Lessons in Prevention
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By Alfred I. Neugut, as told to Sue Rochman

Lessons in Prevention

What can oncologists learn from their cardiologist colleagues about preventive care?

By Alfred I. Neugut, as told to Sue Rochman


Over the past 15 years, there has been a revolution in the field of cardiology, with both the incidence of and mortality from cardiovascular disease plummeting. There have been improvements in treatment, to be sure. But the main reason we are seeing this decline is due to advances in primary and secondary prevention. As a result, I expect that within the next two years we’ll see cancer replace heart disease as the No. 1 killer in the U.S. This will occur not because cancer mortality has risen, but because cardiovascular disease has declined.

The typical cardiologist is no longer treating only coronary artery disease. Instead, these doctors are spending about half of their time doing prevention work—and that’s sensational. Disease prevention in cardiology includes encouraging patients to adopt lifestyle changes, such as getting more exercise, losing weight and quitting smoking. But preventive medications are also playing a huge role in preventing cardiovascular disease. A large number of people are on anti-hypertensive medications to reduce high blood pressure or on statins to control lipids and reduce cholesterol. We don’t treat hypertension primarily because we care about hypertension itself. We treat it because we don’t want you to get heart disease. And likewise for the lipids. It’s really for cardiovascular prevention.

In cardiology, you can see a dramatic impact from prevention much more quickly than you can in oncology. That’s because the time frame in which these risk factors have an impact is much shorter in cardiology. Cardiologists were able to test anti-hypertensives and lipid-controlling drugs and prove in these beautiful trials that these drugs really reduce mortality, because these drugs reduce your risk of having a heart attack almost immediately.

Oncology isn’t the same. Oncologists have a heck of a time doing those types of trials, because it’s hard to do a study when you want to look at an endpoint that is going to happen in 20 years. It’s almost impossible. And from a scientific perspective, it’s more difficult to prove that things work, and getting a research study off the ground in the first place is very difficult. So something that is fairly commonplace in cardiology is rarely done in oncology, a field in which you have to wait much longer to see the effects.



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