The Answer to Cancer

By Carolyn D. Runowicz, M.D., and Sheldon H. Cherry, M.D., with Dianne Partie Lange

Published by Rodale

October 2004; $24.95US/$35.95CAN; 1-57954-730-3

There's exciting news from the front line of cancer research. Scientists are testing an arsenal of drugs that could prove to be the most potent weapons in the fight against cancer. They don't promise a cure. Instead, they offer something even better: an unprecedented opportunity to beat cancer by stopping the disease process before it reaches an advanced stage -- or by keeping it from starting in the first place.

While some of these drugs are new, others -- like aspirin and ibuprofen -- are household names. Still others use therapeutic doses of common nutrients such as selenium and vitamin A.

The Answer to Cancer introduces you to state-of-the-art cancer prevention, the therapies that could transform how modern medicine combats the disease that currently ranks as our nation's number-two killer. But you don't need to wait for the outcome of ongoing studies to take action. In The Answer to Cancer, you will find an exclusive 7-step cancer prevention plan, featuring the most important lifestyle strategies for reducing your cancer risk.

Whether you are a cancer survivor or you hope to avoid the disease altogether, The Answer to Cancer provides the information and advice that can help keep you cancer-free for the rest of your life. You can take control of your cancer risk, even if you have a family history of the disease or a genetic predisposition to it. Why not act now?

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Unprecedented advances in prevention are transforming how the medical community and the general public view cancer. The message from those leading the fight is clear: The best way to beat cancer is to stop it before it gains a foothold. And the most effective plan of attack combines cutting-edge medical interventions, proven lifestyle strategies, and the latest in screening technology.

In The Answer to Cancer, Carolyn Runowicz, M.D., and Sheldon Cherry, M.D. -- two of the country's preeminent cancer experts -- draw on solid scientific evidence and years of clinical experience to help you customize your own cancer prevention plan, based on your individual risk. Inside you'll find:

• Up-to-the-minute reports on pharmaceuticals and other medical measures that offer real protection against specific kinds of cancer


• Surprising new evidence in support of key lifestyle factors that can influence cancer risk positively or negatively


• Personal risk assessments for the nine most common cancers


• Preventive strategies that target specific cancers, plus a comprehensive 7-step plan that can lower your overall cancer risk

No other book explores cancer prevention with the comprehensiveness, depth, and clarity of The Answer to Cancer.

Its recommendations represent the leading edge in cancer research and the most significant development in the fight against cancer short of a cure.

Authors

Carolyn D. Runowicz, M.D., currently serves as director of the University of Connecticut Cancer Center in Farmington. She is second vice president of the American Cancer Society and a past president of the Society of Gynecologic Oncologists, the first woman to hold the post. Her husband, Sheldon H. Cherry, M.D., is clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine in New York City. Dr. Cherry and Dr. Runowicz reside near Hartford, Connecticut.

Their coauthor, Dianne Partie Lange, is the former editor-in-chief of Natural Health magazine and a former syndicated health news columnist for the Los Angeles Times. She resides in Carnelian Bay, California.

Reviews

"Cancer is potentially the most preventable and the most curable of all life-threatening diseases . . . The wealth of knowledge in The Answer to Cancer can help anyone achieve a healthier lifestyle -- and a substantially lower cancer risk."

--John R. Seffrin, Ph.D., chief executive officer, American Cancer Society

Excerpt

The following is an excerpt from the book 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

Published by Rodale; October 2004; $24.95US/$35.95CAN; 1-57954-730-3

Copyright © 2004 Carolyn D. Runowicz, M.D., and Sheldon H. Cherry, M.D.

Stopping Cancer Before It Starts

Thanks to advances in molecular biology, scientists are finding new ways to detect cellular changes at their earliest stages, before they lead to cancer. They also are developing new tools and techniques to retrieve cells from all parts of the body, without surgery or pain. One such technique, which we'll explain in more detail in chapter 9, allows a physician to obtain cells from within the breast ducts with minimal discomfort. Analysis of these cells can reveal whether abnormalities that could progress to cancer are occurring within the ducts, where most breast cancer begins. This test is especially useful for women who are at high risk for the disease.

