Why the ‘bad luck’ theory of cancer may be bad science

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I have been very troubled by the latest research which has had the effect of encouraging people to disregard the Common Sense Approach to illness – i.e. taking control, improving your diet, taking exercise and thinking positively. If you believe the results of the Science paper you might just say, So what, if I get cancer it’s just bad luck and there’s nothing I can do about it

So I was delighted when The Doc sent me this piece from the Lancet which treats the new findings with caution and exhorts us not to encourage our bad luck by smoking, drinking, but to continue to ‘promote healthy diet and exercise’.  The full article is below. Keep the faith!

On Jan 2, a research paper published in Science by
Cristian Tomasetti and Bert Vogelstein proclaimed
that most individual cancers, 65%, could be attributed
to “bad luck”—random events such as errors in DNA
replication—rather than to environmental or inherited
risk factors. This eyecatching message has drawn
comment, partly because of the inbuilt uncertainty in
the study’s methods and headline estimate (with its
95% confi dence interval of 39–81) and partly because
of the conclusion’s incompatibility with public health
evidence and thinking.
Owing to successes in medicine and public health,
life expectancies have grown substantially over many
years, especially in developed countries. According to
the Global Burden of Disease Study 2013, global life
expectancy for both sexes increased from 65·3 years to
71·5 years over the period 1990–2013. The good fortune
of living longer brings with it an increased risk of cancer.
World Cancer Day, which falls on Feb 4 and this year is
themed Not beyond us, highlights the 8·2 million people
expected to die of cancer, worldwide, every year. Yet
almost half of these deaths are premature, in people
aged 30–69 years. The overall burden of cancer morbidity
and mortality remains substantially dependent on
behavioural and environmental risk factors, including
tobacco smoke, unhealthy diets and physical inactivity,
and cancer-causing infectious diseases.
In developing countries, the rapid and ongoing
growth in non-communicable diseases can be expected
to increase the burden of certain cancers, such as
oesophageal cancer, in places where opportunities
for treatment might be limited. Disparities in cancer
outcomes between developing and developed
coun tries are very pronounced: of the 236 000
women estimated to have died from cervical cancer
in 2013, most lived in low-income countries.
Cervical Health Awareness Month, marked in January,
highlights an area of particular concern where
screening and vaccination programmes should be able
to protect all women and girls against papillomavirus
infections and their consequences.
In Cancer Statistics, 2015, published on Jan 5,
the American Cancer Society’s annual estimates
of the cancer burden expected to be borne by the
US population in the coming year anticipate some
1 658 000 new cancer cases in 2015, and 589 000 cancer
deaths. Cancer death rates in the USA have fallen by 22%
in 20 years, from 215·1 per 100 000 in 1991 to 168·7 per
100 000 in 2011. Here too, however, there are disparities
in cancer survival, with cancer death rates in southern
states having declined by just 15% over the relevant
period, as compared with declines of 25–30% in states
in the northeastern USA. In 2015, the leading cause of
cancer death in the USA is anticipated to be the category
of malignancies of the lungs and bronchi, at 28% of
deaths in men and 26% of deaths in women.
In a 5-year initiative recently announced by NHS
England, referral of patients with suspected cancer
is to be streamlined in an attempt to render earlier
diagnoses and also to improve prognosis for patients
with cancer. Often, cancer treatment itself is not only
arduous for patients but also challenging for societies
to organise and pay for. Also in the news in the UK
has been the Cancer Drugs Fund, which provides
substantial funding to benefi t cancer patients in
England, to pay for oncology drugs that are new or
have not been adjudged cost eff ective by the National
Institute for Health and Care Excellence. Cost pressures
mean that the fund will grow to £340 million from
April, 2015, but 25 drugs will not be available to new
patients, including cabazitaxel for patients with
advanced castration-resistant prostate cancer, and
eribulin for patients with advanced breast cancer.
The Cancer Drugs Fund owes its existence to the high
cost of some cancer medicines and fi nancial pressures
on National Health Service provision, and its future
beyond the end of its planned lifetime in March, 2016,
is uncertain. Although 55 000 patients with cancer
have benefi ted since the fund’s inception in 2011, it is
questionable whether a fund only for cancer medicines
is equitable and cost eff ective for the NHS overall.
Valuable though it is to understand molecular events
involved in neoplasia, the importance and complexity
of cancer call for clarity. Along with the imperative of
providing eff ective cancer diagnosis and treatment
in all settings, the public health agenda for cancer
control must continue to be to promote healthy diet
and exercise, and diminish tobacco smoking and
other unhealthy behaviours, through individual and
societal eff orts. „ The Lancet

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