Letter from the Editors

Issue 27 Summer/Fall 2016

As we are currently embroiled in a presidential election season, we can ponder one of the issues that the candidates occasionally address, the cost of healthcare. From the individual citizen's point of view, this has become an increasingly large part of his/her budget, and as healthcare costs have continued to escalate, this cost has necessarily become a consideration in making healthcare decisions for large parts of the U.S. population.

The high costs of cancer care in particular have led to difficult decisions and consequences for many. Obviously, this has been a major issue in the realm of cancer therapy where drug costs and care are skyrocketing.

But what about in the arena of cancer prevention? Traditionally, a major axiom of public health and preventive medicine has been to provide public health measures and interventions at low cost so as to make them readily available to large swathes of the population. Hence, public health officials recommend tobacco cessation, weight loss, physical activity, low-dose aspirin, and the like for purposes of cancer control.

However, medicine is now developing more advanced technology interventions for cancer prevention that are raising the ante and hence the burden on the public, financially speaking. Even such traditional interventions as mammography screening cost over $100, especially when coupled with ultrasounds, not to mention MRIs.

The newly recommended low dose CT scan screening for lung cancer among heavy smokers is certainly a heavier financial cost. And that's before considering the cost of chemopreventive agents for high risk individuals such as the use of aromatase inhibitors for breast cancer prevention, let alone the treatment of hepatitis C for the prevention of liver cancer.

Of course, as with many medical interventions, most of this is made moot for individual patients by medical insurance. Insurance often pays for most of the expenses related to these interventions and removes cost as a barrier. Indeed, studies show, for example, that screening rates decline in people who are 63 or 64 years of age, as they await becoming 65 years old and becoming eligible for Medicare in order to afford the full costs of their procedures.

It is in this spirit that we read the article in this issue of Cancer Prevention which illustrates one impact that Obamacare appears to have had upon cancer screening.

The provision of insurance to those who were formerly uninsured has removed a major barrier to the receipt of effective cancer screening and permits this population to increase its screening rates. Whether Obamacare is the optimal plan by which to achieve these goals we leave to the individual voter, but there can be no clearer demonstration that financial barriers to clearly effective cancer prevention modalities need to be reduced or removed.

The Editors

Andrew J. Dannenberg, MD
Henry R. Erle, MD-Roberts Family Professor of Medicine
Weill Cornell Medical College
Associate Director for Cancer Prevention
Meyer Cancer Center
Co-Director, Cancer Prevention Program
NewYork-Presbyterian Cancer Centers

Alfred I. Neugut, MD, PhD
Myron M. Studner Professor of Cancer Research
Professor of Medicine and Epidemiology
Associate Director for Population Sciences
Herbert Irving Comprehensive Cancer Center
Columbia University College of Physicians and Surgeons and Mailman School of Public Health
Co-Director, Cancer Prevention Program
NewYork-Presbyterian Cancer Centers