Other tests look for certain cancer biomarkers in the bloodstream. These substances, which come from cells, indicate that the cancer process already has begun. For example, the presence of a protein called CA-125 is a red flag for ovarian cancer. Similarly, large amounts of prostate-specific antigen (PSA) -- which is produced by cells in the prostate gland and is found in semen -- may point to an abnormal condition in the prostate, including cancer.

Over time, scientists will identify even more substances that could alert both physician and patient to precancerous changes. For a physician, the presence of such a biomarker would serve as a cue to investigate further. For the patient, the awareness of increased cancer risk may prompt extra vigilance, in terms of more frequent checkups or screenings, or perhaps chemopreventive therapy. Scientists also are investigating whether measurable changes in DNA, a shift in the rate of cell division or growth, or alterations to substances that stimulate cell growth could be detectable biomarkers for precancers.

While screening tests are for healthy people at all levels of risk, the frequency of testing may vary with the severity of risk. Some tests are best reserved for those who are most likely to develop certain kinds of cancer. Others are genetic tests, intended to assess a person's cancer susceptibility. We'll say more about these in part 2, when we talk about specific cancers.

Where Screening Guidelines Come From

Many government agencies, medical societies, and health organizations have established guidelines for cancer screening tests. These groups base their recommendations on thorough evaluations of the scientific evidence regarding the safety and accuracy of the tests, the sensitivity of the tests in detecting cancer and cancer precursors, the cost of providing tests to those who need them, and the benefit of knowing the results.

For various reasons, the groups don't always agree. And like any institution, each is subject to outside pressures of one sort or another. One particular concern is cost, especially in countries that have single-payer health care systems, like Canada. In the United States, where the government doesn't regulate health care, recommendations -- particularly for tests to detect cancer precursors -- tend to be more liberal. Still, whether the testing is covered by insurance companies and managed care plans can vary considerably.

The U.S. Preventive Services Task Force (USPSTF) is the government agency that makes recommendations for public health care policy, including preventive services such as immunizations and cancer screening tests. The USPSTF assigns letter grades from A to E to their recommendations for screening tests, based on the scientific evidence in support of each test. For instance, both the Pap test and mammography earn an A for women between ages 50 and 69. In the USPSTF's words, "There is good evidence to support the recommendation (that the condition) be specifically considered in a periodic health examination." On the other hand, the chest x-ray and the PSA test get a D, meaning "there is fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination." In fact, the USPSTF recently concluded that there is not sufficient evidence to recommend for or against routine screening for prostate cancer.

Another source of guidelines for screening tests is the National Cancer Institute, which bases its recommendations on the Physician Data Query database program. This program continually reviews scientific studies and recommendations by other institutions and periodically releases statements about cancer screening and early detection.

American Cancer Society Guidelines

Many experts consider the American Cancer Society's recommendations to be the gold standard among screening guidelines. For this reason, we've chosen to include them here. You'll find more detailed explanations of various tests and exams in part 2, where we discuss the nine most common cancers. Those chapters also will identify screening tests that may not be appropriate for everyone but that could be helpful for people at high risk for certain cancers.

Cancer-Related Checkup

The ACS recommends a cancer-related checkup every 3 years for people between ages 20 and 40, and every year for people ages 40 and older. This exam should include health counseling and -- depending on someone's age -- examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some nonmalignant diseases.

Breast

Physicians should inform their female patients about the benefits and limitations of monthly breast self-exam. These guidelines also apply.

• Clinical physical breast examination every 3 years for women ages 20 to 40 and every year after age 40; this exam should occur close to, and ideally before, a scheduled mammogram


• Mammography every year for women ages 40 and over

Cervix

A woman should begin cervical cancer screening within 3 years of first engaging in vaginal intercourse, but no later than age 21. Screening should occur every year with the regular Pap test or every 2 years with the newer, liquid-based Pap test. At or after age 30, women who get normal results for three tests in a row may cut back on their screenings to every 2 to 3 years. Those ages 70 and older who get normal results on at least three consecutive tests, and who've had no abnormal results for at least 10 years, may choose to discontinue screenings altogether.

