Editorial
Cancer is the primary cause of death in many countries, now exceeding heart disease. In lower income countries, incidence is rising fast, creating unprecedented challenges for health systems, many of which were designed in an era that did not foresee, were simply incapable of pre-empting, or knowingly ignored the future. For lower-to-middle income countries, these challenges are multiplied by the double burden of disease—the long-running battle against infection complicated by the rising burden of chronic diseases. Advances in care are allowing patients to live longer, better quality lives. Survival has improved substantially as knowledge of the biology and aetiology of cancer has increased, offering the promise of precision oncology. However, these remarkable achievements come at a price—the cost of care is outpacing national budgets, the numbers of cancer patients and survivors are putting greater pressures on health-care systems, and increasing numbers of vulnerable patients from less traditional demographics, such as children and younger
adults, require different clinical solutions that have yet to be fully conceived. This month, The Lancet Oncology launches a campaign focused on tackling the cancer epidemic at a systems level. This campaign will provide a comprehensive assessment of the necessary changes in patient services and outcomes. We will document, via monthly updates, the evolution of four Commissions intended for publication later this year that aim to define the scale of the challenge, the underlying drivers, and the improvements needed to cancer-care systems. These special reports will cover global access to radiotherapy, surgical resource availability and its fundamental role in cancer treatment, the intersection of primary care in a comprehensive cancer service fit for the 21st century, and the ongoing oncology requirements in the low-to-middle income countries of Latin America. When published, we hope these Commissions will offer practical advice and specific recommendations to help overcome this tremendous health-care challenge. ■ The Lancet Oncology
Stringer/Reuters/Corbis
Tackling the cancer epidemic
To read more about The Lancet Oncology’s cancer campaign and the four Commissions go to http://www.thelancet.com/ campaigns/cancer/
Direct-to-consumer (DTC) advertising is in the headlines again. On Feb 19, 2015, 23andMe was granted approval by the US Food and Drug Administration (FDA) to market a genetic test for Bloom syndrome. And on Feb 25, 2015, the US Federal Trade Commission (FTC) fined two companies for marketing melanoma detection apps (MelApp and Mole Detective) and banned them from making “misleading or unsubstantiated health claims” in the future. Finally, on March 5, 2015, a report in the JNCI concluded that most personalised cancer tests promoted online have no evidence of clinical effectiveness. The decision to permit 23andMe limited access to the DTC market is a remarkable turnaround for a company that on Nov 22, 2013, received an FDA warning letter instructing them to stop all marketing. At that time, the FDA insisted the company seek approval for each specific indication in their pan-genomic test along with robust evidence for each claim—in line with the requirements for other over-the-counter home-use tests. 23andMe have now provided sufficient evidence that its test is accurate to detect Bloom syndrome carrier www.thelancet.com/oncology Vol 16 April 2015
status. This decision is a landmark in the burgeoning field of genomics home-testing. Despite the seeming appropriateness of the decision, it creates an uneasy precedent—one that could open the door to other less reliable tests if the delineations of the ruling are not firmly upheld. Indeed, the FTC’s verdict on the melanoma apps is a useful reminder of the need to ensure consumers are protected from unscrupulous claims. These concerns are further underscored by the JNCI article showing that websites promoting personalised cancer medicine products contain more information about the benefits than the limitations, and most focus on one or more non-standard tests. Ensuring people take an active interest in their health is central to a strong health-care system, but health-care decisions need to be a bilateral process between patients and their doctors. In our December, 2008, editorial, we concluded that “the marketing of tests should be restricted to health professionals, rather than the lay public, and only accessed through health-care providers on the basis of their advice”. That conclusion is still valid today. ■ The Lancet Oncology
Hank Morgan - Rainbow/Science Faction/Corbis
Dangers of direct-to-consumer advertising exposed again
For our previous Editorial on direct-to-consumer marketing see Lancet Oncol 2008; 9: 1113
