- ‘A natural way to diversify’: Janet Yellen now says Americans should expect a decline in the USD as the world’s reserve currency — what’s really going on and how can you prepare? Yahoo Finance
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Short-Term Inflation Expectations Decline; Perceived and Expected Credit Conditions Mostly Unchanged – FEDERAL RESERVE BANK of NEW YORK – Federal Reserve Bank of New York
- Short-Term Inflation Expectations Decline; Perceived and Expected Credit Conditions Mostly Unchanged – FEDERAL RESERVE BANK of NEW YORK Federal Reserve Bank of New York
- CPI Inflation, Debt Ceiling Deadline and the State of Small Business | Market Takes Dion Rabouin | WSJ
- Americans bracing for higher inflation in the long term, NY Fed survey shows Fox Business
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Ultra-Processed Food May Exacerbate Cognitive Decline, New Studies Show : ScienceAlert
Scientists have known for years that unhealthy diets – particularly those that are high in fat and sugar – may cause detrimental changes to the brain and lead to cognitive impairment.
Many factors that contribute to cognitive decline are out of a person’s control, such as genetics and socioeconomic factors. But ongoing research increasingly indicates that a poor diet is a risk factor for memory impairments during normal aging and increases the risk of developing Alzheimer’s disease.
But when evaluating how some diets may erode brain health as we age, research on the effects of consuming minimally processed versus ultra-processed foods has been scant – that is, until now.
Two recent large-scale studies suggest that eating ultra-processed foods may exacerbate age-related cognitive decline and increase the risk of developing dementia. In contrast, another recent study reported that ultra-processed food consumption was not associated with worse cognition in people over 60.
Although more research is needed, as a neuroscientist who researches how diet can influence cognition later in life, I find that these early studies add a new layer for considering how fundamental nutrition is to brain health.
Lots of ingredients, minimal nutrition
Ultra-processed foods tend to be lower in nutrients and fiber and higher in sugar, fat, and salt compared to unprocessed or minimally processed foods.
Some examples of ultra-processed foods include soda, packaged cookies, chips, frozen meals, flavored nuts, flavored yogurt, distilled alcoholic beverages, and fast foods. Even packaged breads, including those high in nutritious whole grains, qualify as ultra-processed in many cases because of the additives and preservatives they contain.
Another way to look at it: You are not likely to find the ingredients that make up most of these foods in your home kitchen.
But don’t confuse ultra-processed with processed foods, which still retain most of their natural characteristics, although they’ve undergone some form of processing – like canned vegetables, dried pasta, or frozen fruit.
Parsing the research
In a December 2022 study, researchers compared the rate of cognitive decline over approximately eight years between groups of people that consumed different amounts of ultra-processed foods.
At the beginning of the study, over 10,000 participants living in Brazil reported their dietary habits from the previous 12 months. Then, for the ensuing years, the researchers evaluated the cognitive performance of the participants with standard tests of memory and executive function.
Those who ate a diet containing more ultra-processed foods at the start of the study showed slightly more cognitive decline compared with those that ate little to no ultra-processed foods. This was a relatively modest difference in the rate of cognitive decline between experimental groups.
It is not yet clear if the small difference in cognitive decline associated with higher consumption of ultra-processed foods will have a meaningful effect at the level of an individual person.
The second study, with about 72,000 participants in the U.K., measured the association between eating ultra-processed foods and dementia. For the group eating the highest amounts of ultra-processed foods, approximately 1 out of 120 people were diagnosed with dementia over a 10-year period. For the group that consumed little to no ultra-processed foods, this number was 1 out of 170.
Research examining the relationship between health and ultra-processed foods uses the NOVA classification, which is a categorization system based on the type and extent of industrial food processing.
Some nutritionists have criticized the NOVA classification for not having clear definitions of food processing, which could lead to misclassification. They also argue that the potential health risks from consuming ultra-processed foods could be explained by low levels of fiber and nutrients and high levels of fat, sugar, and salt in the diet rather than the amount of processing.