A doctor may recommend more frequent Pap tests if a woman has certain risk factors, such as human immunodeficiency virus (HIV) infection or a weakened immune system. Screening after a total hysterectomy (removal of the uterus and cervix) is not necessary unless the procedure is a treatment for cervical cancer or a precancer. Other special circumstances may require ongoing screening as well. For example, women who've undergone hysterectomy without removal of the cervix should continue with screenings at least until age 70.

Colon and Rectum

Beginning at age 50, both men and women of average cancer risk should choose one of the following five testing schedules:

• Fecal occult blood test every year, using a home testing kit for multiple stool samples


• Flexible sigmoidoscopy every 5 years


• Fecal occult blood test every year plus flexible sigmoidoscopy every 5 years; this combination is preferred over either test alone


• Double-contrast barium enema every 5 years


• Colonoscopy every 10 years, or after positive results on any of the previous tests

People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of these risk factors:

• A personal history of colorectal cancer or adenomatous polyps


• A strong family history of colorectal cancer or polyps, as indicated by either condition in a first-degree relative before age 60 or in two first-degree relatives of any age (remember that a first-degree relative is a parent, sibling, or child)


• A personal history of chronic inflammatory bowel disease


• A family history of a hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary nonpolyposis colon cancer)

Endometrium

All women should be informed about the risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their doctors. Those with or at high risk for hereditary nonpolyposis colon cancer should be given the option of annual screening for endometrial cancer with endometrial biopsy beginning at age 35.

Prostate

The death rate from prostate cancer has declined, but whether it's a direct result of screening is not known for certain. For this reason, the ACS advises physicians to educate their male patients about the potential benefits and risks of early detection and treatment for prostate cancer. In addition, they should offer both prostate-specific antigen (PSA) testing and digital rectal examination (DRE) to men with a life expectancy of at least 10 years, beginning at age 50.

Men who choose to undergo testing should start at age 50. The exceptions are those in high-risk groups, such as African-American men and men with a first-degree relative who developed prostate cancer while young; they should begin testing at age 45. According to the ACS guidelines, doctors should not discourage prostate cancer screening for any patient. If a man asks his doctor to make a decision about screening on his behalf, the doctor should recommend both the PSA test and DRE.

In men who show no symptoms of prostate cancer, testing can detect tumors at a more favorable stage. For the PSA test, an abnormal result is a value above 4.0 ng/ml (nanograms per milliliter). Keep in mind, though, that elevated PSA can result not only from cancer but also from benign prostate conditions.

Compared with the PSA test, the digital rectal exam is less effective in detecting prostate cancer. For best results, DRE should be performed by a skilled health care professional who can recognize subtle prostate abnormalities.

Other Groups Weigh In

Organizations that represent various medical specialties also offer screening guidelines for those cancers that their doctors may diagnose and treat. For example, the American College of Obstetricians and Gynecologists (ACOG) endorses a screening schedule for cervical cancer that differs from American Cancer Society recommendations. According to the ACOG guidelines, women should get their first Pap test approximately 3 years after beginning sexual intercourse or by age 21, whichever occurs first. The screening should continue on an annual basis up to age 30. At that point, a woman who has gotten negative results on at least three consecutive tests can reduce her screenings from every year to every 2 or 3 years.

Women ages 30 and older also may opt for a Pap test and a test for certain types of human papillomavirus (HPV) that are known risk factors for cervical cancer. If they get negative results on both tests, they require screening only every 3 years. More frequent screening may be necessary if either test comes back positive.

Another example of possible variations in screening guidelines pertains to early detection of skin cancer. The American Academy of Dermatology suggests an annual exam, while the ACS makes no specific recommendation for skin screening.

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.. 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.

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