Cancer Prevention

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Introduction

No other disease strikes as much fear deep within our souls as cancer. The reason? Almost all of us have witnessed firsthand the ravaging effects of cancer, as well as chemotherapy and radiation, on a loved one. Cancer statistics in the United States present us with some sobering facts:

• More than 1.25 million new cases of invasive cancer will be diagnosed each year.

• An additional 1.5 million new cases of noninvasive cancers will be diagnosed each year.

• More than 500,000 people will die from cancer each year.

• Cancer causes one in five of all deaths.

• Cancer will affect one out of every three people alive today.

• Of those diagnosed with cancer, 50% will die of their disease.

• The annual economic toll of cancer is more than $110 billion.1

Despite dedicating significant resources to the battle against cancer, conventional medicine alone has had very limited success against this disease. Granted, there have been some tremendous advances for a few of the less common cancers, but for the most part we are losing the war on cancer—more people are dying of cancer today in America than ever before.

We’ve all heard it said: “An ounce of prevention is worth a pound of cure.” When it comes to cancer, that old saying carries a ton of truth. There is no guarantee, but the basic strategy for cancer prevention is reducing or eliminating as many risk factors associated with cancer as possible while at the same time focusing on those health habits, dietary factors, lifestyle components, and attitudes that are linked to a reduced risk of getting cancer.

Understanding and Preventing Cancer

To understand how natural prevention strategies are effective in preventing cancer, it helps to know some basic facts about the cells in your body and cancer. Your body contains trillions of cells. Within each cell is a central core known as the nucleus. Inside the nucleus lies the key to life itself: a long, twisted molecule of deoxyribonucleic acid, better known as DNA. Put simply, DNA contains the instructions (the genes) that the cell needs to make its vital proteins as well as replicate itself. Abnormal changes in a cell’s DNA are called mutations. Usually cells with mutations recognize they are damaged and simply die—a process called apoptosis. But sometimes they continue to divide at a rapid, uncontrolled rate to form clumps of cells that grow into the mass of tissue we call a tumor. There are two types of tumors: benign and malignant.

• Benign tumors are not cancerous because the cells are normal (they have not mutated) and do not usually pose a threat to life. They can usually be surgically removed or treated with drugs. Cells from benign tumors do not spread to other parts of the body.

• Malignant tumors are cancerous. Their mutated cells divide without control or order, and they can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system, forming new tumors in other organs.

Mutations are usually the result of DNA molecules coming into contact with free radicals—highly reactive atoms that can destroy or alter body structures, including DNA. Free radicals assault us from all directions. Some of these come from our environment, in pollutants such as chemicals or cigarette smoke; others come from our diet, in the form of fats damaged by frying or nitrates in smoked or cured meats. Even sunlight produces free radical damage. But free radicals also result from the cell’s own metabolic activity. Most carcinogens (cancer-causing compounds) are dangerous because they cause severe free radical or oxidative damage to DNA.

Fortunately, nature counteracts free radicals and the oxidation they cause by neutralizing them with other molecules known as antioxidants. By mopping up free radicals, antioxidants are powerful weapons in the fight against cancer and other degenerative diseases. So if you want to reduce your risk of cancer, it’s important to:

• Reduce free radical formation in the body.

• Limit exposure to dietary and environmental sources of free radicals.

• Increase your intake of antioxidant nutrients and other substances that support immune function.

Identifying Risk Factors

Cancer risk factors fall into two main categories: inherited and environmental. There’s not a lot we can do to eliminate genetic risk factors, because they’re passed on from generation to generation and are present at birth. However, inherited genetic defects are responsible for only about 15% of all cancers. This statistic means that approximately 85% of all cancers result from environmental risk factors, such as diet, lifestyle, and exposure to harmful substances.

In assessing the likelihood that an individual will develop a certain disease, specialists in epidemiology (observational and statistical studies of people and diseases) use a concept known as relative risk. Relative risk (abbreviated RR) is a number that shows how much more likely it is that individuals who possess a certain trait will develop a condition, compared with individuals who do not share that trait. For example, someone whose RR is 1.5 is 50% more likely to develop a condition than someone whose RR is 1. A relative risk of 2 means you are twice as likely (100% more likely), and so on.

Here’s one dramatic statistic that should make the point. Compared with nonsmokers, cigarette smokers are said to have a relative cancer risk of 10—in other words, they are 10 times, or 1,000%, more likely to get lung cancer than someone who never smoked.

