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Are We Finally Winning the War on Cancer?

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  • David M. Cutler

Abstract

President Nixon declared what came to be known as the "war on cancer" in 1971 in his State of the Union address. At first the war on cancer went poorly: despite a substantial increase in resources, age-adjusted cancer mortality increased by 8 percent between 1971 and 1990, twice the increase from 1950 through 1971. However, between 1990 and 2004, age-adjusted cancer mortality fell by 13 percent. This drop translates into an increase in life expectancy at birth of half a year--roughly a quarter of the two-year increase in life expectancy over this time period and a third of the increase in life expectancy at age 45. The decline brings cancer mortality to its lowest level in 60 years. In the war on cancer, optimism has replaced pessimism. In this paper, I evaluate the reasons for the reduction in cancer mortality. I highlight three factors as leading to improved survival. Most important is cancer screening : mammography for breast cancer and colonoscopy for colorectal cancer. These technologies have had the largest impact on survival, at relatively moderate cost. Second in importance are personal behaviors , especially the reduction in smoking. Tobacco-related mortality reduction is among the major factors associated with better health, likely at a cost worth paying. Third in importance, and more controversial, are treatment changes . Improvements in surgery, radiation, and chemotherapy have contributed to improved survival for a number of cancers, but at high cost. The major challenge for cancer care in the future is likely to be the balancing act between what we are able to do and what it makes sense to pay for.

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File URL: http://www.aeaweb.org/articles.php?doi=10.1257/jep.22.4.3
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Bibliographic Info

Article provided by American Economic Association in its journal Journal of Economic Perspectives.

Volume (Year): 22 (2008)
Issue (Month): 4 (Fall)
Pages: 3-26

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Handle: RePEc:aea:jecper:v:22:y:2008:i:4:p:3-26

Note: DOI: 10.1257/jep.22.4.3
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  1. Laibson, David, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, MIT Press, vol. 112(2), pages 443-77, May.
  2. Gary Becker & Kevin Murphy & Tomas Philipson, 2007. "The Value of Life Near its End and Terminal Care," Levine's Working Paper Archive 122247000000001428, David K. Levine.
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Cited by:
  1. David M. Cutler & Fabian Lange & Ellen Meara & Seth Richards & Christopher J. Ruhm, 2010. "Explaining the Rise in Educational Gradients in Mortality," NBER Working Papers 15678, National Bureau of Economic Research, Inc.
  2. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-doing in a highly skilled profession when stakes are high: evidence from advanced cancer surgery," Working Paper Series 2014:7, IFAU - Institute for Evaluation of Labour Market and Education Policy.
  3. Robert Rosenman, 2011. "The public finance of healthy behavior," Public Choice, Springer, vol. 147(1), pages 173-188, April.
  4. Jon H. Fiva & Torbjørn Hægeland & Marte Rønning, 2009. "Health Status After Cancer. Does It Matter Which Hospital You Belong To?," Discussion Papers 590, Research Department of Statistics Norway.
  5. Datta Gupta, Nabanita & Kleinjans, Kristin J. & Larsen, Mona, 2011. "The Effect of an Acute Health Shock on Work Behavior: Evidence from Different Health Care Regimes," IZA Discussion Papers 5843, Institute for the Study of Labor (IZA).
  6. Heinesen, Eskil & Kolodziejczyk, Christophe, 2013. "Effects of breast and colorectal cancer on labour market outcomes—Average effects and educational gradients," Journal of Health Economics, Elsevier, vol. 32(6), pages 1028-1042.
  7. Laibson, David, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, MIT Press, vol. 112(2), pages 443-77, May.
  8. Cutler, David M. & Lange, Fabian & Meara, Ellen & Richards-Shubik, Seth & Ruhm, Christopher J., 2011. "Rising educational gradients in mortality: The role of behavioral risk factors," Journal of Health Economics, Elsevier, vol. 30(6), pages 1174-1187.
  9. Jay Bhattacharya & Alan M. Garber & Matthew Miller & Daniella Perlroth, 2011. "The Value of Progress against Cancer in the Elderly," NBER Chapters, in: Investigations in the Economics of Aging, pages 203-233 National Bureau of Economic Research, Inc.
  10. Christopher J. Ruhm, 2013. "Recessions, Healthy No More?," NBER Working Papers 19287, National Bureau of Economic Research, Inc.

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