I have lost family and friends to cancer. As a physician, I have cared for more people than I can remember who were fighting the disease. Some people have been successful in their fight. Too many have not. Many who have been “successfully treated” nonetheless end up with lifelong disability from the disease, the associated surgery, or the often quite harsh treatment. Life after cancer can include chronic bone pain, peripheral neuropathy, kidney or liver damage, or “chemo brain.” The hardest cases for me, as both a friend and a caregiver, have been the children.
My experiences are not unique. Cancer is the No. 2 cause of death in Texas1 and across the United States. In 2018 alone, there were more than 120,000 new cases diagnosed and over 41,000 cancer-related deaths in Texas.2 The death rates are 15% higher for African Americans3 than for whites and are not evenly distributed across the state.4 Rates of lung cancer are markedly higher in Northeast Texas5, and cervical6 and liver7 cancers occur in higher rates in South Texas. Cancer is so prevalent that an estimated 40% of men and 38% of women alive today will develop some type of cancer.8
The good news is that things change, and we can be active agents in making sure that they change for the better. The Cancer Prevention and Research Institute of Texas (CPRIT) was established by a voter-supported constitutional amendment in 2007. It is a unique Texas resource, and is now second only to the National Institutes of Health in overall cancer research funding. On Nov. 5, voters will have the opportunity to extend CPRIT’s important work for an additional 10 years and $3 billion. If approved, Texas will continue to lead the nation and the world in the fight against cancer. If the new funding is not approved, far too much of this important work will end.
Reauthorization of CPRIT would do more than keep the ball rolling; it would save lives. (See “Vote for CPRIT,” page 18.)
CPRIT has dedicated 10% of its $280 million per year to grants that promote cancer prevention.9
This has been aimed squarely at the more than half of cancer cases that are attributable to preventable causes like tobacco use, HPV infection, Hepatitis C, and sun exposure. That funding has empowered our fellow Texans to adopt healthier behaviors, better understand their own health and health risks, and protect their children from communicable diseases.
CPRIT funding has led to 5.5 million discrete prevention services in Texas, including vaccines, education and training, genetic testing and counseling, tobacco cessation services, screening for various cancers, and assistance in the care of cancer survivors.
Through these activities, over 16,000 cancer precursors and 3,600 cancers have been detected. Fewer people are smoking cigarettes (though more are using electronic cigarettes, unfortunately). More adolescents are receiving the HPV vaccine. More adults are being diagnosed with, and receiving treatment for, Hepatitis C. Countless lives have been saved and improved.
12% of CPRIT’s research funding has supported childhood cancer research.10
This makes Texas the second-largest funder of childhood cancer research in the nation, after the federal government, and includes substantial funding for better diagnostics, more unified data collection and analysis systems, and breakthrough treatments. At the moment, 8 of 10 children diagnosed with cancer can expect to be cured. We can continue to increase that cure rate, and we can make the lives of childhood cancer survivors longer and better.
Overall, deaths due to cancer are decreasing.11
Against a larger backdrop of declining life expectancy in the United States, this is a cause for celebration. Thanks in large part to the kind of research toward which CPRIT dedicates the lion’s share of its money, the cancer death rate has been steadily declining in both men and women over the past decade. More and better research has led to more and better treatments, including those based on the work of Nobel laureate Jim Allison, PhD, which uses the body’s own immune system to fight its cancers.
Dr. Allison is one of more than 175 researchers who have been recruited to Texas through funding from CPRIT. He and his colleagues across the state are pushing the frontier of research in the biology, development, prevention, and treatment of cancer. Thanks in part to CPRIT funding for research, we now have three National Cancer Institute comprehensive cancer centers in Texas (compared with one before the advent of CPRIT), 43 CPRIT core facilities, dozens of new and expanded biotech companies, thousands of patients in clinical trials, and billions of dollars in additional funding from other sources.
The bill to allow voters to authorize more funding had very strong bipartisan support from both branches of the Texas Legislature, as well as from Gov. Greg Abbott and Lt. Gov. Dan Patrick. The outlook for the reauthorization vote on Nov. 5 is good. But it’s not a lock. Less media attention has been focused this year on CPRIT than during the vote in 2007, and voter turnout is always low in odd years.
I encourage my fellow Texas Medical Association members to take an active role in educating your community on the importance of the CPRIT reauthorization and the need to further cancer prevention and research here in Texas. We can make the lives of the next generation healthier and longer than the last.
David Lakey, MD
Texas Commissioner of Health 2007-2015
1. Stats of the State of Texas. National Center for Health Statistics. https://www.cdc.gov/nchs/pressroom/states/texas/texas.htm
2. American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society; 2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf
3. Cancer Health Disparities in Texas by Race/Ethnicity, 2011-2015. Prepared by the Texas Cancer Registry. Texas Department of State Health Services. https://www.dshs.state.tx.us/tcr/data/disparities/cancer-disparities-in-texas-2011-2015.pdf
4. Death Rate Report for Texas by County. National Cancer Institute/CDC. Created by statecancerprofiles.cancer.gov on 08/29/2019 10:23 am. https://statecancerprofiles.cancer.gov/map/map.withimage.php?48&county&001&001&00&0&02&0&1&5&0#results
5. Death Rate Report for Texas by HSA: Lung & Bronchus, 2012-2016. Created by statecancerprofiles.cancer.gov on 08/29/2019 10:25 am. https://statecancerprofiles.cancer.gov/map/map.withimage.php?48&hsa&001&047&00&0&02&0&1&5&0#results
6. Death Rate Report for Texas by HSA: Cervix, 2012-2016. Created by statecancerprofiles.cancer.gov on 08/29/2019 10:27 am. https://statecancerprofiles.cancer.gov/map/map.withimage.php?48&hsa&001&057&00&2&02&0&1&5&0#results
7. Death Rate Report for Texas by HSA: Liver & Bile Duct, 2012-2016. Created by statecancerprofiles.cancer.gov on 08/29/2019 10:41 am. https://statecancerprofiles.cancer.gov/map/map.withimage.php?48&hsa&001&035&00&0&02&0&1&5&0#results
8. Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2014. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER website, April 2017.
9. CPRIT’s statute limits the agency to using “not more than 10 percent of the money appropriated by the legislature for grants in a state fiscal year may be used for cancer prevention and control programs during that year.” Texas Health & Safety Code Section 102.203(e). CPRIT always requests that the legislature appropriate the maximum amount allowable for prevention program awards.
10. Real Momentum, Measurable Results. CPRIT. https://www.cprit.state.tx.us/media/2063/report_momentum_inserts_08212019.pdf
11. Siegel, Cancer Statistics 2019, Ca A Cancer Journal for Clinicians, Volume 69, Issue1 January/February 2019 Pages 7-34.
Tex Med. 2019;115(10):5-6
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