Cancer is the leading cause of death in North Carolina. This issue of the NCMJ discusses cancer prevention, screening, treatment, and survivorship; disparities in incidence and mortality; and ethics of clinical trials. Highlighting the importance of comprehensive data for understanding cancer, original articles in this issue address how medical homes can reduce health care utilization among breast cancer patients and how distance to care affects receipt of radiation therapy.
Pushing Back Against the Long Shadow of Cancer
In his Pulitzer Prize–winning book The Emperor of All Maladies, oncologist Siddhartha Mukherjee presents a “biography” of cancer. Mukherjee describes the complex and evolving interactions between environment, race, sex, and genes that not only cause our cells to mutate and turn on us but also thwart and confuse the scavenging cells that ought to clean of us the aberration. In his descriptions, Mukherjee humanizes cancer by fleshing out the “personality” of this disease that devours flesh and steals hope.
A diagnosis of cancer instills fear in patients, physicians, and those who are not directly affected by the disease. We look the other way. But the epidemiology of cancer is personal. Families share ominous genomes. Where we call home affects our survival. Our relatives, residence, sex, race, ethnicity, behaviors, and lifestyles all offer a murky and sinister prediction of cancer incidence and survival. Unfortunately, cancer is guilty of discrimination, as it disproportionately affects poor and minority individuals, and treatment options may be limited by availability, bias, and cost.
This issue of the NCMJ offers insights into how we employ drugs, data, and ingenuity to address cancer. This issue discusses various aspects of treatment, as well as prevention, response, and responsibility. While cancer remains the leading cause of death in North Carolina, this issue offers hope and promise. Screening, detection, and treatment are not our only options; prevention is also possible.
Even when cancer cannot be prevented, more and more of our neighbors, friends, family, and patients are living in remission from cancer or are living longer with cancer. Compassion for cancer survivors is paramount—both for those living with the disease and for those living with its memory. Finally, hospice and palliative care can offer relief for all who are affected by this disease. By restoring dignity, we can push back against the long shadow that cancer casts over both patients and families alike.
This issue inspires and renews our convictions. We too have biographies to be written.
Peter J. Morris, MD, MPH, MDiv
Editor in Chief