March 18, 2011
By Harvey B. Simon, M.D.
Harvard Medical School
Ask average guys if they're more worried about heart disease or cancer, and most will say cancer. Even though more Americans die each year from heart disease than cancer — about 617,000 compared with about 566,000 — the choice is understandable. Here's why:
- About 1 out of every 3 Americans will develop some form of cancer during their lifetimes.
- Cancer is the second leading cause of death in America. It will become the leading killer as deaths from heart disease decline.
But statistics don't really explain why we fear cancer so much. Many people equate cancer with a death sentence — and a nasty, painful one at that. That's sometimes the case, but many cancers are now highly treatable, even curable.
Researchers at the Harvard School of Public Health have estimated that up to 75% of cancer deaths in this country can be prevented. Smoking, tobacco use, obesity and diet account for 60% of cancer deaths, according to the 1996 Harvard report Cancer Prevention, Cancer Causes and Control. Surely, early diagnosis is important. But you can do a lot to protect yourself from cancer.
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Two Early Detection Tools
Screening tests can help detect cancer before it causes any symptoms or when it's in the earliest stages. Here are the tests you need.
- Men between ages 15 and 35 should have a periodic testicular exam by a doctor and do regular self-exams.
- All men older than 50 should have regular screening for colon cancer. They should also make an informed decision about screening for prostate cancer with a prostate-specific antigen (PSA) test.
- Every man should routinely inspect himself for signs of melanoma and other skin cancers.
Always be alert for symptoms of cancer. Listen to your body and report concerns to your doctor.
Use this guide that the American Cancer Society developed years ago:
C – Change in bowel or bladder habits
A – A sore that does not heal
U – Unusual bleeding or discharge
T – Thickening or lump in the breast or elsewhere
I – Indigestion or difficulty in swallowing
O – Obvious change in wart or mole
N – Nagging cough or hoarseness
It's a rough guide at best. In most cases, such symptoms are caused by noncancerous disorders, and cancers can produce symptoms such as unexplained weight loss or fatigue that don't show up on the list. But it's still a useful tool.
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The 10 Commandments of Cancer Prevention
In February 2011 the American Cancer Society estimated that taking some simple measures could prevent about 2.6 million cancer deaths worldwide each year.
You don't have to be an international scientist to understand how you can protect yourself and your family. Here are the top 10 steps you can take.
- Avoid tobacco in any form. This includes exposure to secondhand smoke.
- Eat smart. Eat less saturated fat and red meat, which appear to increase the risk of colon and prostate cancers. Limit your use of charbroiled foods (especially meat) and avoid deep-fried foods. Eat more fruits, vegetables and whole grains. (Although other reports are mixed, two large studies found that high-fiber diets may reduce the risk of colon cancer.) And don't forget to eat fish two to three times a week; it protects against heart disease and you may reduce your risk of prostate cancer.
- Exercise regularly. Physical activity has been linked to a reduced risk of colon cancer; it may even help prevent prostate cancer. Exercise also appears to reduce a women's risk of breast and possibly reproductive cancers.
- Stay lean. Obesity increases the risk of many forms of cancer. Calories count; if you need to slim down, take in fewer calories and burn more with exercise.
- Limit alcohol to one to two drinks a day. Excess alcohol increases the risk of cancers of the mouth, larynx (voice box), esophagus (food pipe), liver and colon, especially in smokers; it also increases a woman's risk of breast cancer. Smoking further increases the risk of many alcohol-induced cancers.
- Avoid unnecessary exposure to radiation. Get medical imaging studies only when you need them. The dramatic increase in computed tomography (CT) scans in the past 15 years has improved diagnosis, but at a price. Although the risk from a single CT is small, the huge number of CTs explains why they already account for almost 2% of all cancers in the United States. Scientists expect that the CTs performed in 2007 alone will cause about 29,000 cancers and 15,000 deaths over the coming years.
Protect yourself from natural radiation, too. Check your home for radon, which increases the risk of lung cancer. Wear sunscreen to block ultraviolet radiation from the sun and reduce your risk of melanomas and other skin cancers. But don't worry about electromagnetic radiation from high voltage power lines or radiofrequency radiation from microwaves and cell phones. They do not cause cancer.
- Avoid exposure to industrial and environmental toxins, such as asbestos fibers, benzene, aromatic amines and polychlorinated phenols (PCBs).
- Avoid infections that contribute to cancer, including Helicobacter pylori, the "ulcer bug," hepatitis viruses, HIV and the human papillomavirus.
- Consider taking low-dose aspirin. Men who take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) appear to have a lower risk of colon cancer and possibly prostate cancer. This has not yet been proven, however. Also, aspirin can lead to stomach bleeding and other side effects, even in low doses. On the plus side, though, low-dose aspirin does protect men from heart attacks and certain strokes; men at the highest risk reap the greatest benefits.
- Get enough vitamin D. Many experts now recommend 800 IU to 1,000 IU a day. Most people need to take a supplement to get that much. Although protection is far from proven, current evidence suggests that vitamin D may help reduce the risk of prostate cancer, colon cancer and other cancers. But don't count on other supplements. Careful studies show that selenium, vitamins C and E, beta carotene, folic acid and multivitamins are not protective. Some may do more harm than good.
These lifestyle changes have another cancer-preventing benefit: If you stay healthy, you won't need cancer treatments (chemotherapy, radiotherapy, drugs that suppress the immune system) that ironically can increase the risk of other cancers. And if that's not enough to get you started, remember that the first five commandments will also sharply reduce your risk of heart disease.
As always, prevention is the best medicine.
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Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.
