difficult to treat, highly complicated, and very expensive no matter where you are in the world, which is why I would emphasize that part of the challenge we have in low middle income countries is to make sure that they have the very essential medicines and the essential technologies to deal with those cancers that are most common, and that is the real challenge we face. Now, we take our lead from the World Health Organization on there so we have a refreshed essential medicines list, most of which are generic, and therefore a lot cheaper than some of the more innovative medicines. And if that list was available in lower middle income countries, than a lot of the more common cancers which your reporter stated earlier, would actually be treated successfully at an early stage of presentation.
MA: Let me give you sort of a hypothetical question here, and I think it applies here about the cost and about the inequities that we see in the systems. Let's say you got two twins, both with the same type of deadly cancer, both the same stage, one lives in New York, the other one lives in Kampala. What is the prognosis for both?
CA: Well, the prognosis for on average for children with cancer that can be treated successfully in high income countries is an 80% survival rate, which is fantastic, and that wasn't in place, ten, fifteen years ago, but we're able to deliver the right treatment to the right child at the right time and we expect, we would expect, 80% survival rate. Unfortunately, in lower middle income countries, you're looking at a survival rate of around 20%. Now, a lot of that is not necessarily available to the drugs, it's fact that the child is in remote areas, the family is not aware of the symptoms, even the primary health care physician is not aware of the symptoms. So unfortunately, that child is not presented early enough to actually receive the medication or the treatment in the country, even if it's there. So it's a highly complicated problem, but it's something where it shows the potential is there to have a dramatic impact over time to bring those sort of survival rates up higher in lower middle income countries. 
MA: So, UICC is partnering with the World Health Organization. You're holding a summit later this fall in Kazakhstan. What do you hope to accomplish at that summit?
CA: Well, the summit is taking place every year, and we take them to different parts of the world, and we engage the region in which we are operating the particular summit. So this year it's in Kazakhstan, as you say, and we run that summit with the World Health Organization, and two other UN agencies, and the ambition that each summit is to bring together 3 to 350 of the top people in the world, including representatives from the American Cancer Society, discuss a topic which we believe we need to address, understand, and take back to our countries and and cajole governments to put cancer in that agenda. Now this particular one is looking at universal health coverage. There is a September meeting of the United Nations on universal health coverage. So it's quite appropriate that the cancer community reflects on the decisions taken at that meeting in New York, and then decides how we can proactively make it happen for people with cancer around the world. So as governments develop their plans, they place cancer treatment and care right in the heart of those decisions. 
MA: Just, just one last question because I know we're running out of time. With so many countries involved at this summit, does it ever get political? I mean, does it seem a little bit like a larger expanded G20 meeting when, when all the cancer specialists get together?
CA:  Quite the reverse actually. I'm always astonished and amazed by the quality of collaboration which actually emerges from these particular summits. Yes it involves the UN agencies, yes we have ministers of health there, but it's a really diverse group of people, it's leaders in private sector, NGOs, academia, and also government officials. And what we have created over many years now is a collective responsibility that addressing cancer cannot be left to one sector, and the amount of collaborative commitments that we find from that meeting is quite inspiring and we've seen impacted result before. 
MA: Thank you so much Cary Adams, Chief Executive Officer at UICC. We appreciate it.

Cancer treatment has come a long way over the years. 
It used to be strictly radiation and chemotherapy. But now, depending on the type of cancer, the treatment is becoming more precise, less invasive, and one hopes 
more effective.

Here's VOA's Health correspondent Carol Pearson with a look at the future of cancer treatment.

((NARRATOR)) 
Chemotherapy, radiation and surgery are standard treatments to combat cancer. But chemo and radiation kill healthy cells as well as malignant ones, and the side effects are legendary. 

Cancer treatment is now moving toward precision medicine, therapies that target just the cancer and not other tissue. 

For example, focused radiation can be used on women with early stage breast cancer after surgery that removes just the malignant tumor. The side effects are minimal, plus it takes less time than full breast radiation.

