The American Cancer Society publishes a journal entitled CA.  It is sent as a public service to all physicians in the United States.  It is also available on-line at http:\\CAonline.AmCancerSoc.org. Every January, they update the cancer statistics for the United States and rehash the trends over the past 50 years.  These statistics are very useful in recommending steps in healthcare maintenance and cancer prevention.

 According to the most recent data from the United States census bureau, the population of the United States is now around two hundred eighty million people.  The annual death rate is around 1% but more accurately in the year 2000, there were two million four hundred three thousand three hundred fifty one (2,403,351) deaths recorded in the United States.  Of these, 29% died of heart disease, and 23% died from cancer.  There were thus five hundred fifty six thousand (556,000) recorded cancer deaths in the United States in the year 2000 which is the most recent year for which data are available.

 By far, the most common cancer in men is cancer of the prostate accounting for 1 in 3 cases of cancer.  Fortunately, the condition is usually responsive to surgery or chemotherapy and the death rate from cancer of the prostate is relatively low accounting for only 10% of all cancer deaths in men although prostate cancer causes 33% of all cancer in men.  Early detection and treatment does contribute to a higher cure rate and less suffering through the course of the disease.

 In women, the most common cancer is cancer of the breast.  Fortunately, it too can be effectively treated through surgery and chemotherapy.  Mammography has had the greatest impact in early detection and cure rates of any cancer program thus far.  If a lady’s breast cancer is detected by mammography before the tumor can be felt by the lady or her physician, the cure rate is 80%.  If a tumor reaches such size that the lady herself or her healthcare provider can feel the lump then the cure rate is only 40%.  Mammography is the single most important health care maintenance step a lady takes to prevent cancer morbidity or mortality.

Second, on the list of most common cancers in men and women is cancer of the lung.  Although it is second in an incidence of cancer, it is the leading cause of death from all cancers accounting for 172,000 deaths per year from cancer of the lung.  That is, one-third of all people who die of cancer die of cancer of the lung.  It is a cigarette related disease.  Unfortunately, once the disease is diagnosed 95% of the individuals with this condition die within two years and there is little if anything that can be done to create remissions or cures short of those lucky individuals whose cancers can be completely removed by surgery.  Note, this is less than five people in one hundred.

 The third major cause of cancer in our population is cancer of the colon and rectum accounting for 10% of all cancer cases and accounting for 10% of cancer related deaths.  Unfortunately, chemotherapy has little impact on survival with colon cancer although some chemotherapy programs are used to alleviate symptoms.  Very fortunately cancer of the colon is a preventable disease.  If a person will have their colonoscopies done and polyps can be removed before they ever turn into cancer, the cancer of the colon never occurs.  As undignified as a colonoscopy is, I absolutely promise you it is well worth preventing cancer of the colon.

 All of the other cancers that may occur make up less than half of the cases of cancer and the causes of death for cancer.  Be that as it may, it is recommended that individuals between age 20 and 39 have a cancer related check up every three years. Women in this age group should have a pap smear every year as this is the peak time for development of carcinoma of the uterus.  Beginning at age 40, women should have a baseline mammogram done.  A second mammogram should be done at age 45 unless there is a strong family H/O breast cancer; if a blood relative  has developed breast cancer, mammography should be done annually beginning at age forty.  Annual mammograms should be done at age 50 and after in all women.

 For men, the two cancer screening tests that are impactful in early detection and prevention of morbidity and mortality is screening for prostate cancer and colonoscopy.  Beginning at age 50, digital rectal exam and prostate specific antigen tests should be done on an annual basis. Colonoscopy should be done at age 50.  If polyps are found at that age, follow up exams should be done a year later, two years later, and then every three years until there are three negative exams.  If no polyps are found at age 50, a recheck every five years seems a reasonable compromise until three successive examinations are negative.

 If a woman reaches age 60 with no history an abnormal pap smear and she does not have risks factors for development of carcinoma of the uterus, further pap smears do not serve a purpose either.

 Independent of early detection of cancers that may occur is the avoidance of risky behavior that predisposes the person to cancer.  As mentioned above by far the most serious risk factor in our society is smoking cigarettes.  There has been great controversy regarding estrogen replacement therapy in the recent past.  The best estimate at this time, is that it may increase the risk of breast cancer in the general population from a baseline value of 10 chances in 100 in a woman’s lifetime to 13 chances in a 100 in a woman’s lifetime.  This would amount to approximately 10,000 mortalities per year from breast cancer.  As a balance then for consideration, there are approximately 15,000 women per year that die from hip fractures and thus there appears to be an equal tradeoff.  The use of estrogen replacement therapy with its slight  predisposition to breast cancer (3 chances in 100) prevents more deaths from hip fractures.

 There being relatively few causes of cancer that are caused by environmental factors it is obvious that genetic and hereditary factors play a major role.  Thus if there is a family history of tumors in a given organ system, increased surveillance of this system is important.  Examples include families that develop cancer of the stomach, cancer of the prostate, and cancer of the breast.

 The healthcare professionals at your local clinic are well versed in cancer related checkups and can counsel individuals regarding their risks with suggestions for surveillance and preventive measures.  Avoiding cancer related death and disability is well worth the effort.