A few words of caution: relative risk is a statistic that’s used to compare large numbers of people. So we cannot with any certainty predict your specific (absolute) risk as an individual. Some nonsmokers get lung cancer, while some smokers never develop the disease. If you are a nonsmoker, we have no idea if you will be, among every 10 people who develop lung cancer, the 1 who doesn’t smoke. If you are a smoker, we cannot accurately predict if you will be the rare smoker who evades the disease.

This chapter discusses the main cancer risk factors and then offers a self-assessment survey. By completing that survey, you’ll be able to evaluate your risk of developing certain cancers. The higher the rating, the more aggressive your primary prevention strategies will need to be.

Genetic Factors

Studies on identical twins (who share the exact same DNA) confirm the point we made above, that most cancers do not arise from genetic defects. Instead, diet and lifestyle play a more significant role. Surprisingly, that’s true even for cancers that tend to run in families. Still, researchers have identified about 30 genetic defects that increase the risk for certain cancers. Some of these cancers are rare; they also tend to be types that develop more often in childhood.

Age

It’s a fact of life: the older you are, the more likely you are to develop cancer. As we age, our cells become less proficient at repairing damage to our DNA. As a result, there are more cells present in the body that possess mutations and that are prone to develop cancer. In the year 2000, more than 60% of new cancer cases and more than 70% of all cancer-related deaths occurred in people over the age of 65.

Family History

Some (but not most) cancers seem to run in families. For example, if a woman has two first-degree relatives (mother, aunt, or sister) who developed breast cancer, her risk for breast cancer is two to five times greater than that of a woman without such a family history. The same sort of relationship exists concerning prostate cancer in men.

Race

Overall, black Americans are more likely to develop cancer than persons of other racial and ethnic groups (see the table below). The incidence of certain types of cancers also varies by race. Compared with other groups, black men are more likely to have cancers of the prostate, colon and rectum, and lung. In fact, black men have at least a 50% higher rate of prostate cancer than any other group. In contrast, breast cancer rates are highest among white women (114 per 100,000) and lowest among Native American women (33.4 per 100,000).

Overall Incidence of Cancer Among Ethnic/Racial Groups2

GROUP

RATE (PER 100,000)

Blacks

445

Whites

402

Asians/Pacific Islanders

280

Hispanics

273

Native Americans

153

Some of the differences in cancer rates among racial and ethnic groups may be due to factors associated with social class rather than race or ethnicity. Such factors include education, access to health care, occupation, income, and exposure to harmful substances in the environment. Diet is also critical to look at in evaluating data on race and cancer.

Medical History

Sometimes, having one disease can increase your risk for developing another. Diseases known to increase the risk of certain cancers include alcoholism, chronic hepatitis, diabetes, history of genital warts, HIV infection, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and peptic ulcer. The presence of any of these conditions requires a more concerted effort to reduce cancer risk.

Hormonal Factors

Certain cancers, most notably prostate and breast cancer, are affected by hormonal factors. In prostate cancer, the primary hormonal factor is testosterone, while in breast cancer the hormone of concern is estrogen. For more information, see the chapter “Breast Cancer (Prevention),” or the chapter “Prostate Cancer (Prevention).”

Environmental Factors

As described above, exposure to tobacco smoke is a leading cause of cancer, especially lung cancer. A long and growing list of other environmental factors linked to certain cancers includes pesticides, herbicides, heavy metals, asbestos, solvents, and possibly exposure to electrical power lines. The risk depends on the concentration, intensity, and duration of exposure. Substantial increases in risk have been demonstrated in occupational settings where workers have been exposed to high concentrations of certain chemicals, metals, and other substances.

Certain Medical Treatments

Sometimes medical treatment increases the risk of certain cancers. For example, radiation therapy and many chemotherapy drugs carry with them an increased risk for producing new cancers later on. Estrogen and oral contraceptives have been linked to an increased risk of breast cancer. The term iatrogenic refers to diseases that arise inadvertently as a result of medical or surgical treatment.

Lifestyle Factors

The importance of a healthful lifestyle in cancer prevention cannot be overstated. The key components are avoiding tobacco use and exposure to cigarette smoke; exercising regularly; and avoiding alcohol or drinking only moderate amounts.

Smoking

The evidence is overwhelming that smoking is the most preventable cause of cancer and premature death in the United States. Smoking is responsible for nearly 90% of all lung cancers. Lung cancer mortality rates are more than 20 times higher for current male smokers and 12 times higher for current female smokers compared with people who have never smoked. Smoking is also associated with an increased risk for virtually every other cancer and accounts for at least 30% of all cancer deaths. Smoking is also a major cause of heart disease (the leading cause of death in the United States), strokes, chronic bronchitis, and emphysema.

