A recent New York Times article, In Sickness and in Health: a Wedding in the Shadows of Cancer, struck a particularly sensitive chord. It profiled the courageous journey of two of my patients, a husband with advanced pancreatic cancer and his wife with metastatic breast cancer and their preparation for the wedding of their daughter in the face of their battle with cancer. Among the responses of readers, an interesting and common concern stood out, why we continue to have an epidemic of cancer and why have we not dealt with the toxic mix of chemicals in our environment that they assume are a major cause of these cancers.
This perception is widespread. While there is little doubt that there are adverse health effects from these exposures, their role in the origin of the typical “western cancers” (breast, colorectal, prostate, etc.) remains uncertain. Certainly the central role of tobacco in lung cancer and several other cancers is undisputed.
What is most striking is the lack of awareness among the public and health care providers alike about the growing evidence that many non-smoking related cancers may actually be, in part, a direct effect of modern good health. The marked improvement in maternal and early childhood nutrition has played an important role in the health and well being of modern populations.
It is important to understand risk and why Americans have a particular difficulty with the issue of cancer risk.
This, in part, reflects a unique American belief that we can have control of all aspects of our lives. As a result, any adverse event may be linked to something “we did or potentially could have avoided.” Many patients desperately seek to understand the underlying cause of their cancer, in the hope that they can reverse or control this and improve their chances of survival. It is important to understand the “randomness” of mutational events that often initiate the cancer process and our inability to prevent all cancers. The message we get from the media and even the medical press is that we eventually will be able to explain every cancer that arises.
This is simply not true. And in many cases, “I thought I did everything right!” does not apply. We cannot necessarily identify any specific trigger or cause of many cancers. I believe the identification of tobacco and cancer risk and other less common exposure-related cancers, like asbestos, has in some ways fueled this confusion, as has the constant media attention to the “latest exciting findings” that link some exposure or dietary factor to cancer. Continue reading →