((Julia White, M.D., Ohio State University Comprehensive Cancer Center))
“The short five-day treatment is just as good as the whole breast irradiation for four to six weeks.” 

((NARRATOR))  ((Cancer therapies))
Other treatments use the body's own immune system. 

((William Nelson, M.D., Johns Hopkins Medicine))  
“It’s now pretty clear that that the immune system sees cancer cells, sees them as abnormal, and if we unleash the immune system, it can attack and destroy the cancer cells in a very helpful way.”

Still another treatment involves testing the cancer cells to determine their genetic makeup and then using medicine designed to kill only those cells. 

((Marcia Brose, M.D., Abramson Cancer Center, University of Pennsylvania))  
"We're talking about targeting cells at the very core of what made them a cancer to begin with, and that’s what precision medicine is really about." 

((NARRATOR))   
Each patient's cancer is unique, just like their DNA. That's what helps determine what medicine will work best. Healthy cells are left alone, and patients' side effects can be remedied.   

((Marcia Brose, M.D., Abramson Cancer Center, University of Pennsylvania)) 
"Very few of them have had a side effect that I've even needed to do anything about, and the couple that I've had, if I just dropped the dose one level, not only is the side effect gone, but the treatment still remains effective."

((Marcia Brose, M.D., Abramson Cancer Center, University of Pennsylvania))  
"Right now, where I think the biggest impact is being felt is for those patients whose cancer is not cured, that comes back over and over again, or actually spread to other parts of the body." 

((NARRATOR)) 
The results are very promising. 

((Marcia Brose, M.D., Abramson Cancer Center, University of Pennsylvania))  
"I get this patient in who’s been told he's only going to be around for three months, and he's got a cancer that typically is not treatable, even with chemotherapy they don't do well. I give him this pill, and that was four years ago, and he has no evidence of disease. And I meet another woman who has sarcoma. She was in a wheelchair and on oxygen, and in my and in my lifetime that person would be gone in a year, and here it is three years later and she's hiking with her kids.” 

((NARRATOR)) 
These therapies are still new, but cancer specialists say targeted therapy, whether focused radiation, immunotherapy or the genomic testing followed by precision medicine is the future of cancer treatment. 

((Carol Pearson, VOA News Washington))
 

One man who is laser focused on the future of cancer treatment is Dr. Otis Brawley.

He is a Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University.

He's also Associate Director for Community Outreach & Engagement at the Kimmel Cancer Center...

and the recipient of the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control.

Thank you for joining us Dr. Brawley.
OB = Otis Brawley
MA = Mil Arcega

OB: Thank you for having me. 

MA: I want to talk about what we just saw there. Are we going to see a cure, in our lifetime?
OB: For certain cancers, think of cancer as at least 200 different diseases. For certain cancers, we already have cures. We're going to have cures for more, but for the majority of cancers, I think what we should hope for is people who are going to have better, more effective treatments and what we should think about is people living with their disease like in diabetes or HIV now where they're still going to have cancer, but they're gonna be able to live more productively with less side effects with their disease for a very long time.

MA: So that's where we are now. When we first heard of the AIDS epidemic, it was automatically a death sentence. Certain types of cancers are still considered a death sentence but no longer the case, we're able to live longer. Is that what you're saying?
OB: That's right. Now, in certain lymphoma... certain leukemias, we can actually cure them now. In other diseases, you just heard the doctor talking about in certain lung cancers with certain precision medicines, we actually have people who are able to do very well for three four or five years, who used to only have a seven to nine month life expectancy. 

MA: Are you happy with the progress you've seen in the way of cancer treatment, cancer research?
OB: Happy, but not satisfied. We need to do better. 

MA: Where do we need to do better?
OB: We need to do better in a couple of ways. We need drugs that work even better than we have now. You know, I can make many people have diseases that used to die six to nine months after diagnosis now live five years or maybe eight years... we need to go further. We also even in the United States and Western Europe, need to work at getting the treatments to people. In the United States, we've got data to show that perhaps 20 percent of people who are dying from cancer now would not die if they could get the technologies that we already have.

