Our strategic plan must also acknowledge that, even optimistically, cancer deaths cannot be reduced to
zero. Patients will die of cancer due to treatment refusal, compliance issues, medical conditions which
interfere with treatment, treatment error, treatment failure for unknown reasons and the development of
additional cancers.
The continued high number of US cancer deaths can be viewed as a management problem that requires
that we optimize each step of cancer’s clinical pathway, as indicated below.
1. We should focus on aggressive cancers that cause the most cancer deaths.
To reduce US cancer deaths by 500,000 per year, we must focus on the leading causes of cancer death,
namely most cancers of the pancreas, lung and liver and aggressive cancers of the colon, breast and
prostate (What will success look like in the war on cancer?).
2. We must make our prevention programs more effective.
Between 30-50% of cancer deaths can be prevented by dramatically reducing tobacco use, excess
weight and lack of cancer screening, avoiding other risk factors and implementing existing evidence
based prevention strategies (World Health Organization, accessed 23Aug21).
* We should promote a national program, such as the American Code Against Cancer, that promotes a
culture of being healthy and reducing risk factors.
* States, local governments, nonprofits, the business community and individuals should develop,
implement or support their own cancer action plans.
* We must optimize access to medical care that reduces cancer deaths. This includes providing this care
to needed patient populations and reducing disparities based on race or ethnicity, region of residence and
socioeconomic status (Ma 2019, Michigan Cancer Plan 2021-2030).
3. We must develop better screening programs for cancers with high mortality.
This includes early detection of lung, pancreatic and liver cancers, detection of aggressive colorectal,
breast and prostate cancers and life threatening second cancers in those currently being treated
(Zaorsky 2017). We should study whether screening for chronic inflammation associated with many
cancers is useful and if so, how best to do it.
4. We must reduce cancer deaths that occur shortly after diagnosis.
Some cancer patients die shortly after diagnosis due to treatment side effects, based on treatment aimed
at killing all cancer cells as quickly as possible. However, focusing instead on managing cancer may
actually be more important and the aggressiveness of treatment should be balanced against patient risk
(Huang 2014). In addition, some patients with cancer die of infections shortly after diagnosis, which
should be anticipated and prevented (Zheng 2021, Van de Louw 2020). Finally, we speculate that
although many patients have advanced disease at diagnosis (McPhail 2013, Suhail 2019), some die
primarily due to disruptions to essential physiologic networks and not due to cancer related destruction of
essential organs (Zaorsky 2017). We should investigate cancer deaths that occur shortly after diagnosis
to determine what physiologic pathways are involved and to create treatment protocols to counter these
changes, similar in concept to creating protocols to treat new onset diabetes presenting with life
threatening ketoacidosis (Curing Cancer Blog - Part 9).
5. For each cancer site and histologic type, we should compile a list of partially effective
treatments and promising malignant attributes to target.
We speculate that for each cancer histologic type, even the most aggressive, there exists a combination
of perhaps 8-10 therapies that individually may be only partially effective but together can be substantially
effective (Curing Cancer blog - Combinations of Therapy).
Life is based on principles of complexity science: the behavior of the whole is greater than the sum of the
behavior of the parts. These extra properties are due to interactions between the parts which are often
unpredictable. Each specific type of cancer is caused by behavioral risk factors or random events that
cause small network changes that slowly percolate across adjoining networks and cause them to change.
Eventually, the accumulation of these small changes may produce bursts of major changes that cause
premalignant conditions and additional bursts may cause overt cancer. Due to the complicated nature of
these network changes, no simple therapy can eradicate all cancer cells and restore order to the large