Public health advocates urge action on menthol, applaud accomplishments like patient navigation as Biden administration celebrates 2-year anniversary of ‘cancer moonshot’

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As the Biden administration celebrated the two-year anniversary of its Cancer Moonshot initiative Friday, public health experts applauded its accomplishments, such as ensuring insurance coverage of cancer navigators and the establishment of ARPA-H—a governmental agency that funds cutting-edge biomedical research.

They also vehemently urged the Biden administration to ban menthol cigarettes, a move they say could help the program achieve a good portion of its mission—to prevent 4 million cancer deaths by 2047—in one fell swoop.

Dr. Danielle Carnival—deputy assistant to the president for the program—told Fortune she had no word of movement on the potential prohibition, a surprisingly hot button issue in a contentious election year. Public health experts have long said that such action could save hundreds of thousands of lives in a matter of decades. 

Instead, Carnival emphasized the administration’s efforts to decrease smoking and promote cessation services. When asked if a menthol ban would indeed be enacted—and if so, when—she replied, “I think we’re still in the rulemaking” process before referring additional questions on the matter to the U.S. Food and Drug Administration.

The FDA has not responded to a request for comment on the matter.

Karen Knudsen, CEO of the American Cancer Society, told Fortune that while she celebrates Cancer Moonshot’s achievements, there is no “scientific rationale behind” delaying a menthol ban, adding that the proposed action has been “on the table for entirely too long.”

The potential ban is currently in the hands of the Biden administration, with the FDA requesting a year to implement it, if approved. Given the lead time required, proponents of such a ban recently decried the White House’s lack of action ahead of Jan. 20, the day on which inauguration is held after a presidential election. If action is eventually taken, the ban won’t be implemented before the next president is sworn in—and depending on politics, may never occur.

Every day a decision on the matter is delayed, “more lives are lost,” Dr. Georges Benjamin, executive director of the American Public Health Association, told Fortune

“While I understand that neither [Carnival] nor the FDA can respond because the issue is still in the rulemaking process, this is an important decision that will save lives,” he said.

The ACS “very strongly urges the White House to finish the job,” Knudsen said. “If he (Biden) really wants to complete the moonshot, this is something within their grasp.”

‘Good policy is good politics’

For two decades, public health activists have pushed for a ban on menthol, which has been added to some cigarettes since the 1920s to make smoke feel cooler and more pleasant to inhale. It also boosts nicotine’s addictive effect. A majority of Black smokers (85%) use menthol cigarettes compared to 29% of white smokers, according to data from the 2018 National Survey on Drug Use and Health. 

That’s because the industry aggressively markets menthol tobacco products to Black consumers, public health advocates say, offering free products in predominantly Black communities and sponsoring events geared toward Black audiences.

In a Nov. 16 statement on tobacco as a global public health issue, the World Health Organization said menthol, along with “flavored cigarettes and candy-flavored e-cigarettes with eye-catching designs” have made such dangerous products more appealing to youth. Many consumers are unaware that tobacco use causes 25% of all cancer and kills over 8 million people each year, it added.

With the exception of menthol, flavored cigarettes were banned in the U.S. when President Barack Obama signed the Family Smoking Prevention and Tobacco Control Act into law in 2009.

A ban on menthol in cigarettes was initially proposed in 2013, under the Obama administration, but didn’t receive further traction until two years ago, under the Biden administration. The move is a politically tricky one for Biden, especially during an election year. Some civil rights leaders with ties to the tobacco industry, like the Rev. Al Sharpton, have expressed concerns that a ban would criminalize the products and fuel potentially deadly interactions with law enforcement.

But the NAACP, the Congressional Black Caucus, and countless other organizations—in addition to public health officials—have endorsed the ban, emphasizing that while the proposed rule would make the sale and manufacture of menthols illegal, it would do nothing to prevent consumers from owning or using them. The proposed rule itself says the regulation “does not include a prohibition on individual consumer possession or use, and FDA cannot and will not enforce against individual consumers for possession or use of menthol cigarettes.”

“FDA’s enforcement will only address manufacturers, distributors, wholesalers, importers, and retailers,” it reads. “State and local law enforcement agencies do not independently enforce the Federal Food, Drug, and Cosmetic Act. These entities do not and cannot take enforcement actions against any violation.”

Menthol bans have already been enacted on a state level in Massachusetts and California, Knudsen said, calling them “real-life living experiments” that have proven the initiative’s feasibility and safety for individual citizens, who are in no way the target of such a policy.

Benjamin agreed.

“The bulk of the African American and civil rights community, as well as the health community, are behind the FDA proposal,” he said. “So banning menthol is the right policy decision. Good policy is good politics.”

Knudsen says the ACS doesn’t “fully understand” why the White House is hesitant to take action on the matter, noting that while it is an election year, the issue should be an apolitical one.

“Certainly the Biden administration is very proud of what they’ve accomplished,” she said. “We’ve accomplished so much together in the last two years. This is something that is so well established in terms of rationale and feasibility. It’s within their grasp. We don’t understand why they’re reluctant to implement it.”

