Treatments - Cancer Treatment: The Case For Prevention

Treatment helps people survive cancer longer. Our methods of destroying cancers are becoming sophisticated. But cancer survival rates are still not at 100%. Not surprisingly, the health authorities are laboring to prevent the disease — by trying to change our behavior.

The graphic illustrates the correlation between cigarette smoking and lung cancer. Tobacco became the drug of choice the world over when Columbus set foot in the New World and the natives offered large, brown leaves as welcoming gifts. The leaves had a pleasant odor, but the discoverers didn't know what to do with them. They did by the time they were returning home again. Tobacco has been an integral part of the American experience from the start — but it was cigarette smoking that has had the most massively lethal impact on the U.S. population. Women at first modestly refrained — except the most daring — so much so that in the sixties a cigarette advertising slogan was, "You've come a long ways, baby!"

We deal with this subject in more detail elsewhere in this volume (see Chapter 4, Risky Behavior). In the case of cigarette smoking — and other forms of tobacco consumption — we're making a certain amount of progress. Other areas are not quite so clear. Let's look at some of the risk factors over which people have some degree of control..

Obesity. According to the American Cancer Society (ACS), "in 1981, approximately 2% of all cancer deaths … were attributed to overweight, and more than one-third of all cancer deaths to dietary factors in adulthood." Obesity increases cancer risks for post- menopausal breast cancer (50% higher risk for obese women), colon cancer for men (40% increase in risk), cancer of the gallbladder and endometrium (uterine cancer), and there may also be positive association between obesity and cancer of the kidneys, pancreas, rectum, esophagus, and liver. The ACS puts it like this: "Obesity alters complex interactions among diet, metabolism, physical activity, hormones, and growth factors."¹

The Centers for Disease Control has labeled obesity "an epidemic." We deal with the subject elsewhere; see for instance Women's Health: Weighty Trends in Chapter 1. When it comes to obesity, we are losing the battle against one of the cancer risk factors.

Alcohol. Consumption of alcohol — especially in combination with smoking, use of snuff, and chewing tobacco — increase the risks of mouth and throat cancer. Alcohol consumption also appears to increase the risk of breast cancer. The mechanism is not understood, but alcohol may influence the estrogen level in a woman's body.

Diet and Exercise. The right kind of food and vigorous exercise keep off the pounds — hence the obesity-related risks are lower. People who like diets high in fat put themselves at greater risk for colorectal cancers, cancer of the prostate, and uterine cancer. It is not yet clear which kind of fat is the culprit. The risks of colon and prostate cancer are higher for people who eat red meat. Prostate cancers are associated with high levels of testosterone — which seem to be more prevalent in men who eat large amounts of fat. Prostate cancer rates are lowest in Japanese men. They eat a lot of fish.

Modern Drugs, Treatments, Pastimes. Relatively low risks are associated with hormone replacement therapies and oral contraceptives for women. More risk is associated with having been exposed to high-dose ionizing radiation to the chest (breast cancer). Tanning, whether in salons or on the beach, increases the risk of skin cancer.

Staying trim, avoiding fat, tobacco, alcohol, and some drugs doesn't guarantee a cancer- free life. Cancer can appear anywhere in the body — even in the heart and in the bones. In the digestive system alone, in 2002, estimated new cases of cancer were as follows: in the esophagus (gullet)-13,100; stomach-21,600; small intestine-5,300; colon-107,300; rectum-41,000; anus, anal canal, and anorectum-3,900; liver and bile duct-16,600; gallbladder-7,100; pancreas-30,300; and other digestive organs-4,400.

Many stresses to the body may trigger the onset of cancer — one of these may be the cumulated stresses of aging. Cancer kills those in advancing years. One strategy of prevention may be to stay forever young — but that may be more difficult than finding a cure for cancer.

Source: U.S. Department of Agriculture (cigarette consumption). CDC Wonder data base for cancer mortality rates. Background data from American Cancer Society publications available at http://www.cancer.org, especial Cancer Facts or Cancer Facts & Figures for various years.