Many ultra-processed foods are high in additives, preservatives, or coloring agents, while also having other features of an unhealthy diet, such as being low in fiber and nutrients. Thus, it is unclear if eating food that has undergone more processing has an additional negative impact on health beyond low diet quality.
For example, you could eat a burger and fries from a fast food chain, which would be high in fat, sugar, and salt as well as being ultra-processed. You could make that same meal at home, which could also be high in fat, sugar, and salt but would not be ultra-processed. More research is needed to determine whether one is worse than the other.
Brain-healthy diets
Even when the processes that lead to dementia are not occurring, the aging brain undergoes biochemical and structural changes that are associated with worsening cognition.
But for adults over the age of 55, a healthier diet could increase the likelihood of maintaining better brain function. In particular, the Mediterranean diet and ketogenic diet are associated with better cognition in advanced age.
The Mediterranean diet emphasizes the consumption of plant-based foods and healthy fats, like olive oil, seeds, and nuts. The ketogenic diet is high in fat and low in carbohydrates, with the primary fiber source being from vegetables. Both diets minimize or eliminate the consumption of sugar.
Our research and the work of others show that both diets can reverse some of these changes and improve cognitive function – possibly by reducing harmful inflammation.
Although inflammation is a normal immune response to injury or infection, chronic inflammation can be detrimental to the brain. Studies have shown that excess sugar and fat can contribute to chronic inflammation, and ultra-processed foods might also exacerbate harmful inflammation.
Another way that diet and ultra-processed foods may influence brain health is through the gut-brain axis, which is the communication that occurs between the brain and the gut microbiome, or the community of microorganisms that live in the digestive tract.
Not only does the gut microbiome help with digestion, but it also influences the immune system, while producing hormones and neurotransmitters that are critical for brain function.
Studies have shown that the ketogenic and Mediterranean diets change the composition of microorganisms in the gut in ways that benefit the person. Ultra-processed food consumption is also associated with alterations in the type and abundance of gut microorganisms that have more harmful effects.
The uncertainties
Disentangling the specific effects of individual foods on the human body is difficult, in part because maintaining strict control over people’s diets to study them over long periods of time is problematic. Moreover, randomized controlled trials, the most reliable type of study for establishing causality, are expensive to carry out.
So far, most nutritional studies, including these two, have only shown correlations between ultra-processed food consumption and health. But they cannot rule out other lifestyle factors such as exercise, education, socioeconomic status, social connections, stress, and many more variables that may influence cognitive function.
This is where lab-based studies using animals are incredibly useful. Rats show cognitive decline in old age that parallels humans. It’s easy to control rodent diets and activity levels in a laboratory. And rats go from middle to old age within months, which shortens study times.
Lab-based studies in animals will make it possible to determine if ultra-processed foods are playing a key role in the development of cognitive impairments and dementia in people. As the world’s population ages and the number of older adults with dementia increases, this knowledge cannot come soon enough.
Sara N. Burke, Associate Professor of Neurobiology and Cognitive Aging, University of Florida
This article is republished from The Conversation under a Creative Commons license. Read the original article.
New study finds 6 ways to slow memory decline and lower dementia risk
While researchers have long known that there is a link between dementia and factors such as social isolation and obesity, the size and scope of the new study adds substantial evidence to a global body of research that suggests a healthy lifestyle may help brains age better.
It also suggests that the effects of a healthy lifestyle are beneficial even for people who are genetically more susceptible to memory decline — a “very hope-giving” finding for the millions of individuals around the world who carry the APOEε4 gene, a major risk factor for Alzheimer’s disease, said Eef Hogervorst, chair of biological psychology at Loughborough University, who was not involved in the study.
Memory naturally declines gradually as people age. Some older people may develop dementia, an umbrella term that can include Alzheimer’s, and generally describes a deterioration in cognitive function that goes beyond the normal effects of aging. But for many, “memory loss can merely be senescent forgetfulness,” write the authors of the BMJ study — like forgetting the name of that TV program you used to love, or that pesky fact you wanted to look up.
