By Alanna Kennedy
A New Direction for the American Cancer Society?
Otis Brawley will be the new chief medical officer
By Alanna Kennedy
When oncologist Otis Brawley takes the reins as chief medical officer of the American Cancer Society (ACS) on Nov. 1, he will hold “one of the most important positions in all of the American Cancer Society,” says John R. Seffrin, the society’s chief executive officer. Brawley, who will replace retiring chief medical officer Harmon J. Eyre, will oversee research programs, cancer control (the best strategies in prevention, early detection, treatment and patient support) and medical affairs for the cancer society. Brawley will also join the team responsible for “the strategic direction of the entire institution,” says Seffrin.
Brawley plans to use his new position “to create a dialogue” with politicians about health disparities and insurance coverage. “There are a number of people with illnesses who cannot afford complete care or cannot afford care at all,” he says, and politicians must deal with the problem. “Seven percent of black women in metropolitan Atlanta who are diagnosed with a localized, curable breast cancer don’t get it cured; they don’t get it surgically removed,” says Brawley. “On the other end, we have a group of folks who are overscreened and in some instances overtreated.” This kind of disparity prevents people from getting the best evidence-based treatment, he says.
According to Seffrin, Brawley’s interest in health disparities played a role in his being hired by the ACS. Brawley “has done important research on disparities and on how to reach the underserved communities,” says Seffrin. “I’d be hard-pressed to come up with anyone who would be more ideally suited.”
Brawley brings to the society 20 years of experience as an oncologist. He has worked most recently as a professor and the deputy director for cancer control at Emory University in Atlanta, and as the director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital, also in Atlanta. Along with a group of other scientists, Brawley helped to shape the ACS’s cancer screening guidelines in 1997 and 2000.
Some of Brawley’s opinions on screening have been controversial. For instance, Jim Williams, a prostate cancer survivor and patient advocate with the Pennsylvania Prostate Cancer Coalition, disagrees with the oncologist’s position questioning the usefulness of screening for prostate cancer using the prostate-specific antigen (PSA) test, which monitors the concentration of PSA protein in a man’s blood. An elevated PSA level may be a red flag signaling cancer, but is also found to be high in many men without the disease. Brawley has been outspoken about his doubts that using the test for screening improves prostate cancer survival rates.
Another patient advocate, two-time breast cancer survivor Jane Perlmutter, says she was pleased to hear that the ACS has hired someone with skepticism about screening. “I think there are actually some harms associated with it,” she says. “We mislead ourselves and we spend a lot of money. And there are a lot of people with questionable diagnoses who get treated for diseases that won’t amount to anything.”
If ACS funds are directed toward improving access to care, rather than promoting screening, says Perlmutter, it could greatly reduce heath disparities. “If everybody in our country had the best possible evidence-based cancer care ... we could make significant strides in reducing the cancer burden.”
Brawley hopes to make such strides. “This job is one of the best jobs in the U.S. in cancer control where you can have a significant impact,” he says. “One of the most important things I think we can do over the next several years is make health care into an issue for the politicians to deal with.”