More than 13 million Americans are cancer survivors, a new report says. That number is expected to jump to 18 million in 10 years. The American Cancer Society and the National Cancer Institute issued the report. It shows that more people are surviving cancer for several reasons. The number of people diagnosed is rising. So is the size of the older population – including cancer survivors. About 45% of U.S. cancer survivors are 70 or older, the report says. People are also living longer with some of the most common cancers. About 43% of male survivors had prostate cancer. Among female survivors, 41% had breast cancer. More than 58,000 Americans are survivors of childhood cancer. About 64% of survivors learned they had cancer at least 5 years ago. About 15% were diagnosed at least 20 years ago. CA: A Cancer Journal for Clinicians published the report. HealthDay News wrote about it June 14.

By Mary Pickett, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Currently, there are 13.7 million cancer survivors in the United States. By 2022, this number will grow to 18 million. That is the prediction made this week by the American Cancer Society.

When I started my medical training, it was fairly rare to be a cancer survivor. Patients who were newly diagnosed with cancer would ask me, "Doctor, how long do I have left?" Now, patients want to know, "What do I have to go through to beat this?" Almost half of our current cancer survivors are age 70 or older.

Just a couple of weeks ago I talked with a patient in my office who has survived testicular cancer. His cancer has been absent for 15 years. He has dutifully come back year after year for a physical exam. He has also had regular tests such as CT scans to make sure the cancer had not returned.

At his most recent visit, I told him that he did not need to get any more CT scans. He looked at me as if he had a completely new self-image.

"I am past it," he said. Before I told him we should stop testing, he had not yet allowed himself to believe it.

There are two major reasons that we have more cancer survivors than ever before. First, screening tests can find cancers at an early stage, when they are treatable and beatable. Second, treatments have improved and expanded.

For example, let's take breast cancer. Among female cancer survivors, 2 out of every 5 had breast cancer. Breast cancer can be treated with surgery. Most women also get radiation treatments, hormone therapy or chemotherapy. Women who treat their breast cancer aggressively are likely to become long-term survivors:

• Under age 50 without cancer in lymph nodes: 78% are survivors
• Under age 50 with cancer in lymph nodes: 53% are survivors
• Age 50 to 69 without cancer in lymph nodes: 69% are survivors
• Age 50 to 69 with cancer in lymph nodes: 49% are survivors

These statistics came from women who had both surgery and chemotherapy. A woman gets to be counted as a breast cancer survivor if she has lived for 10 years beyond her diagnosis. By that time, the cancer isn't likely to return.

What Changes Can I Make Now?

Here are my top strategies for cancer prevention:

• Don't smoke.
• Limit the amount of alcohol you drink.
• Have a colonoscopy to remove colon polyps. (If the polyps aren't there, cancers are less likely to appear.)
• Stop estrogen replacement within five years of menopause.
• Have regular Pap smears. (Problems that are pre-cancers can be treated.)
• If you are younger than 26 (man or woman), get the human papilloma virus vaccine. It prevents cervical cancer, anal cancer and some cases of throat cancer.
• Wear sunscreen.
• Protect yourself against HIV and hepatitis C. These conditions can increase your risk of certain cancers. Avoid sharing needles and always use condoms with sex partners.
• Take good care of yourself in general, and get plenty of sleep. A healthy immune system keeps a lookout for cancer, and kills cancer cells when they appear.

Cancer can be cured if it is diagnosed at an early stage. Here are my top strategies for early detection of cancers:

• Have a colonoscopy.
• For women after age 40 (or for sure, by age 50), have mammograms every 2 years and breast examinations by a doctor.
• Consider having a yearly low-dose radiation CT scan to scout for lung cancer if you:
  
  • Are age 55 to 74 and
  • Have a history of heavy smoking (30 years of a pack each day, or 15 years with 2 packs per day)

One cancer that we no longer recommend screening for is prostate cancer. The prostate-specific antigen (PSA) blood test found many prostate cancers. But most were in such an early stage that treatment was more likely to cause lasting harm than the cancer itself was. Some prostate cancers are killers. However, in order to treat those we also have to treat many cancers that would not lead to harm. This puts all of those men at risk for side effects of treatment.

Prostate cancers that are too small to cause symptoms are probably best left alone -- or not even found. Men with untreated prostate cancer can still be survivors of cancer -- they just survive with it, instead of after it.

What Can I Expect Looking to the Future?

Our best advances against cancer in the last decade have been prevention and early detection. These strategies rely on the American public to be educated and to take action to preserve their health. So the public and the media deserve much of the credit for the last decade of gains against cancer.

Americans are getting more health conscious and smoking less. They are putting more focus on concerns about the environment and product safety. Cutting cancer may involve eating fewer processed foods that contain cancer-causing trans fats (such as snack foods containing hydrogenated or partially hydrogenated oils). Cutting down on processed, heat-treated carbohydrates (such as cereals, chips and fries) may help too. These foods can contain traces of the carcinogen acrylamide.