What Else Can We Do?

I found myself in a conversation the other day with some friends about cancer. Everyone in the conversation either had had cancer or had a close friend or relative who had had cancer. Some survived the illness, others did not. Well, if truth be told, they all survived, just to different extents, but that’s another topic.

We talked about treatments—how they have changed and how they haven’t changed. We talked about the side effects of treatment including the nausea that one person constantly experienced, the alopecia another was dealing with, and of course the hot flashes. Those were times when you think that you’d certainly burst into flames because of the intense heat you experience.

But the most interesting part of the conversation, for me, came when one of my friends asked why we don’t do more about preventing cancer. This friend is very well versed on the benefits of good nutrition, natural foods and supplements, and exercise. She is a smart woman, but she actually believed that we, the oncology community of healthcare, weren’t doing much about getting the word out on prevention. After all if people just knew the real benefits of living a healthy lifestyle the rate of cancer would surely plummet. “Hmmmm,” I thought, “why didn’t we think of that?”

I took a deep breath before speaking and attempted to explain that billions of dollars are spent on prevention and early detection every year. Thousands of research hours are spent trying to find screening and detection methods for cancer as well as preventative measures.

The American Cancer Society highlights their efforts in the annual Cancer Prevention and Early Detection Statistics 2009. This document focuses on efforts regarding tobacco, obesity and nutrition, and cancer screening. The information is astounding. According to the ACS, smoking and exposure to secondhand smoke result in an estimated 443,000 premature deaths and $193 billion in healthcare expenditures and labor losses in the United States each year. Despite the efforts of the federal government as well as state and local governments on behalf of smoking cessation, the prevalence among high school students has not changed significantly over the past 6 years! There is a clear link between tobacco use and cancer—lung cancer, head and neck cancer, breast cancer—and still, people smoke.

Currently an estimated 18% of adolescents and 35% of adults are obese. The ACS guidelines for nutrition and physical activity for cancer prevention focuses on the importance of individual nutrition and physical activity choices for the prevention of cancer. These guidelines are fairly basic and include information about maintaining a healthy weight throughout life by balancing caloric intake with physical activity across the life span. They recommend that adults engage in at least 30 min of moderate exercise beyond their normal routine on five or more days of the week with 45minutes to 60 minutes of intentional vigorous exercise preferable. For children at least 60 minutes of moderate- to-vigorous exercise is recommended at least five days a week. As for nutrition, choosing a healthy diet with emphasis on plant sources is best. Eating at least five servings of fruits and vegetables a day is optimal as well as choosing whole grains and avoiding processed foods and red meats. No more than one alcoholic drink per day is recommended for women and two for men.

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Efforts regarding prevention and early detection of skin cancer are also addressed. Measures include avoiding direct sun exposure between the hours of 10 and 4, wearing wide brimmed hats to cover the face and ears, using a sunscreen with an SPF of at least 15, and avoiding the use of tanning beds.

Screening guidelines are also addressed in the ACS document. Guidelines for screening for breast, colorectal, prostate, cervical, and endometrial are outlined. With as much as we know about the success of screening, mammography usage has not increased since 2000. In 2005, just over 50% of women over the age of 40 reported getting a mammogram in the past year. Only 78% of women reported having a pap test in the past three years and not even half of women over age 50 had a colorectal screening.

So the question remains. What more do we do? As we sat in the sun, sipping our drinks, waiting for our char-grilled chicken to arrive, with others around us smoking, one has to wonder.

One of the women admitted she had not been to the doctor not even for a pelvic exam and pap test in over three years. My friend who wondered why we don’t promote prevention more goes to the tanning bed regularly year round, despite the hard time that I continually give her about it.

I don’t know that we have the answer. We continue the effort. We do the best we can. We try to set a good example. But none of us believes we are going to get cancer. No one sets out that way. We make choices every day based on what we believe to be good for us. Sometimes that means what’s good for us in the moment and sometimes that means what’s good for us for a life time. Hopefully we can all start to make more life time choices and still learn to enjoy the moment.