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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.

Suggested Citation

  • David M. Cutler, 2008. "Are We Finally Winning the War on Cancer?," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 3-26, Fall.
  • 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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    File URL: http://www.aeaweb.org/articles.php?doi=10.1257/jep.22.4.3
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    References listed on IDEAS

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    1. 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.
    2. repec:aph:ajpbhl:1997:87:5:755-759_9 is not listed on IDEAS
    3. David Laibson, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, Oxford University Press, vol. 112(2), pages 443-478.
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    Cited by:

    1. Dubois, Pierre & Kyle, Margaret K, 2016. "The Effects of Pharmaceutical Innovation on Cancer Mortality," CEPR Discussion Papers 11487, C.E.P.R. Discussion Papers.
    2. 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.
    3. J.-Matthias Schulenburg & Martin Frank, 2015. "Rare is frequent and frequent is costly: rare diseases as a challenge for health care systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(2), pages 113-118, March.
    4. Howdon, Daniel & Jones, Andrew M., 2015. "A discrete latent factor model for smoking, cancer and mortality," Economics & Human Biology, Elsevier, vol. 18(C), pages 57-73.
    5. Kadiyala Srikanth & Strumpf Erin, 2016. "How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 87-139, June.
    6. 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, Center for Labor Studies 2014:9, Uppsala University, Department of Economics.
    7. 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.
    8. Thomas Barnay & Mohamed Ali Ben Halima & Emmanuel Duguet & Christine Le Clainche & Camille Regaert, 2016. "The effects of breast cancer on individual labour market outcomes: an evaluation from an administrative panel," TEPP Working Paper 2016-05, TEPP.
    9. Thomas C. Buchmueller & Léontine Goldzahl, 2018. "The Effect of Organized Breast Cancer Screening on Mammography Use: Evidence from France," NBER Working Papers 24316, National Bureau of Economic Research, Inc.
    10. Avdic, Daniel & Lundborg, Petter & Vikström, Johan, 2014. "Learning-by-Doing in a High-Skill Profession when Stakes are High: Evidence from Advanced Cancer Surgery," Annual Conference 2014 (Hamburg): Evidence-based Economic Policy 100278, Verein für Socialpolitik / German Economic Association.
    11. Michael Chernew & David M. Cutler & Kaushik Ghosh & Mary Beth Landrum, 2016. "Understanding the Improvement in Disability-Free Life Expectancy in the U.S. Elderly Population," NBER Chapters,in: Insights in the Economics of Aging, pages 161-201 National Bureau of Economic Research, Inc.
    12. repec:eee:jhecon:v:58:y:2018:i:c:p:151-175 is not listed on IDEAS
    13. Jon H. Fiva & Torbjørn Hægeland & Marte Rønning, 2009. "Health Status After Cancer. Does It Matter Which Hospital You Belong To?," Discussion Papers 590, Statistics Norway, Research Department.
    14. David Laibson, 1997. "Golden Eggs and Hyperbolic Discounting," The Quarterly Journal of Economics, Oxford University Press, vol. 112(2), pages 443-478.
    15. 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.
    16. Seabury Seth A. & Goldman Dana P. & Lakdawalla Darius N. & Gupta Charu N. & Khan Zeba M. & Chandra Amitabh & Philipson Tomas J., 2016. "Quantifying Gains in the War on Cancer Due to Improved Treatment and Earlier Detection," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 141-156, June.
    17. Ruhm, Christopher J., 2015. "Recessions, healthy no more?," Journal of Health Economics, Elsevier, vol. 42(C), pages 17-28.
    18. Robert Rosenman, 2011. "The public finance of healthy behavior," Public Choice, Springer, vol. 147(1), pages 173-188, April.
    19. Shurtz, Ity & Brzezinski, Amnon & Frumkin, Ayala, 2016. "The impact of financing of screening tests on utilization and outcomes: The case of amniocentesis," Journal of Health Economics, Elsevier, vol. 48(C), pages 61-73.
    20. Dubois, Pierre & Kyle, Margaret, 2016. "The Effects of Pharmaceutical Innovation on Cancer Mortality Rates," TSE Working Papers 16-688, Toulouse School of Economics (TSE).
    21. Datta Gupta, Nabanita & Kleinjans, Kristin J. & Larsen, Mona, 2015. "The effect of a severe health shock on work behavior: Evidence from different health care regimes," Social Science & Medicine, Elsevier, vol. 136, pages 44-51.
    22. 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.
    23. Kolodziejczyk, Christophe & Heinesen, Eskil, 2016. "Labour market participation after breast cancer for employees from the private and public sectors: Educational and sector gradients in the effect of cancer," Economics & Human Biology, Elsevier, vol. 21(C), pages 33-55.
    24. 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).
    25. Bertoni, M.; Corazzini, L.; Robone, S.;, 2017. "The Good Outcomes of Bad News. A Randomized Field Experiment on Formatting Breast Cancer Screening Invitations," Health, Econometrics and Data Group (HEDG) Working Papers 17/27, HEDG, c/o Department of Economics, University of York.

    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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