Passive smoking—exposure to secondhand smoke—is an important risk for cancer (particularly lung and breast cancer) and is an even greater risk for causing heart disease. People who don’t smoke but who inhale smoke from the environment may be even more susceptible to the free radical damage the chemicals in smoke cause to their heart and arteries, because their bodies just aren’t used to dealing with such a heavy toxic load. One study found that a woman who has never smoked has an estimated 24% greater risk of getting lung cancer if she lives with a smoker.3 The U.S. Environmental Protection Agency estimates that passive smoking causes 3,000 lung cancer deaths each year.

Exercise

A number of studies have found a link between low physical activity levels and an increased cancer risk. On the other hand, increased physical activity, whether from structured exercise or physical labor, has been found to cut the overall cancer risk nearly in half. The greater the activity level, the lower the risk. The association is strongest for colon and breast cancers. The preventive effects of exercise are seen even in people who have other risk factors, such as poor diet, excess body weight, and smoking.4,5

Alcohol Consumption

There is a clear association between alcohol consumption and many forms of cancer. The higher the dose (amount of alcohol), the greater the risk. While moderate consumption (that is, one glass of wine, one beer, or 1 fl oz hard liquor per day) poses little risk, drinking alcohol beyond this amount greatly increases the chance of getting cancer of the throat, liver, colon, or breast. Alcohol is metabolized into highly reactive compounds such as acetaldehyde that act as free radicals and damage DNA repair mechanisms, further raising the risk.

Psychological Factors

Stress, personality, attitude, and emotional state are thought to predict the development of many diseases, including cancer. Although this idea is somewhat controversial, personality stereotypes have emerged that reflect an increased risk for certain diseases. For example, the so-called type A personality—easily angered, competitive, and hard-driving—is associated with an increased risk for heart disease. The typical cancer personality is type C, associated with the denial and suppression of emotions, in particular anger. Other features of this pattern are “pathological niceness,” avoidance of conflicts, exaggerated social desirability, harmonizing behavior, overcompliance, excessive patience, high rationality, and a tendency toward feelings of helplessness. What the type C personality displays on the outside is a facade of pleasantness. However, this outward expression quickly dissolves during times of stress. Typically the type C personality deals with stress through excessive denial, avoidance, and suppression and repression of emotions.6 This internalization is thought to contribute to the development of cancer by amplifying the negative effects that stress produces on the immune system.

What research continues to tell us is that how a person handles stress is more crucial than the stressor itself and that the response to stress is highly individualized. Two people might have the same stressful experience, but they may react to it in entirely different ways; as a result, some may develop cancer, while others may not.7

It is our belief that helping a person develop an effective method to deal with stress is more important than identifying a particular “cancer personality.” Put simply, dealing with stress in a positive manner through exercise, relaxation techniques, and counseling appears to offer protection against cancer and boost immune function regardless of personality type. In contrast, inappropriate ways of dealing with stress such as suppression of emotion, denial, drinking alcohol, using drugs, or overeating will have a negative effect.

Two chapters—“A Positive Mental Attitude,” and “Stress Management”—provide general recommendations that have also been shown to fight cancer and boost immune function.

Diet

Dietary factors are the major cause of cancer in the United States. There are two main reasons. One is that a poor diet fails to supply the body with the nutrients and other dietary factors it needs to maintain healthy cells and tissues. A poor diet means the immune system is less able to defend against foreign invaders that can trigger the onset of cancer.

Another reason poor diet is a concern is that it promotes obesity. A report by RAND Corporation researchers found that obesity contributes at least as much to the development of chronic degenerative disease—including cancer—as smoking does.8 Obesity severely disturbs the body’s ability to regulate the complex interactions among diet, metabolism, physical activity, hormones, and growth factors. Women who are obese after menopause have a 50% higher relative risk of breast cancer. Obese men have a 40% higher relative risk of colon cancer. Gallbladder and endometrial cancer risks are five times higher among obese individuals, and obesity appears to raise the risk of cancers of the kidney, pancreas, rectum, esophagus, and liver.

In the chapter “A Health-Promoting Diet,” we focus on general dietary recommendations for good health that overlap with specific dietary recommendations for cancer prevention. The recommendations in the chapter “Supplementary Measures” provide a strong level of additional cancer-fighting support. The goal of these recommendations is to reduce dietary factors that increase cancer risk while increasing the intake of substances that protect against cancer.