MA: And of course, those technologies are important but only part of the equation because I know you talk a lot about prevention. 
OB: Absolutely.

MA: Is that the key to controlling the spread of cancer?
OB: Absolutely. In the United States, just to give you just a couple of numbers... In the United States, the death rate of cancer went from 60 per 100,000 in 1900 to 215 per 100,000 by 1990. And, that's because we started introducing things having to do with industrialization and smoking that caused cancer. 

MA: We started paying attention to the causes...
OB: If we could withdraw those causes we could lower the death rate considerably. 

MA: We prepared a graphic here of simple things you can do... sort of basic steps you can do... stay away from tobacco. Right? That's, that's been very effective. I believe 20 percent?
OB: Tobbacco is the cause still of a third of all cancer deaths.

MA: Use sunblock, because skin cancer is a big killer as well.
OB: Better even than using sunblock... stay out of the sun, long sleeves, wide brim hat, avoid sun exposure.
MA: Ofcourse, being healthy and exercising that improves your immune capabilities.
OB: Second leading cause of cancer by the way is the combination of too many calories, obesity and lack of physical activity. We call that energy balance. Tobacco smoking number one. Energy balance number two. These are true actually in the United States, Europe and many parts of Asia and South America.

MA: Do you see a time, doctor, when you can be vaccinated against certain types of cancer or just take a pill and say you're going to be okay?
OB: That time is here for certain things. The HPV vaccination actually prevents cervical cancer, likely prevents five other cancers that are caused by the human papillomavirus. Hepatitis B vaccination is very effective in preventing hepatitis, which causes liver cancer. Indeed, in Southeast Asia, there's been tremendous control of liver cancer in certain countries in Southeast Asia to the hepatitis B vaccine. We're going to have more vaccines in the future.

MA: What do you see is the biggest challenge... sort of in a global way... of reducing the risk the human population has?
OB: The biggest challenge right now is getting all the prevention's that you just talked about... to everybody, to get people actually the focus on preventing cancer. If we just did those simple very inexpensive things, we could reduce the number of cancers and reduce the number of cancer deaths considerably. Then, we need to talk about screening diagnosis and treatment of those cancers we can't prevent.

MA: Could governments around the world, could they be doing more to reduce some risks?
OB: Oh absolutely, absolutely. Governments have really... it's only government that can get many of these things to the populations, many of the things that are quite beneficial. We know, for example, excise taxes to make cigarettes and tobacco more expensive decreases use of tobacco. Decreasing use of tobacco decreases cancer incidence for 18 different cancers. We know that getting vegetables and fruits available to people who don't have them and getting very high caloric foods out of the population can actually reduce the amount of cancer. 

MA: Well Dr. Otis Brawley, we thank you so much for your advice and for the wisdom and insight that you provided us on the whole cancer problem. 
OB: Well thank you, and thank you for getting the word out, spreading the word is one of the ways we overcome cancer.

MA: That is the key isn't it. Dr. Otis Brawley. Thank you so much.


We've hit you with a lot of cancer statistics today.
We are after all, dealing with a worldwide epidemic so the stakes are high.  Cancer is the second leading cause of death globally.

Medical researchers have made tremendous progress 
in a more targeted approach to treatment and they are confident that a cure to all forms of cancers may be just on the horizon.

But more money for research and resources is needed. And the importance of early screening cannot be stressed enough.

As you've heard, many forms of cancer are curable if detected early and many in the medical community believe early prevention, detection and a targeted approach to treatment hold the key to wiping out cancer maybe not in our lifetimes but perhaps in our children's lifetimes.

That's all the time we have for today. 

Stay plugged in by liking us on Facebook at Voice of America. 

You can also like our Facebook page at facebook-dot-com-forward-slash-Greta. And follow Greta on Twitter – at Greta.

Thanks for being Plugged In.
.