Memory loss is no less damaging for being gradual, and age-related memory decline can in some cases be an early symptom of dementia. But the good news, the researchers say, is that it “can be reversed or become stable rather than progress to a pathological state.”
The BMJ study was conducted in China between 2009 and 2019. Researchers conducted tests on over 29,000 people ages 60 and older and then tracked their progress or decline over time — what’s known as a population-based cohort study. Although more than 10,500 participants dropped out of the study over the next decade — some participants died or stopped participating — the researchers still used the data collected from those individuals in their analysis.
At the start of the study, researchers conducted baseline memory tests as well as testing for the APOE gene. They also surveyed participants about their daily habits. Participants were sorted into one of three groups — favorable, average and unfavorable — based on their lifestyle.
The six modifiable lifestyle factors the researchers focused on included:
- Physical exercise: Doing at least 150 minutes of moderate or 75 minutes of vigorous activity per week.
- Diet: Eating appropriate daily amounts of at least seven of 12 food items (fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts and tea).
- Alcohol: Never drank or drank occasionally.
- Smoking: Never having smoked or being a former smoker.
- Cognitive activity: Exercising the brain at least twice a week (by reading and playing cards or mah-jongg, for example).
- Social contact: Engaging with others at least twice a week (by attending community meetings or visiting friends or relatives, for example).
Over the course of the study, the researchers found that people in the favorable group (four to six healthy factors) and average group (two to three) had a slower rate of memory decline over time than people with unfavorable lifestyles (zero to one healthy factor).
People living favorable lifestyles that included at least four healthy habits were also less likely to progress to mild cognitive impairment and dementia.
The results show that “more is better of these behaviors,” says Hogervorst — in other words, the more healthy lifestyle factors you can combine, the better your chances of preserving your memory and staving off dementia.
Notably, this held true even for people who carried the APOE gene associated with a higher risk of Alzheimer’s disease.
“These results provide an optimistic outlook, as they suggest that although genetic risk is not modifiable, a combination of more healthy lifestyle factors are associated with a slower rate of memory decline, regardless of the genetic risk,” wrote the study authors.
The study stands out because of its size and follow-up over time, and because it was conducted in China, whereas “most publications are based on western high income countries,” Carol Brayne, a professor of public health medicine at the University of Cambridge who researches older people and dementia, said in an email.
However, the study authors acknowledge several limitations, including that people’s own reports of health behaviors may not be fully accurate, and that the people who took part in the study were more likely to be leading healthy lives to begin with.
Some of the study’s findings differ from the results of other large studies conducted in the United States and in Europe, says Hogervorst. For instance, the BMJ study found that the lifestyle factor with the greatest effect on reducing memory decline was a balanced diet. Other studies have suggested that diet matters less in old age than physical and mental exercise, says Hogervorst.
Still, its results align with the broad scientific consensus that there is a link between how we live and our cognitive function as we age — and perhaps more important, suggest that it may never be too late to improve your brain health.
“The overall message from the study is a positive one,” Snorri B. Rafnsson, associate professor of aging and dementia at the University of West London, said in an email. “Namely, that cognitive function, and especially memory function, in later life maybe positively influenced by regularly and frequently engaging in different health related activities.”
Six lifestyle choices to slow memory decline named in 10-year study | Memory
A combination of healthy lifestyle choices such as eating well, regularly exercising, playing cards and socialising at least twice a week may help slow the rate of memory decline and reduce the risk of dementia, a decade-long study suggests.
Memory is a fundamental function of daily life that continuously declines as people age, impairing quality of life and productivity, and increasing the risk of dementia.
Evidence from previous research has been insufficient to evaluate the effect of healthy lifestyle on memory trajectory, but now a study suggests that combining multiple healthy lifestyle choices – the more the better – is linked with softening the speed of memory decline.
