May 7, 2001 -- Sad to say, but you probably know someone with cancer.
Yes, rates of many cancers are increasing alarmingly in North America and, no, doctors have not identified all the factors that play a part in getting it. We do know that genes play a significant role -- something you can't do anything about -- but we also know that lifestyle is a major player, and there is a lot you can do about that.
The American Association for Cancer Research (AACR) is dedicated to informing the public about the risks of cancer and providing them with the latest scientific findings. That's why at their annual meeting -- held this past March in New Orleans -- they opened up the conference to the public and addressed many of the issues that concern us all. One of those was preventing cancer.
Here's what the AACR experts had to say about the best ways to minimize your cancer risk. The information here is specifically geared toward men -- although, of course, much of it applies to women, too. (Check out "Cancer Risk: It's a Girl Thing", on the Healthy Women channel)
Know Thy Enemy
Cancer is an imbalance between cell growth and cell death, explains Donald S. Coffey, MD, resulting in the accumulation of large numbers of cells.
"When cells pile up, it's called a tumor," he says. "They can pile up like a fist or a tangerine, which can be taken out, and that's benign. Most of what's seen in breast and prostate tumors are benign tumors.
"The other kind looks like your open hand," he says -- although historically this more dangerous, malignant cancer was compared to the spread-out crab-shaped stars in the constellation Cancer.
"The word for the zodiac was here before the disease, and that's why it's called cancer," says Coffey, professor of oncology, pathology, urology, and pharmacology at Johns Hopkins University School of Medicine in Baltimore. Coffey was involved in organizing the AACR public forum and gave a talk on the definition of cancer.
Don't Smoke. Don't Smoke. Don't Smoke.
"Don't smoke," says Anna D. Barker, PhD, president and CEO of Bio-Nova Inc., and a member of AACR's board of directors.
Simply by heeding that straightforward bit of advice, you can avoid 35% of all cancers, says Barker, who was a moderator and organizer at the public forum.
There's no good reason to become part of the statistics: If you haven't started smoking, don't -- and if you have, it's time to butt out!
Shun the Sun.
The era of bathing beauties is over. Rather than thinking of a deep tan as something that makes you look healthy and vibrant, think of it as a dermatologist does: as your body's reaction to damage, like a scab forming on a cut.
Don't want to get skin cancer? Then you need to stay out of the sun, especially when it is strongest, between 10:00 a.m. and 3:00 p.m. If you must be in the sun at any time of day, protect yourself with wide-brimmed hats, large sunglasses, and sunblock with an SPF of at least 15. Report any new, unusual, or changing moles or other marks on your skin to your doctor.
Live an Anticancer Lifestyle
No one who's been conscious the past two decades should be surprised to hear about the strong link between smoking, sun, and cancer. But you might be surprised to learn that all that advice you've been getting about living a heart-healthy lifestyle is also good for preventing cancer.
"There is a direct relationship between obesity and cancer as well as exercise and lack of cancer," says Barker. "There's also no question that diets rich in fruits and vegetables are very effective at preventing cancer. ... Some of these things have been looked at scientifically in enough depth that we're beginning to see some patterns. ...
"You really just have to adopt a [cancer-] prevention lifestyle," Barker continues. "You have to exercise, eat right, and watch your weight. You have to stay out of the sun, and you can't smoke. Even the simple things like drinking eight glasses of water a day ... are very important. In this society we don't like to take the time for things like that."
Talk to Your Doctor If You Know You're at High Risk
Your father had colon cancer, and so did an uncle and a cousin? You'll want to share a family pedigree like that with your physician, who will want to make sure you get earlier, more aggressive screenings than other men your age.
A rule of thumb: Begin those screenings 10 years before the age your closest relative was diagnosed. Dad got the bad news at age 50? Start those screenings by age 40.
Supplements and Vitamins Might Help
"I take vitamins," says Barker. "I'm interested in the biology of pro-oxidants and antioxidants, so I understand a little more than some people about how this stuff works. I think people who take vitamins C and E are a bit more protected than people who don't. Vitamin C especially has a very short lifespan, and unless you eat a lot of fruits and vegetables you probably aren't getting enough of it. For vitamin E, you can't really overdose on the stuff, and it's a very good antioxidant. ... I think taking a multivitamin is not a bad idea"
If Prevention Fails, Catch It Early
The next best thing to cancer prevention is early detection.
