Out-takes from an Interview in August 2013 with Brian Lamb, a journalist and the founder, executive chairman, and now retired CEO of C-SPAN which provides coverage of the U,S. Congress as well as other public affairs events and Francis Collins an American physican-genetist who currently is the Director of the National Institute of Health (NIH) in Bethesda, Maryland. Fact checking performed by Darryl Mitteldorf, Executive Director of Malecare.
Brian Lamb: Let me ask you about prostate cancer and breast cancer, the numbers, you probably have them but on that, I think from reading that more men get prostate cancer than women get breast cancer.
Francis Collins: That’s true. He has this correct. According to ACS in 2013 the estimated new cancers are: for breast (women) 232,590 and for prostate (for men) 238,590
Brian Lamb: Why do we not see the pink ribbons for prostate cancer and we see all of this attention on breast cancer? You almost see no campaigns and you know much as nothing on prostate cancer.
Francis Collins: There’s a bit, I mean, there’s certainly are groups of prostate cancer foundations that have very much promoted the importance of this. But prostate cancer, generally, is a disease of older men and prostate cancer is also less frequently lethal, perhaps. So, perhaps, therefore, it’s not seen as quite a public health emergency as breast cancer. But, certainly, there is a lot of advocacy that plays a role in terms of the visibility of particular conditions. And it isn’t always connected in terms of the seriousness of the problem, I mean, if you look at diabetes, diabetes kills a lot of people. From heart attacks, from kidney failure, it blinds people, but does diabetes have the same visibility as breast cancer? It doesn’t seem to. In part because there’s a different level of urgency and that’s promoted sometime by just how effective the advocates have been.
Fact Check: Deaths for breast cancer are 39,620 (a ratio of 17% against newly diagnosed) and for PC 29,720 (a ratio of 12.5% against newly diagnosed). However, the claim that 29,720 yearly deaths does not qualify as a public health emergency is shocking. His comments that PC is a disease of older men so it isn’t a public emergency is crossing a ethical, political and moral line that should not be approached, no less crossed. Additionally , his facts are simply wrong – As of January 1, 2012 the median age for breast cancer diagnosis was 61 years old and for prostate cancer it is was 67 years. I guess it depends on when you become old, is there a difference between 61 and 67 years?
Brian Lamb: How much money does the National Council Institute spend on breast cancer and how much does it spend on prostate cancer?
Francis Collins: I don’t know the numbers, it’s a lot, the national cancer institute…
Brian Lamb: Breast a lot more than prostate?
Francis Collins: I bet they’re fairly close and you know what, this is also something that’s important in terms of how we allocate funds. What we’re learning about cancer is that probably, our designation of cancers by the organ in which they arose is not very helpful. What really matters is which genes are activated, so if somebody is studying breast cancer, they might make a discovery that was actually more useful for prostate cancer than for breast. We should think about cancer research in a different way now and not try to pass it out into particular tissues of origin.
Fact Check: In 2010 breast cancer received 631.2 million dollars for research from the NCI while prostate cancer received only 300.5 million dollars, prostate cancer received only 47.6% of the NCI funding received by breast Cancer! His statement that a research finding in BC might be more effective for prostate cancer can be true, but it would need research dollars to make the jump, it doesn’t happen automatically and of course the reverse could be equally true, so the comment is out of line. This discrepancy is consistent from other US agencies, i.e. DOD breast cancer received for FY 92- FY13 2.924.5 million dollars and PC received 1.290 million dollars or 44% of the total funding for BC
Joel Nowak: Besides the numbers being appalling, we need to be very concerned that the Director of the NCI has no idea what he is claiming. He clearly has no clue about the level of funding of cancer research of his agency and he has no idea about the true nature of breast or prostate cancer.
Joel T. Nowak, M.A., M.S.W.
Hi Joel:
Great post. Just a few observations.
Francis Collins is the Director of the National Institutes of Health (NIH). Harold Varmus MD is the director of the National Cancer Institute (NCI), which is a unit of the NIH [http://www.cancer.gov/aboutnci/director/] So, I am not completely shocked that Collins would not have the detailed NCI budget figures off the top of his head, or be as informed as we might like on specific cancer issues. I’m shocked however that he cites the ACS diagnosis numbers, when his very own NCI provides all that same diagnosis/death data at the cancer.gov site.
None of this is to detract from your point that PCa is far behind BCa in terms of research funding. The reasons for this are many and complex, several of which I deal with in my book (Chapter 9). Also, there is an entire book, “Cancer Activism: Gender, Media and Public Policy” [Kedrowski & Sarow, Chicago, University of Illinois Press, 2007] devoted to the differences between breast and prostate cancer advocacy.
Finally, we can all be thankful we don’t have lung cancer, a far more lethal disease than either BCa or PCa. The “Death/diagnosis ratio” you cite that as 17% for BCa and 12.5% for PCa is a shockingly high 70% for lung cancer.
Another way of looking at the NCI budget is research $ spent per death from the particular cancer: In 2011 (The latest year budget numbers are available) the NCI spent $15,785 on BCa research for each person who died from breast cancer in 2013, $9,707 for each man who died in 2013 from PCa, and a mere $1,862 for each person who died from lung cancer in 2013. [The NCI budget numbers come from the “NCI 2011 Fact Book” page xii, “Research Dollars by Various Cancers” at http://obf.cancer.gov/financial/attachments/11Factbk.pdf%5D
Joel,
I would have a different slant on the content of this article.
First of all, Francis Collins is the Directory of NIH, not NCI.
Secondly, I disagree with some of the comparisons made between breast and prostate cancer. I believe that there is a big difference between getting cancer at 61 vs. 67, a big difference between 39,620 deaths and 29,720 deaths, and a big difference between a disease that kills its victims more quickly or more slowly. Considering all these together, and the fact that women’s life spans are normally a bit longer than men’s, it may well be the case that twice as many years of life, or even more, are lost each year to breast cancer as to prostate cancer.
But thirdly, and most importantly, I think it’s a mistake to attack NCI or NIH for not sufficiently funding prostate cancer research. It may well be that, in terms of lives lost per dollar, that we’d be better off taking money away from both breast and prostate cancer and investing it in heart disease, lung cancer, Alzheimer’s Disease, malaria, HIV, and/or other diseases.
Research decisions should not be made based on competing patient advocacy groups, but on the most objective criteria. Breast cancer may indeed have more advocacy behind it than prostate cancer, but I don’t think the solution to that problem is to have more advocacy for prostate cancer or to demand that funds be taken away from breast cancer research and given to prostate cancer research. What I want is for NCI and NIH to make the best decisions they can without regard to advocacy groups – something that is increasingly hard for them to do as everyone pressures them.
If I had a choice, I would take money away from the wars in the middle east and from the tax breaks for corporations and agribusiness, and I would increase taxes on the wealthy who make way more than they need to lead a luxurious life while paying lower tax rates than upper middle class Americans. That’s where I think the money should come from for increased cancer research. The “war on terror” cost us many, many times as much as we’ve spent on all medical research combined, even though terrorism is far, far less dangerous to the average American than cancer, heart disease, or Alzheimer’s Disease.
I hope you’ll publish this comment. I have made comments before and not seen them appear. Perhaps I’m looking for them in the wrong place?
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Thanks for your work on PCa. My criticisms of the concepts in this article are intended to be constructive and supportive of your work – which I much appreciate.