“A combination of positive healthy behaviours is associated with a slower rate of memory decline in cognitively normal older adults,” researchers from the National Center for Neurological Disorders in Beijing, China, wrote in the BMJ.
Practising multiple healthy lifestyle choices together “was associated with a lower probability of progression to mild cognitive impairment and dementia”, they added.
Researchers analysed 29,000 adults aged over 60 with normal cognitive function who were part of the China Cognition and Aging Study.
At the start of the study in 2009, memory function was measured using tests and people were checked for the APOE gene, which is the strongest risk-factor gene for Alzheimer’s disease. The subjects were then monitored for 10 years with periodic assessments.
A healthy lifestyle score combining six factors was calculated: a healthy diet; regular exercise; active social contact; cognitive activity; non-smoking; and not drinking alcohol.
Based on their score, ranging from zero to six, participants were put into lifestyle groups – favourable (four to six healthy factors), average (two to three healthy factors), or unfavourable (0 to 1 healthy factors) – and into APOE-carrier and non-carrier groups.
A healthy diet was deemed as eating at least seven out of 12 food groups: fruits, vegetables, fish, meat, dairy, salt, oil, eggs, cereals, legumes, nuts and tea.
Writing, reading, playing cards or other games at least twice a week was the second area of healthy behaviour.
Other areas included drinking no alcohol, exercising for more than 150 minutes a week at moderate intensity or more than 75 at vigorous intensity, and never having smoked or being an ex-smoker.
Social contact at least twice a week was the sixth healthy behaviour, including activities such as visiting family and friends, attending meetings or going to parties.
After accounting for factors likely to affect the results, the researchers found that each individual healthy behaviour was associated with a slower-than-average decline in memory over 10 years.
A healthy diet had the strongest effect on slowing memory decline, followed by cognitive activity and then physical exercise.
People with the APOE gene who had healthy lives on the whole also experienced a slower rate of memory decline than those with APOE who were the least healthy.
Overall, people with four to six healthy behaviours or two to three were almost 90% and almost 30% respectively less likely to develop dementia or mild cognitive impairment relative to those who were the least healthy, the BMJ reported.
Dr Susan Mitchell, head of policy at Alzheimer’s Research UK, said: “This is a well-conducted study, which followed people over a long period of time, and adds to the substantial evidence that a healthy lifestyle can help to support memory and thinking skills as we age.
“Too few of us know that there are steps we can all take to reduce our chances of dementia in later life.”
Midriff bulge linked to later physical decline, study says
Editor’s Note: Seek advice from a health care provider prior to starting a workout program.
CNN
—
If you are a man or woman approaching 50, look down at your middle. If you’re like many people, you might have to lean over a bit to see your feet. Yes, it’s the dreadful midriff bulge — that expanding waistline that can often creep up on you as you age, much like a receding hairline or extra wrinkles.
Tough to combat, it almost seems like a rite of passage, just part of the cycle of life, right? But a new study has found that allowing your middle to expand will do more than send you shopping for the next size up in britches -— it can also harm your physical abilities later in life.
The study, which followed 4,509 people who were 45 years old or older in Norway for over two decades, found participants who had a high or moderately high waist circumference at the start of the study were 57% more likely to be “frail” than those with a normal waistline.
But frailty is not that “tottering” elderly person bent over a cane that comes to mind. Instead, frailty includes a poor grip strength, a slower walking speed, overall exhaustion, unintentional weight loss and low physical activity.
People who were obese at the start of the study, defined as having a body mass index (BMI) of 30 and higher, were also 2.5 more likely to be frail than those with normal BMI (18.5 to 24.9), according to the study published January 23, 2023, in the journal BMJ Open.
There could be several reasons, according to study authors. Obesity leads to an increase in inflammation in fat cells, which can damage muscle fibers “resulting in reduced muscle strength and function,” study coauthor Shreeshti Uchai, a doctoral research fellow in nutritional epidemiology at the University of Oslo in Tromsø, Norway, and her colleagues wrote.
