The weekend Journal has this very fine article –

Why We’ll Never Cure Cancer – WSJ.com – Your odds of survival depend heavily on your physician

You may not be able to access the article through the link – it may be in the subscriber-only section. If you can’t, I have posted the entire article in the post continuation -just hit the link below –

Here’s an excerpt –

Recently the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society trumpeted a 2% annual decline in cancer mortality rates as proof that the progress we are making in cancer research is benefiting patients. I think they’re celebrating the glass being 1/50th full.

To be sure, scientists have made tremendous scientific advances in prevention, early detection and management of cancer. But these organizations should decry the inability of the health-care system to deliver these advances to the patients who need them.

The article goes on to give examples, such as colon, breast, and prostate cancer. It’s written by a Sloan Kettering physician.

Why We’ll Never Cure Cancer

Recently the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society trumpeted a 2% annual decline in cancer mortality rates as proof that the progress we are making in cancer research is benefiting patients. I think they’re celebrating the glass being 1/50th full.

To be sure, scientists have made tremendous scientific advances in prevention, early detection and management of cancer. But these organizations should decry the inability of the health-care system to deliver these advances to the patients who need them. The gaps are glaring:

According to the government’s Agency for Healthcare Research and Quality, however, only four in 10 people who should be screened have ever gotten a colonoscopy or similar test to look for precancerous polyps — in part because doctors forget to recommend the test to patients who should have it.

Even for those who do get colonoscopies, the quality is uneven. Not all colonoscopists (doctors who perform colonoscopies) are good at finding the precancerous polyps in the colon.

In a study published this year in the American Journal of Gastroenterology, researchers reported that the most-skilled colonoscopists found pre-cancerous growths in 40% of the patients they tested, but the least-skilled found polyps in only 15% of those screened. When it came to the most concerning types of polyps, the most-skilled doctors found more than three times as many of them. The authors concluded that the most important predictor of whether a patient actually benefits from having a colonoscopy is the ability of the doctor who does the test.

Five years ago, my colleagues and I published a study in the New England Journal of Medicine showing that only very experienced surgeons actually achieve the low complication rates that all patients deserve. This summer, a study in the Journal of the National Cancer Institute showed that experienced surgeons who have done 250 or more prostate surgeries are also very good at achieving cancer control — almost twice as good as those surgeons who have performed relatively few operations in their career (around 10 or so).

If inexperienced surgeons were the exception, this would not be a big problem, as most prostate cancer patients would be getting the best medicine had to offer. But this is not the case.

In New York State in 2002, the average prostate surgeon performed fewer than four operations, and there were 114 surgeons who did only one prostate operation. In other words, even though expertise is needed to deliver an important treatment that should have low complications and high success rates, there is nothing that ensures that men with prostate cancer can have access to such expertise.

Figuring out which women should get Herceptin is the key to personalizing this treatment, yet this is not being done as well as it should. At the American Society for Clinical Oncology conference meeting this year, we learned that about 10% of the time tumors that are reported to be positive, and thus should respond to Herceptin treatment, are in fact negative. There was another study suggesting that 20% of the tumors that the tests say are negative may actually still respond to Herceptin. So one of the most important advances in personalized breast-cancer treatment may be going to women it shouldn’t, and not going to women it should.

Yet, a study in the New England Journal of Medicine in 2000 reported that in our system, pharmacies don’t actually stock many of the medications doctors prescribe for cancer pain. The shortfalls are most profound in poor and black communities where lung cancer is also more prevalent. Three quarters of pharmacies in poor neighborhoods do not have adequate supplies of cancer pain medications.

In the interviews surrounding the announcement about cancer death rates, most observers argued that more spending on research was urgently needed, to build on the scientific advances that have been made. That’s right. We should also be spending more, much more, to ensure that scientific advances benefit patients.

When a new screening test is developed, we should make sure that patients find their way to doctors who can perform it. When a new targeted therapy is discovered, we should make sure the right patients get it. When a drug that can relieve a person’s pain is proven to work, we should make sure it is sitting on every pharmacist’s shelf. If we address these problems, we’ll have a real reason to celebrate.

Dr. Bach is a physician at Memorial Sloan-Kettering Cancer Center in New York City, and a member of the National Cancer Policy Forum of the Institute of Medicine. He formerly served as senior adviser to the administrator of the Centers for Medicare and Medicaid Services in Washington, D.C.