Book Excerpt: The Answer to Cancer

The Odds of Recurrence

Having cancer once increases your chances of getting it again. Cancer cells from the original tumor may spread to create a secondary cancer at another site. Or an entirely new cancer may develop in association with the same risk factors that contributed to the initial malignancy. For instance, a smoker who managed to beat lung cancer remains at risk for throat cancer. On rare occasions, a new cancer totally unrelated to the prior one can occur.

Prevention may be more important for cancer survivors than for anyone else. Whether they beat the disease long ago or they're in the thick of the battle, taking steps to minimize the chances of a recurrence is an essential component of treatment. Cancer survivors should continue to get screening tests to catch any abnormalities early on. Depending on the type of cancer, their doctors may recommend more frequent testing than usual. These people also may have periodic tests to monitor those organs most likely to be affected by a secondary cancer. For instance, a person with colorectal cancer may undergo testing of liver function at established intervals.

Another active area of scientific research involves tests to identify particular indicators, or biomarkers, that may help predict whether a cancer is likely to recur or spread, initiating a secondary cancer. We're especially optimistic about a test called DNA microarray analysis, which involves the examination of hundreds of genes from the DNA of a person's cancer cells for characteristic clues about a cancer's aggressiveness.

The test results may tell us, for example, whether a woman who has been treated for breast cancer would benefit from chemopreventive therapy with tamoxifen. We'll say more about specific tests, and the clinical trials to evaluate their usefulness, later in this book.

Perception Isn't Reality

How concerned you are about cancer has a lot to do with how much control you have over your risk. New York Times health columnist Jane Brody wrote about an acquaintance who participates in dangerous sports like rock climbing and white-water rafting, yet eats only organically grown food. The woman's extreme activities, Brody noted, are "far riskier than all the chemical fertilizers, pesticides, and antibiotics combined." All of us have known people like this -- people who are overly cautious, if not phobic, about some aspect of life when other aspects present far greater dangers, statistically speaking. Perhaps we're this way ourselves.

What makes one woman fearful of food but not of heights, or terrified of flying but not of driving on the freeway, is that she believes she has more control in one situation than the other. Whether it involves being tethered to the side of a mountain or changing lanes, a sense of being in control tends to diminish fear.

A family history of cancer is one of those things that we can't choose. So those of us who are at high risk may respond in extreme and opposing ways. Some assume that they will get cancer no matter what, resign themselves to their fate, and do little to lower their chances. They may even avoid screening tests that could detect cancerous changes early on. Others are at the opposite end of the spectrum, interpreting every twinge as a sign of cancer.

Between these two extremes is the woman who says, "Since my mother died from colorectal cancer at age 43, my risk is higher than my husband's, whose parents are alive and well at 70. So I'm going to do whatever I can to lower my risk. And I'm going to have routine screening tests earlier and maybe more often than my husband does." Depending on the type of cancer, this woman may want to consider testing to determine whether she carries a genetic mutation that could increase her risk.

Women routinely overestimate their chances of developing breast cancer. The reality is, the average 40-year-old woman who has never smoked has only a 0.2 percent chance of dying from breast cancer by the time she turns 50. According to a Dartmouth University researcher who studies risk perception, we can't accurately assess our personal risk if we have nothing against which to gauge the statistics. And for some of us, those statistics loom frighteningly large, obscuring other, perhaps more dangerous risk factors.

As an example, let's suppose that same 40-year-old woman does smoke, which means she has a 13 percent chance of dying from lung cancer by age 70. She may be worried about getting breast cancer, but her chances of getting lung cancer are far higher.

A realistic awareness of your cancer risk is essential to cancer prevention because it affects almost every decision, from which screening tests to have to which lifestyle changes to make. If you are at high risk, your choices may include trying a chemopreventive therapy or enrolling in a clinical trial to evaluate such a therapy. If you are at very high risk, you may want to look into options such as genetic testing, prophylactic surgery, or special diagnostic tests.

Reprinted from: The Answer to Cancer: Stop It Before It Starts - Arrest It In Its Earliest Stages - Keep It From Coming Back by Carolyn D. Runowicz, M.D., and Sheldon H. Cherry, M.D., with Dianne Partie Lange © 2004 by Carolyn D. Runowicz, M.D., and Sheldon H. Cherry, M.D. (October 2004; $24.95US/$35.95CAN; 1-57954-730-3) Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.