The results highlight the need to stay on top of both overall weight gain and any rise in waist circumference, and to broaden the definition of frailty, the authors concluded.
“In the context where the population is rapidly ageing and the obesity epidemic is rising, growing evidence recognises the subgroup of ‘fat and frail’ older individuals in contrast to viewing frailty only as a wasting disorder,” they wrote.
Exercise can help counter the growing frailty that aging may bring. Adults should perform muscle-strengthening exercises involving all major muscle groups on at least two or more days each week, in addition to exercising at least two hours and 30 minutes per week at a moderate intensity, according to the US Department of Health and Human Services’ physical activity guidelines for Americans.
Reducing body fat and building lean muscle can help improve balance and posture, Dr. Nieca Goldberg, the medical director of Atria New York City and clinical associate professor of medicine at New York University’s Grossman School of Medicine, told CNN previously.
To stay strong and healthy, try to do both aerobics and strength exercises.
They “appear to work together and help each other move toward better outcomes,” said Dr. William Roberts, a professor in the department of family medicine and community health at the University of Minnesota Medical School. “A balanced program of strength and aerobic activity is probably best and probably more closely mimics the activities of our ancestors, which helped determine our current gene sets.”
To get started on strength exercises, CNN fitness contributor Dana Santas, a mind-body coach in professional sports, suggests mastering body-weight movements first before moving on to free weights.
– Source:
CNN
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Try this 10-minute body-weight workout
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How Exercise Might Mitigate Age-Related Decline in Skeletal Muscle Structure and Function
Summary: Study reveals exercise is associated with myonuclear remodeling and may contribute to the protective effects of exercise on muscle function throughout the lifespan.
Source: King’s College London
Research has found that exercise is associated with changes to the nucleus in muscle fibres and may contribute to the protective effects of exercise on muscle function throughout the lifespan.
The paper’s authors, from the School of Cardiovascular and Metabolic Medicine & Sciences and the Centre for Human & Applied Physiological Sciences, isolated single muscle fibres from young and older exercise trained individuals.
In particular, they used tissue from young marathon runners and elderly master cyclists – with the latter capable of cycling 100km in under 6.5 hours (with an average age of 76).
Strikingly, they found that myonuclei – commonly referred to as the ‘control centre’ of muscle fibres – were more spherical, less deformable, and contained more of a protein called lamin A than untrained individuals. Parallel studies in mice confirmed changes in lamin A, and showed that myonuclei were stiffer as a result of exercise.
Writing in the Journal of Physiology, they concluded that exercise is associated with myonuclear remodelling, which is preserved in older people, and may contribute to the protective effects of exercise on muscle function throughout the lifespan.
Age-related decline in skeletal muscle function, such as muscle strength and endurance, can result in reduced quality of life. Whilst it is appreciated that exercise can mitigate the decline in muscle function, the precise mechanisms that control this process are not fully understood.
Characterizing the subcellular changes associated with exercise may therefore improve our understanding of how exercise can extend functionality in old age.
Apart from housing the genome of the cell, the nucleus is capable of sensing and responding to physical forces, which can alter nucleus shape and activate cell communication pathways.
Defects in proteins that control the mechanics of nuclei, such as lamin A, are hallmarks of some diseases including heart disease, muscular dystrophy and premature aging disorders.
In these conditions, nuclei are misshapen and more deformable, with aberrant cell communication. However, whether these particular properties are affected in aging and exercise was previously unknown.
The researchers speculated that nuclei in muscle cells, called myonuclei, would show similar abnormalities to laminopathies in aging individuals.
Dr Matthew Stroud, Principle Investigator of the Stroud Lab, said: “Whilst we know that exercise is able to overcome various detrimental aspects of the aging process, our molecular understanding of this is incomplete. Here we used both humans and mice to show that changes to nucleus shape and structure in muscle are strongly associated with exercise.”
As gatekeepers of the genome, nuclei govern cell fate and function, and the nuclear alterations we observed may promote muscle adaptation to exercise. This may help to mitigate muscle dysfunction with age.”