349
Cancer is the primary cause of death in many countries, now exceeding heart disease. In lower income countries, incidence is rising fast, creating unprecedented challenges for health systems, many of which were designed in an era that did not foresee, were simply incapable of pre-empting, or knowingly ignored the future. For lower-to-middle income countries, these challenges are multiplied by the double burden of disease—the long-running battle against infection complicated by the rising burden of chronic diseases. Advances in care are allowing patients to live longer, better quality lives. Survival has improved substantially as knowledge of the biology and aetiology of cancer has increased, offering the promise of precision oncology. However, these remarkable achievements come at a price—the cost of care is outpacing national budgets, the numbers of cancer patients and survivors are putting greater pressures on health-care systems, and increasing numbers of vulnerable patients from less traditional demographics, such as children and younger
adults, require different clinical solutions that have yet to be fully conceived. This month, The Lancet Oncology launches a campaign focused on tackling the cancer epidemic at a systems level. This campaign will provide a comprehensive assessment of the necessary changes in patient services and outcomes. We will document, via monthly updates, the evolution of four Commissions intended for publication later this year that aim to define the scale of the challenge, the underlying drivers, and the improvements needed to cancer-care systems. These special reports will cover global access to radiotherapy, surgical resource availability and its fundamental role in cancer treatment, the intersection of primary care in a comprehensive cancer service fit for the 21st century, and the ongoing oncology requirements in the low-to-middle income countries of Latin America. When published, we hope these Commissions will offer practical advice and specific recommendations to help overcome this tremendous health-care challenge. ■ The Lancet Oncology
Stringer/Reuters/Corbis
Tackling the cancer epidemic
To read more about The Lancet Oncology’s cancer campaign and the four Commissions go to http://www.thelancet.com/ campaigns/cancer/
Direct-to-consumer (DTC) advertising is in the headlines again. On Feb 19, 2015, 23andMe was granted approval by the US Food and Drug Administration (FDA) to market a genetic test for Bloom syndrome. And on Feb 25, 2015, the US Federal Trade Commission (FTC) fined two companies for marketing melanoma detection apps (MelApp and Mole Detective) and banned them from making “misleading or unsubstantiated health claims” in the future. Finally, on March 5, 2015, a report in the JNCI concluded that most personalised cancer tests promoted online have no evidence of clinical effectiveness. The decision to permit 23andMe limited access to the DTC market is a remarkable turnaround for a company that on Nov 22, 2013, received an FDA warning letter instructing them to stop all marketing. At that time, the FDA insisted the company seek approval for each specific indication in their pan-genomic test along with robust evidence for each claim—in line with the requirements for other over-the-counter home-use tests. 23andMe have now provided sufficient evidence that its test is accurate to detect Bloom syndrome carrier www.thelancet.com/oncology Vol 16 April 2015
status. This decision is a landmark in the burgeoning field of genomics home-testing. Despite the seeming appropriateness of the decision, it creates an uneasy precedent—one that could open the door to other less reliable tests if the delineations of the ruling are not firmly upheld. Indeed, the FTC’s verdict on the melanoma apps is a useful reminder of the need to ensure consumers are protected from unscrupulous claims. These concerns are further underscored by the JNCI article showing that websites promoting personalised cancer medicine products contain more information about the benefits than the limitations, and most focus on one or more non-standard tests. Ensuring people take an active interest in their health is central to a strong health-care system, but health-care decisions need to be a bilateral process between patients and their doctors. In our December, 2008, editorial, we concluded that “the marketing of tests should be restricted to health professionals, rather than the lay public, and only accessed through health-care providers on the basis of their advice”. That conclusion is still valid today. ■ The Lancet Oncology
Hank Morgan - Rainbow/Science Faction/Corbis
Dangers of direct-to-consumer advertising exposed again
For our previous Editorial on direct-to-consumer marketing see Lancet Oncol 2008; 9: 1113
349
