How Healthy Is John McCain?

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Main Category: Dermatology
Also Included In: Seniors / Aging;  Cancer / Oncology
Article Date: 25 Oct 2008 - 0:00 PST

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A correspondence article published in a recent edition of The Lancet probes the issue of US presidential candidate John McCain's health. The senator from Arizona has a history of the skin cancer melanoma, and there has been much debate in the media regarding the age and health of the 72-year-old.

The correspondence was independently funded and penned by Dr John Alam of Cambridge, MA, USA, a registered Democrat who has contributed financially to the Obama campaign as well as the Democratic National Committee. Dr Alam addresses the two prevailing arguments surrounding Mr McCain's health. Some believe that health history and age are non-issues and the senator is fit and ready to be president. Others maintain that there is a probability that if elected, he could die in office and leave the country in the hands of Sarah Palin.

About eight years ago, John McCain began his battle with skin cancer. In August 2000, physicians removed a high-risk skin tumour (cutaneous melanoma). Regarding this event, Dr Alam writes that, "McCain's physicians provided a brief summary of his health status in May, 2008. Although the summary presents limited information on the lesion removed in August 2000, (ulceration and histology status are not provided), sufficient information is given to use the 10-year prognostic model developed by Schuchter. McCain's melanoma fell into the higher-risk categories identified in that study: the tumour was 2.2 mm thick, placing it into the second highest risk category (T3); McCain was older than 60 years at diagnosis; he is male; and his lesion was not on an extremity. As a result, using the prognostic model, his predicted 10-year-survival at the time of diagnosis was only 24%".

The Schuchter model was used to predict a 12% per year mortality risk over the next two years for Senator McCain; this risk would remain similar for several subsequent years. The weakness of this model, however, is that it was designed in an era that did not use sentinel lymph node (SLN) biopsy to indicate whether the cancer had spread. Mr McCain, in fact, did have SLN biopsy, and the result indicated that the cancer had not spread. This additional knowledge improves Mr McCain's health prospects, and the prognostication has adjusted according to findings that show SLN-negative patients (McCain) to have half the mortality risk than SLN-positive patients.

"If we assume that this trend is maintained long-term, McCain's mortality risk due to melanoma is better but not eliminated, remaining at 6% per year," concludes Dr Alam.

US Senator John McCain and risk of melanoma associated mortality
J Alam
The Lancet (2008). 372[9648]: pp. 1462.
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Written by: Peter M Crosta
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