Patient navigators a ‘game changer’ for cancer patients

Knudsen was quick, however, to laud what many say is one of the Cancer Moonshot’s crowning achievements: putting in place billing codes that health insurers, including Medicare, can use to get reimbursed for patient navigation services. 

First lady Jill Biden announced the move in a November briefing, saying that navigators are key to the achievement of positive patient outcomes, helping those with the condition adhere to treatment and access the latest clinical trials they may otherwise be unaware of, due to a lack of health literacy or other factors.

Thanks to such workers, cancer patients are able to spend more time at work and school—and with family—because their symptoms are well controlled, and may even sometimes forget they have cancer, Jill Biden said at the time.

Knudsen agrees with Biden, saying that cancer patients with navigators “understand their care, complete their care as planned, and have better outcomes.” If she could wave a magic wand, she added, one of her greatest wishes would be that “every person who hears, ‘You have cancer,’” next hears, ‘Here’s how you contact your patient navigator.’”

“When I look at Moonshot, I put a giant circle around patient navigation and say that was a win that’s going to accelerate its goals and reduce mortality from cancer.”

Cutting-edge medical research center found bipartisan support

Among Moonshot’s other accomplishments over the past two years, according to Carnival: 

  • establishing a presidential “cancer cabinet”
  • expanding access to cancer screenings
  • limiting out-of-pocket costs for for prescription drugs to $2,000 a year for Medicare patients through the Inflation Reduction Act, a benefit particularly helpful to cancer patients
  • reducing hazardous environmental exposures by cleaning up toxic sites and replacing water lines through the Bipartisan Infrastructure Law
  • screening more than 5 million veterans for toxic exposures like burn pits through the PACT Act
  • driving new cancer-prevention efforts, like smoking cessation resources and accelerated nutrition research

One of its top accomplishments, in her opinion: the 2022 establishment of the Advanced Research Projects Agency for Health, or ARPA-H—a governmental agency that aims to advance “high-potential, high-impact biomedical and health research that cannot be readily accomplished through traditional research or commercial activity.” It does so by issuing grants to innovative researchers through a streamlined awards process.

The agency, nested under the U.S. Department of Health and Human Services, “was realized with $2.5 billion in bipartisan support,” Carnival said. Researchers across the country, she added, are able to contribute their research ideas and advocate for areas of need, “and then become a part of the science, research, and implementation of … innovation.”

Rising diagnoses, disturbingly among the young

As for the country’s rising number of cancer cases—the ACS projects that diagnoses will cross the 2 million mark for the first time this year—Carnival said the pandemic posed a setback, preventing 10 million preventative cancer screenings.

“The good news is we’re back on track for cancer screenings,” she said. “But we want to make sure we’re doing even better. We have to look at the long haul of this.”

Knudsen is of a similar mind, saying that while cancer screenings are recovering from pandemic lows, the U.S. “still hasn’t made up for the people who weren’t screened during COVID.”

Both are worried about the growing number of younger individuals—those under 50—who are being diagnosed with cancer. In 1995, 61% of cancer diagnoses were among those ages 65 and older. But by 2020, that share had dropped to 58%. From 1995 through 2020, the under-50 age group was the only to see increase in cancer rates.

Colorectal cancer has become particularly concerning among younger Americans. In the late 1990s, the cancer was the fourth leading cause of cancer death among men and women under 50. Now, it’s the leading cause of cancer death for men under 50, and the No. 2 cause for women.

Scientists speculate that lifestyle factors particularly common among those born in 1950 and later—like obesity, high consumption of processed meat and alcohol, low levels of physical activity and fiber consumption, and smoking—are fueling the phenomenon.

But something is amiss, both Carnival and Knudsen admit. Such factors can’t fully explain the disturbing rise, and more research is needed, they said.

Both also agree that cancer is more of a marathon than a race. Looking at the battle through such a lens, “there’s a lot of reasons to have hope,” Carnival said.

Knudsen shares that hope, highlighting the fact that last year, the U.S. saw a “staggering” 65% reduction in cervical cancer in women between the ages of 20 and 24—the first generation to be vaccinated against HPV.

“This gives us the first real-world evidence that people vaccinated—including my son, who was one of the first boys—will be protected against six HPV-driven cancers,” including anal, cervical, oropharyngeal, penile, vaginal, and vulvar, she said. “This is massive. This is a huge win.”

Recently released research—highlighted by The Lancet Oncology this past week—found that no new cases of cervical cancer had been detected in Scotland among anyone who had received the HPV vaccine when they were 12- or 13-years old. Lead researcher Dr. Tim Palmer, of Public Health Scotland in Glasgow, told the publication that the country is “well on the way to eliminating cervical cancer in young women,” Knudsen pointed out.

If everyone in the U.S. eligible for the HPV vaccine received it, “we would end cervical cancer as we know it for the entire generation,” she said. “I don’t know a parent alive who wants their child to grow up and get a cancer that could have been prevented.”

The success should inspire scientists, medical professionals, and public health officials to “think more boldly about new interventions that can lead to cancer prevention,” she said. “Prevention is key. We need to strive toward that as much as humanly possible.”

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