Human lifespan has increased substantially over the past half-century and this trend is projected to continue. One concern, however, is that this has not been accompanied by an equivalent extension of healthspan – the part of a person’s life when they are generally in good health – in old age.
Instead of this, morbidity has been extended, and independence and quality of life has reduced. The authors hope that unraveling the beneficial effects of exercise may guide treatments to improve the healthspan of our ever-expanding aging population.
About this exercise, aging, and muscle function research news
Author: Press Office
Source: King’s College London
Contact: Press Office – King’s College London
Image: The image is in the public domain
See also
Original Research: Open access.
“Myonuclear alterations associated with exercise are independent of age in humans” by Matthew Stroud et al. Journal of Physiology
Abstract
Myonuclear alterations associated with exercise are independent of age in humans
Age-related decline in skeletal muscle structure and function can be mitigated by regular exercise. However, the precise mechanisms that govern this are not fully understood. The nucleus plays an active role in translating forces into biochemical signals (mechanotransduction), with nuclear lamina protein
Lamin A regulating nuclear shape, nuclear mechanics, and ultimately gene expression. Defective Lamin A expression causes muscle pathologies and premature ageing syndromes, but the roles of nuclear structure and function in physiological ageing and in exercise adaptations remain obscure.
Here, we isolated single muscle fibres and carried out detailed morphological and functional analyses on myonuclei from young and older exercise-trained individuals.
Strikingly, myonuclei from trained individuals were more spherical, less deformable, and contained a thicker nuclear lamina than untrained individuals. Complementary to this, exercise resulted in increased levels of Lamin A and increased myonuclear stiffness in mice.
We conclude that exercise is associated with myonuclear remodelling, independently of age, which may contribute to the preservative effects of exercise on muscle function throughout the lifespan.
Live news: UK house prices report first monthly decline since October 2021, ONS says
Global oil demand is set to rise to an all-time high in 2023 after China relaxed its Covid-19 restrictions in a move that could drive crude prices higher in the second half of the year, according to the International Energy Agency.
“Two wild cards dominate the 2023 oil market outlook: Russia and China,” the IEA said in its first monthly oil report of the year. “This year could see oil demand rise by 1.9mn b/d to reach 101.7mn b/d, the highest ever, tightening the balances as Russian supply slows under the full impact of sanctions.”
Russian oil supply had “held steady” in December at 11.2mn b/d despite EU sanctions.
However, the Paris-based IEA forecast that the “well-supplied” global oil market at the start of the year could “quickly tighten” as the western sanctions — particularly an EU ban on the import of refined Russian products from February 5 — took full effect.
The IEA said nearly half of the forecast rise in oil consumption this year would come from China even though “the shape and speed” of China’s reopening remained uncertain.
Beijing’s Covid-19 restrictions, which depressed economic activity last year, meant that Chinese oil demand in 2022 fell for the first time since 1990, declining by an average of 390,000 b/d, its biggest ever annual decline.
But the loosening of quarantine and testing measures in November, followed by Beijing’s abrupt decision to abandon its zero-Covid regime in early December, had already boosted Chinese consumption, the IEA said. Chinese oil demand in November rose by 470,000 b/d compared with October, according to IEA data
The Surprising Reason for the Decline in Cancer Mortality
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Last year, I called America a “rich death trap.” Americans are more likely to die than Europeans or other citizens of similarly rich nations at just about every given age and income level. Guns, drugs, and cars account for much of the difference, but record-high health-care spending hasn’t bought much safety from the ravages of common pathogens. Whereas most of the developed world saw its mortality rates improve in the second year of the coronavirus pandemic, more Americans died of COVID after the introduction of the vaccines than before.
But this week, America finally got some good news in the all-important category of keeping its citizens alive. Since the early 1990s, the U.S. cancer-mortality rate has fallen by one-third, according to a new report from the American Cancer Society.
