COVID vs Cancer: Reflecting on 2020

I consider 2020 to be the death of nuance in the US. It didn’t help that it was a presidential election year, and partisan accusations about the response to the COVID-19 pandemic further divided a fearful nation.

Polarization was rife across conventional news outlets and fueled by social media. It was possible to stay inside one’s own bubble of information and never meaningfully be exposed to opposing viewpoints. Perhaps more than ever, people are coexisting with different worldviews. It is an existential crisis of the highest order when neighbors may not share the same reality with which to converse.

History teaches that neither side of any extreme is the sole arbiter of truth. No single political party, religion, or economic model can provide all the answers to all people. Thus, we are left with the uncomfortable yet necessary task of practicing tolerance at a minimum, but ideally putting forth effort to expand one’s intellectual and emotional horizons with informed nuance.

In terms of the pandemic, the extremes are selfishness and self-righteousness. On the one hand is a failure to acknowledge the gravity of the health crises that resulted in an overburdening of the medical system. On the other hand, leading from a place of gripping fear of the pandemic has created public policy that resulted in significant fallout in overall societal health. Each extreme leads to excess suffering with only a harm reduction model providing the ideal blend of quarantine strategies while maintaining many of the moving parts of socioeconomic life. This is a rational conclusion, but one that requires a nuanced approach.

With that foundation laid, I wish to share a nuanced perspective as a cancer patient and clinician caring for cancer patients during a pandemic. As 2020 came to a close, COVID-19 resulted in a purported 350,000 deaths in the US. This disease has unequivocally caused a significant impact on excess mortality in 2020, but the total mortality from SARS-CoV-2 as a percentage of total cases is less than 2% (and trending downward).

Comparatively, cancer in the US resulted in over 600,000 deaths in 2020, as it has for many years prior. Cancer deaths are predicted to increase in the decades ahead, potentially affecting 1 out of every 2 or 3 people in their lifetime. This is further compounded by those who were forced to delay oncology treatment or early detection screening because of the pandemic.

We don’t yet have a firm estimate on what that fallout looks like in the US, but in the UK, delays to cancer diagnosis and treatment may result in upwards of 35,000 extra deaths. That is not an insignificant number for such a small country. I first read about the massive backlog in the UK’s National Health Service in an opinion piece by professor Val Curtis, director of the environmental health group at the London School of Hygiene and Tropical Medicine. Sadly, professor Curtis has since passed away, but her account is a haunting reminder of how the epidemic of cancer has intensified with the added pressure of a pandemic.

One way or another, this pandemic will be under control, presumably through some combination of vaccination and herd immunity. Meanwhile, the epidemic of cancer rips through the modern world killing countless millions. Think about it: How many people do you know personally that died of COVID-19 versus cancer? Moreover, how does Operation Warp Speed produce an astounding mobilization of the pharmaceutical industry while the war on cancer initiated by Nixon in the 70s has done little to slow the cancer epidemic?

The answer to that question is varied and, no surprise, nuanced. Take for an example a cognitive and behavioral blindspot regarding cancer. The cognitive blind spot is the conjecture that genetic defects cause cancer, so called the somatic mutation theory. Jason Fung, MD deftly dismantles this fallacy in his 2020 publication, The Cancer Code:

Genetic mutations may explain the mechanism of how cancers keep growing, but they do not explain the fundamental question of why these genes mutated. The [somatic mutation theory] fails because it is entirely inward-looking, toward our genes, instead of outward-looking, toward the environment. But so many different environmental attributes obviously affect cancer risk. The seed is important, but the soil matters more. 

There is an obvious and massive problem with the assumption that oncogenes underlie cancer formation. To do so presupposes that the cause of cancer is beyond one’s control. The emerging science of epigenetics is very clear in countering this blind spot by stating that genes may load the gun, but environmental and lifestyle influences pull the trigger.

The behavioral blind spot is as apparent as it is disheartening, and it plays upon the aforementioned cognitive blind spot. Simply put, people are their own worst enemy when it comes to being healthy. With the resignation that cancer is an unavoidable feature of unlucky genetics, the abuse of the human frame can be perpetrated perpetually.

Addictions run rampant to satiate the pain of human experience: smoking, drinking alcohol, eating junk food, etc. Carcinogenic behavior abounds, but make no mistake, these self-destructive behaviors are at the root of most all human ills, including the severity of response to the virus that causes COVID-19. What’s different is that few are resigned to die from the new coronavirus kid on the block while society has, at least in part, accepted death from cancer as unassailable.

2020 has passed and many would sooner forget that it ever happened. If you are one of the 98% of people who contracted SARS-CoV-2 and lived to tell the tale, don’t lose the lesson. Don’t be cavalier. Don’t feel fragile, either. Be empowered to take control of your health. The COVID-19 pandemic will pass, but the cancer epidemic is an ever-present reminder of the razor’s edge of nuance with human health.

January 28, 2021

Categories: Cancer, Social Medicine

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