"We know that small tumors can be treated much more easily," says Barker. "The problem is once they [spread] to other organs."
Catching cancer sooner rather than later is so important that Robert C. Bast Jr., MD, vice president for translational research at the University of Texas M.D. Anderson Cancer Center in Houston, gave a talk on just that topic at the AACR public forum.
"The good news is that if you detect cancer early, more than 90% of patients can be cured," he says. "When it's still localized in the organ [where it originates] and when it hasn't had a chance to spread to other parts of the body, conventional therapy, surgery, radiation, chemotherapy, can cure patients 90% or more of the time."
There are only a few cancers for which official screening guidelines exist, although developing such guidelines is a top priority for researchers and cancer agencies. Here is some of the latest information on which screening tests are out there and what kind of progress is being made on developing tests for specific cancers.
- Colon: Common tests include the fecal occult blood test, which tests your stool for invisible amounts of blood; sigmoidoscopy, where the lower colon is visualized using a scope; and colonoscopy, where the whole colon is visualized. Many doctors recommend that guys over age 50 -- and sooner if they're at high risk -- get a fecal occult blood test annually and a sigmoidoscopy every five years.
- Prostate: Common tests include rectal exams -- the "finger test" where your physician feels your prostate; and PSA tests, where the level of a substance produced by the prostate is measured in your blood. New blood tests that use computers to analyze the results are also in development.
- Lung: Currently, no studies have firmly supported the use of imaging technology -- like X-rays or CAT scans -- for the detection of lung cancer. However, some research groups are actively studying the effectiveness and safety of such techniques, such as using low-radiation, high-resolution CAT scans to screen the lungs of smokers for early development of lung cancer.
- Mouth: Mouth cancers have a very good cure rate when they're caught early -- and very poor when they're allowed to advance. Your dentist should be screening for this -- assuming you're scheduling regular appointments. The most common causes of oral cancer: tobacco and alcohol.
- Testicles: Although testicular cancer accounts for only about 1% of all cancers in men, it is the most common kind that hits men between the ages of 15 and 35. Testicular cancer is highly curable if caught in an early stage, and men can greatly increase their chances of an early diagnosis by performing a monthly self-exam -- that is, by feeling manually for lumps in the testicles. Experts recommend doing your self-exam after a warm bath or shower, which causes the scrotal skin to relax and makes it easier to find a lump or mass.
- Anal: Of particular concern to gay and bisexual men, anal cancer is similar to cervical cancer in that it, too, is caused by a sexually transmitted virus -- the human papillomavirus. For that reason, some recent studies have suggested that a Pap smear -- the test used to detect cervical cancer in women -- might work just as well for picking up anal cancer in men.
- Penile: This is a rare cancer that some studies suggest is less common in circumcised than uncircumcised men. However, the issue may be more about hygiene or sexual promiscuity than the presence of extra skin. So for those uncut adults who worry that they might be at risk, it won't hurt to do a quick self-exam. For instance, when you're doing your testicle examination, go ahead and peel back your foreskin and look for anything weird going on -- growths, discoloration, anything that looks unusual -- and report any suspicious findings to your primary care doctor.
With all these tests available, how do you know which ones are right for you?
That depends on your age and risk factors, say experts. Most cancers, with the exception of brain tumors, testicular cancer, and some leukemias, usually strike after age 50, so screening strategies should be stepped up as you age. Having a known genetic predisposition for a certain cancer -- or many relatives with a specific cancer -- places you at higher risk of developing that disease, so you need to screen for it more often.
Bast recommends that everyone schedule a doctor's appointment " every three years between ages 20 and 39 and every year thereafter to go over a cancer-specific screening strategy, ... and also to go over [what you] can do to prevent cancer, such as stopping smoking, having multiple servings of fruits and vegetables each day, maintaining an ideal body weight or as close to it as you can get, and having at least some exercise three times a week."
Don't Give in to Fear
According to Barker, never let fear prevent you from being properly screened for cancer.
"If you think something's wrong," she says, "don't wait or give it time to get worse. You can get a lot done about an early cancer and not a lot done about a late cancer."
The AACR has made their public forum available for all to see via webcast. To see it for yourself, go to their web site and select Saturday, March 24.
Alison Palkhivala is a freelance medical writer working in Montreal, Canada. She has been writing about medicine and healthcare since 1994.
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