When I initially read the news in The Wall Street Journal, my assumption was that this achievement in health outcomes was principally due to medical breakthroughs. Since the War on Cancer was declared by President Richard Nixon in 1971, the U.S. has spent hundreds of billions of dollars on cancer research and drug development. We’ve conducted tens of thousands of clinical trials for drugs to treat late-stage cancers in that time. Surely, I thought, these Herculean research efforts are the primary drivers of the reduction in cancer mortality.
As it turns out, however, behavioral changes and screenings seem just as important as treatments, if not more so.
Let’s start with an obvious but crucial point: There is no individual disease called “cancer.” (Relatedly, nothing like a singular “cure for cancer” is likely to materialize anytime soon, if ever.) Rather, what we call cancer is a large group of diseases in which uncontrolled growth of abnormal cells makes people sick and possibly brings about their death. Different cancers have different causes and screening protocols, and as a result, progress can be fast for one cancer and depressingly slow for another.
The decline in cancer mortality for men in the past 30 years is almost entirely for a handful of cancers—lung, prostate, colon, and rectal. Little progress has been made on other lethal cancers.
Consider the diverging histories of two cancers. In 1930, death rates for lung cancer and pancreatic cancer were measured as similarly low among the American-male population. By the 1990s, however, lung cancer mortality had exploded, and that disease became one of the leading causes of death for American men. Since 1990, the rate of lung cancer has declined by more than half. Meanwhile, pancreatic-cancer rates of death rose steadily into the 1970s and have basically plateaued since then.
What explains these different trajectories? In the case of lung cancer, Americans in the 20th century participated en masse in behaviors (especially cigarette smoking) that dramatically increased their risk of contracting the disease. Scientists discovered and announced that risk, then public-health campaigns and policy changes encouraged a large reduction in smoking, which gradually pulled down lung-cancer mortality. In the case of pancreatic cancer, however, the causes are mysterious, and the disease is tragically and notoriously difficult to screen.
Treatments for late-stage lung cancers have improved in the past few decades, according to the American Cancer Society report. But for all the money we’ve spent on treatments, most of the decline in deaths in the past three decades seems to be the result of behavioral changes. Smoking in America declined from a historic high of about 4,500 cigarettes per person per year in 1963—enough for every adult to have more than half a pack a day—to less than 2,000 by the end of the century. It’s fallen further since then.
Another possible factor in declining cancer mortality is better screening, though the question of how much to screen is still contentious. In the early 1990s, doctors started using blood tests that turned up prostate-specific toxins. This period coincided with a decline in prostate cancer. But many positive results from these tests were false alarms, turning up asymptomatic cases that never would have bloomed into serious cancers. As a result, the federal government discouraged these prostate-cancer tests for men in the 2010s. Since then, advanced diagnoses for prostate cancer have surged, and mortality rates have stopped falling—suggesting that the previous testing regime may have been better after all.
This cancer-screening debate could define the next generation of medicine. As I wrote in last year’s “Breakthroughs of the Year,” companies such as Grail now offer blood tests that look for circulating-tumor DNA in order to detect 50 types of cancer. As these kinds of tests become cheaper and more available, they could reduce the mortality of more cancers, just as antigen tests have helped reduce the death rate of prostate cancer. On their face, these advances sound simply miraculous. But deploying them effectively will require a delicate balancing act on the part of regulators. After all, how much information is too much information for patients if many cancer tests detect false alarms? “They sound wonderful, but we don’t have enough information,” Lori Minasian of the National Cancer Institute has said of these tests. “We don’t have definitive data that shows that they will reduce the risk of dying from cancer.”
The Biden administration’s Cancer Moonshot Initiative should heed the lessons of this latest report. Much of the decline in cancer mortality since the 1990s comes from upstream factors, such as behavioral changes and improved screening, even though the overwhelming majority of cancer research and clinical-trial spending is on late-stage cancer therapies. A cure for cancer might be elusive. But a moonshot for cancer screenings and tests might be the most important front in the future war on cancer.
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