Dietary Factors That Increase Cancer Risk

Meats

Dairy products

Total fat

Saturated fats

Refined sugar

Total calories

Alcohol

Dietary Factors That Decrease Cancer Risk

Fish

Whole grains

Legumes

Cabbage

Other vegetables

Nuts

Fruit

Putting It All Together

Constructing your own personal daily plan for preventing cancer involves strategies for strengthening the four cornerstones of good health detailed in Section II of this book:

• A positive mental attitude

• A healthful lifestyle

• A health-promoting diet

• Supplementary measures

Focusing on these foundations provides the strongest general protection against cancer.

For additional and more specific recommendations for preventing breast or prostate cancer, please go to the chapter “Breast Cancer (Prevention),” or the chapter “Prostate Cancer (Prevention).” For an even more extensive resource on cancer and natural medicine, see our book How to Prevent and Treat Cancer with Natural Medicine (Atria, 2002).

Final Comments

One key strategy in the prevention of cancer is periodic screening. Screening means getting a regular checkup to look for cancer. Screening is especially important for people who have certain risk factors, such as a family history of certain cancers or exposure to environmental toxins.

The major benefit with regular screening examinations by a health care professional is that it can lead to early detection of cancer. Screening-accessible cancers—especially cancers of the breast, colon, rectum, cervix, prostate, testicles, oral cavity, and skin—account for about half of all new cancer cases. In general, the earlier a cancer is discovered, the more likely it is that treatment will be successful. Self-examination for cancers of the breast and skin may also result in detection of tumors at earlier stages. We can’t stress enough the importance of having a complete regular physical exam. Your life may depend on it!

American Cancer Society Recommendations for the Early Detection of Cancer

SITE

RECOMMENDATION

Cancer-related checkup

A cancer-related checkup is recommended every three years for people ages 20 to 40 and every year for people 40 or older. This exam should include health counseling and, depending on a person’s age and gender, might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, and testes or ovaries, as well as for some nonmalignant diseases.

Breast

Women 40 and older should have a mammogram every two years and an annual clinical breast examination (CBE) by a health care professional. They also should perform monthly breast self-examination. Women ages 20–39 should have a CBE by a health care professional every three years and should perform monthly breast self-examination.

Colon and rectum

Beginning at age 50, men and women should follow one of the examination schedules below:

• A fecal occult blood test every year and a flexible sigmoidoscopy every 5 years

• A colonoscopy every 10 years

• A double-contrast barium enema every 5 to 10 years

A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy, or double-contrast barium enema. People who have a family history of colon cancer should talk with a doctor about a different testing schedule.

Prostate

The American Cancer Society recommends that both the prostate-specific antigen (PSA) blood test and the digital rectal examination be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years and to younger men who are at high risk. Men in high-risk groups, such as blacks and those with a strong familial predisposition (i.e., two or more affected first-degree relatives), may begin at a younger age (i.e., 45 years).

Uterus

Cervix: All women who are or have been sexually active or who are 18 and older should have an annual Pap test and pelvic examination. After three or more consecutive satisfactory examinations with normal findings, the Pap test may be performed less frequently. Discuss the matter with your physician.

Endometrium: Women with a family history of cancer of the uterus should have a sample of endometrial tissue examined when menopause begins.

Source: Modified from information from the American Cancer Society, Inc.

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QUICK REVIEW

Cancer is the result of mutations in a cell’s DNA.

To reduce your risk of cancer, it’s important to:

  • Reduce free radical formation in the body.

  • Limit exposure to dietary and environmental sources of free radicals.

  • Increase your intake of antioxidant nutrients and other substances that support immune function.

In assessing the likelihood that an individual will develop a certain disease, specialists in epidemiology (observational and statistical studies of people and diseases) use a concept known as relative risk.

Compared with nonsmokers, cigarette smokers are said to have a relative cancer risk of 10—in other words, they are 10 times, or 1,000%, more likely to get lung cancer than someone who never smoked.

The key components of a cancer-preventing lifestyle are avoiding tobacco use and exposure to cigarette smoke; exercising regularly; and avoiding alcohol or drinking only moderate amounts.

The typical cancer personality is type C, associated with the denial and suppression of emotions, in particular anger.

Dietary factors are the major cause of cancer in the United States.

A report by RAND Corporation researchers found that obesity contributes at least as much to the development of chronic degenerative disease—including cancer—as smoking does.

Constructing your own personal daily plan for preventing cancer involves strategies for strengthening the four cornerstones of good health detailed in Section II of this book.

In general, the earlier a cancer is discovered, the more likely it is that treatment will be successful.