Cancer strategies.

CANCER STRATEGIES

Health topics such as cholesterol, AIDS, and heart disease have gained the interest of the general public over the past few years. However, the topic of cancer seems to get less and less attention in health magazines, newspapers, and on television. Part of the reason for this is that many people think that there is not much that one can do to prevent cancer. I heard someone say recently, "What can I do to beat the odds? You either get cancer or you don't get it."

Cancer is actually not one disease but a collection of more than 100 different diseases. In each of these, abnormal cells grow out of control and take over the normal cells. A person can get cancer at any age, but as one gets older, the chance of developing cancer increases.

About 75 million, or 30 percent, of Americans who are now alive will someday have cancer. Only half of those who develop cancer this year will be alive in five years. This all sounds rather disturbing. However, health experts tell us that many cancers can be prevented or, if discovered and treated at early stages, can be cured.

Over the past 35 years, important progress has been made in the treatment of cancer. Improvements in radiation and drug therapy and better surgical methods have prolonged many lives, made patients more comfortable, and sometimes have cured them. Yet, in the case of dealing with cancer, the saying "an ounce of prevention is worth a pound of cure" is really true. Many types of cancer can be prevented by living a healthy life, including a balanced diet, avoiding cigarette smoking, and having regular health checkups or screenings.

For example, studies have been made of Seventh-day Adventists, a group of Christians who believe strongly in the importance of a healthy lifestyle. Many of them follow a lacto-ovovegetarian diet (a vegetarian diet that includes dairy products and eggs) and abstain from tobacco and alcoholic beverages. As shown by these studies, Seventh-day Adventists have about 40 percent less chance of developing cancer than the general population.

The Public Health Service is presently putting together national health goals to be met by the year 2000. Because prevention is more important than treatment, the year 2000 cancer goals focus mainly on the prevention and early discovery of the disease. The most important areas include reduction of smoking, changes in diet as relates to fat and fiber, and increases in screening for cancer.

Where there's no smoke . . . Tobacco is responsible for more than one of every six deaths in the United States. It is the most preventable cause of disease and death in America. Cigarette smoking causes lung cancer, and is a major risk factor for other types of cancer (throat, esophagus, pancreas, and bladder cancer). At the same time, it causes other lung problems, as well as diseases of the heart and blood vessels. Even passive smoking (breathing air contaminated with someone else's smoke) increases a person's risk of health problems, and may damage the lungs of young children and infants.

Over the past 25 years, we have seen a dramatic decline in cigarette smoking in this country. In 1965, 40 percent of the adults in the United States smoked, whereas in 1987, 29 percent of adults smoked. The graph shows that there is a decrease in smoking among both men and women. However, the decline among men is stronger than among women.

The Public Health Service has set a goal to reduce the percentage of smokers even further (to 15 percent of the adults) by the year 2000. Another goal is to reduce the number of young people that start smoking to 15 percent (as compared to almost 30 percent in 1987). Other health goals include a decrease in the number of women who smoke during pregnancy, the number of children that are exposed to the cigarette smoke of others, and the use of smokeless tobacco.

A healthy diet for a healthy life. Of all cancer deaths, 35 percent may be related to various components in the diet. A diet high in fat has been associated with an increased risk of breast, large bowel, and prostate cancer. A diet low in fiber has been related to an increased risk of cancer of the large bowel. In addition, drinking excess alcohol has been associated with several cancer types, including head and neck cancer.

At the same time, there are components in a healthy diet that seem to protect against cancer. Studies have shown that a diet rich in vegetables and fruits may decrease the risk of lung, prostate, bladder, esophagus, and stomach cancer. Vitamin A, vitamin C, and beta-carotene (the plant form of vitamin A) may be the responsible factors for this finding. Fiber is another important component in a healthy diet. Eating foods that are high in fiber may reduce the risk of large bowel cancer. Based on the results of numerous research studies combined, the National Cancer Institute (NCI) has recently prepared new dietary guidelines, which are listed in Table 1.

With those recommendations in mind, there are two main goals for the year 2000 concerning the diet. The first goal is to lower the average dietary fat intake to no more than 30 percent of calories (presently 37 percent) and the average saturated fat intake to no more than 10 percent of calories (presently 13 percent). The advice is to eat less meat, choose low-fat dairy products, eat less processed foods, and use less fats in food preparation.

The second goal is to increase the average intake of fiber and complex carbohydrates in the diet. Good sources of fiber and complex carbohydrates are whole-grain products, legumes, fruits, and vegetables. Recommended grain products include whole-wheat breads, whole-grain cereals, pastas, and brown rice. Legumes include beans (pinto beans, kidney beans, etc.), peas, and lentils. All fruits and vegetables are good sources of fiber, but for the prevention of cancer those rich in beta-carotene and vitamin C (see Table 2), as well as vegetables from the cabbage family, are especially recommended.

Screening to catch cancer early. It is important to find cancer as early as possible. One way to do this is with routine screening tests. Take, for example, cancer of the large bowel. If it is discovered while still in one single area, the chance of surviving is 85 percent. If the cancer has already spread by the time it is discovered, the chance is decreased to 6 percent. The screening test that helps in discovering large bowel cancer early is a routine exam for small amounts of blood in the stool.

A cancer goal for the year 2000 is to encourage more people over 50 years of age to have such tests. Other recommended yearly exams for those over 50 years of age are examinations for skin cancer and a rectal examination for rectal and prostate cancer. In addition, the Public Health Service plans to increase the proportion of women over 18 years of age that have a yearly Pap smear test for cervical cancer. Women over 40 years of age will be encouraged to have a yearly mammogram (a special type of X-ray of the breasts) for breast cancer.

In order to reach all of the cancer goals by the year 2000, there will be new health laws, as well as nationwide, state, and local awareness campaigns. For example, there will be public campaigns to make people more aware of the importance of screenings for cancer. There also will be smoking prevention programs in schools, work-site smoking policies, clean indoor air laws, and insurance coverage for the treatment of nicotine addiction. In addition, goals are set to provide special training to doctors, nurses, and teachers in stop-smoking counseling, nutrition education, and the recommended cancer screening guidelines.

However, you don't have to sit back and wait for a campaign or for your doctor's advice to get started on cancer prevention. There are many things that you can do today to improve your health. Here are a few suggestions:

* If you presently smoke, stop! If you need help, call your local American Cancer Society for a list of stop-smoking programs in your community. There are good programs around that can help you break the habit.

* If you don't smoke, try to stay away from situations in which you can inhale smoke. Be polite but assertive in asking people not to smoke in your presence.

* If you have children, encourage them to never smoke. Get involved in their school's smoking prevention program.

* Following the dietary guidelines for the prevention of cancer. Not only does this healthy diet help you to reduce you risk for developing certain types of cancer, it also promotes good health in general.

* If you are older than 50 years of age, ask your doctor every year to check your skin and to do a rectal exam as well as a stool test for small amounts of blood.

* If you are a woman older than 18 years of age, see your doctor for a yearly Pap smear test and, if you are over 40, for a mammogram as well.

As you can see, there is much that you can do to beat the odds of developing cancer!

Anne J. Balk-Lamberton, D.H.Sc., M.P.H., R.D., is a health education specialist at the Loma Linda International Heart Institute Lipid Clinic, Loma Linda, California.