Cancer Moonshot misses the mark by glossing over prevention, early detection

Earlier this month, President Biden reignited his Cancer Moonshot initiative with a laudable goal of reducing cancer deaths by at least 50% over the next quarter century. The effort is a continuation of the 2016 initiative that focused on groundbreaking research and advances in cancer treatment. Since that launch, the National Cancer Institute reports having invested more than $1 billion in Moonshot programs and research projects.

Nevada Cancer Coalition and many of our public health and clinical partners across the state participated in some of those early Cancer Moonshot meetings and set priorities to look at how we as a unified force could improve the treatment of cancer and reduce deaths in our state. It was not unlike the planning we’d done just months prior to develop the state’s five-year cancer plan. Except, rather than focus on the needs of Nevada, efforts in the Moonshot work focused on the priorities set forth from a national level.

There have been fantastic developments in treatment and research as a result of the first iteration of the Cancer Moonshot, including improvements in immunotherapies that use a person’s own immune system to fight cancer cells. There was even a part of the initiative focused on improving early detection rates and reducing smoking among those diagnosed with cancer. 

Since 2016, the rates of new cancer cases and deaths in Nevada have declined. That’s great news. But while Nevada has some of the lowest cancer incidence rates among the 50 states, ranking 49th, its rate of cancer deaths is nestled firmly in the middle, ranking 27th.  The American Cancer Society estimates 16,390 Nevadans will be diagnosed with cancer this year, and more than one third of those diagnosed—5,730 Nevadans—will die of the disease. 

Groundbreaking research and aspirational national agendas aside, we have a lot more work to do in Nevada when it comes to reducing cancer deaths. But more than that, and what this new Cancer Moonshot largely misses—during National Cancer Prevention Month no less—is that we can make a greater difference in more people’s lives with a focus and investment in cancer prevention and overall public health. Why spend billions to cure a disease when the same amount of money could not only prevent that disease but many others, including heart disease, the nation’s other top killer?

In Biden’s new Moonshot, it’s noted that lessons learned during the COVID-19 pandemic allow us to set ambitious goals. What we clearly learned during the pandemic is that prevention—masking, handwashing, social distancing, and vaccination—reduced many more deaths than did aggressive treatments. 

Prevention is one of those public health activities that has historically been unsexy as compared to miracle drugs and new technologies. The results of prevention, however, are incredibly sexy from the healthcare, economic, and quality of life perspectives. 

The World Health Organization reports, “Between 30% and 50% of cancer deaths could be prevented by modifying or avoiding key risk factors and implementing existing evidence-based prevention strategies.” 

Those prevented cancer deaths include more than just lives saved. They include reductions in burden on what has now become a strained healthcare system with provider shortages and burned-out staff. Cancer prevention results in lower healthcare spending overall, fewer bankruptcies filed by families who’ve faced a cancer diagnosis, and fewer people undergoing treatments that leave them physically and emotionally scarred. 

Moonshot 2.0 also includes a call to action on cancer screenings. We know that during the COVID-19 pandemic, many cancer screenings were missed or dangerously delayed, and many more people need to catch up on their annual check-ups. 

The call to action on cancer screenings is a great start, and as a statewide cancer control nonprofit, we’ve been advocating for people to get screened for years. Organizations like Nevada Health Centers with its mobile Mammovan offer free or reduced cost mammograms, and community health clinics provide cancer screenings at low or no cost based on their sliding fee scale for services. Despite those and other services, Nevada lags in cancer screening for breast, cervical, colorectal, and lung cancers.

To truly improve cancer screening rates, we need to reduce the barriers to screening and improve access in rural and low socio-economic status communities. That translates to expanding federal and state funding, and support for healthcare in these communities through community health and nursing clinics. We need to reduce transportation barriers that exist for many Nevadans by improving transit, locating healthcare clinics closer to where people live and work, and offering solutions such as rideshare or medical transportation for appointments with special transportation needs, such as colonoscopy. We need to provide childcare so women can make time for essential medical services, and provide paid time off of work for people to attend screening appointments. 

Training and recruiting healthcare providers who represent the racial and ethnic diversity of our state is essential, too, and results in improved outcomes, including screening compliance. In fact, improving our state’s healthcare capacity by increasing the number of practicing physicians, nurses, oncologists, and other licensed professionals should be a top priority. 

Finally, it is essential to create mechanisms where people who need additional screening or diagnosis can access those services, and then treatment, without fearing bankruptcy. Why get screened when there’s no way to pay for further diagnostic testing or treatment? 

Fortunately, policy solutions are available to those who have the will to prioritize people and health over profit and the status quo. In Nevada, during the next legislative session we can: 

• Enact comprehensive smoke free policies to reduce exposure to secondhand smoke. A recently published study from researchers at the University of Nevada, Las Vegas projects $500 million in annual healthcare cost savings in Nevada from such a policy. 
• Place bans on flavored vapes, cigarettes, and cigarillos and regulate synthetic nicotine vapes to reduce youth vaping and smoking. Studies show that youth who vape are more likely to become smokers, creating a new generation of Nevadans battling tobacco-related diseases.
• Require and fund comprehensive physical fitness and health education in grades K-12 to reduce the state’s obesity rate and require insurers to cover the cost of anti-obesity medications proven and approved to treat the disease of obesity. Being overweight or obese is linked to 13 types of cancers—about 40% of all cancer cases—according to the Centers for Disease Control and Prevention. 
• Prioritize infrastructure and built environments, such as bike paths and parks, walkable communities, and community grocery stores, that serve to increase physical activity and access to healthy food and shade. 
• Require insurance reimbursement for navigation and cancer care support services to better serve patients and their caregivers, thus improving outcomes for those who are diagnosed with cancer.
• Provide full and consistent funding to public health programs in the state that are working to reduce cancer, including the Nevada Division of Public and Behavioral Health’s Cancer Control, Tobacco Control, and Obesity programs, Women’s Health Connection and Colorectal Cancer Control screening program (which ceased to exist when federal funding ended), and the Nevada Central Cancer Registry.
• Implement a universal health care plan at the state or federal level with comprehensive coverage for tobacco cessation and other prevention measures, evidence-based early detection and diagnostic exams, and cancer treatment, because no one should have to survive cancer only to be bankrupt.