CANCER:  2004 UPDATE

     Last year on February 13th, a column entitled “Cancer: What Are Your Chances in 2003?” detailed the most common cancers in our society and steps that might be taken to avoid, detect, and treat cancer (column available at www.macpierre.com).  Rural Health, Inc. manages clinics in Gettysburg, Highmore, Onida, Murdo and helps with management in the Presho Clinic.  Rural Health, Inc. is a grant funded effort to provide quality healthcare to small communities in central South Dakota.  They are part of the “Cancer Collaborative”.  The Cancer Collaborative is an effort supported by the American Cancer Society to help prevent, detect, and treat cancer.

     Unfortunately, there are only two cancers that are clearly preventable enough to have an impact on the general population.  One of these is cancer of the lung that is prevented by smoking cessation.  Cancer of the lung is the leading cause of cancer death in our society and more than 90% of lung cancers are caused by smoking.

     The other cancer that is clearly preventable is cancer of the colon.  Cancer of the colon originates from benign small tumors called polyps.  On the average about 7 years after a polyp develops in a person’s colon, cancer can develop there.  If the person has the polyp removed before the cancer ever develops, the cancer is prevented.  Thus, if a person has a screening examination of the colon at age 50 and follow-up exams as indicated, cancer of the colon could virtually be eliminated in our society.  Currently, cancer of the colon is the third leading cause of death from cancer in both men and woman.

     Thus the first and third leading causes of cancer death in our society are preventable.  While these two types of cancer are preventable, 2/3 of all cancer deaths occur from tumors that arise at other sites in the body.  To this time, there are no known predictably effective methods to prevent these other 2/3 of cancer deaths.  Thus the thrust of cancer care for this other 2/3 of the population is early detection.  With early detection many tumors can be surgically removed and completely cured.  The remainder of this column is devoted to recommended steps for an adult to achieve early detection of cancers so they can be cured before they advance to untreatable stages. This is one of the goals of the cancer collaborative sponsored by Rural Health, Inc.

     Breast cancer is not preventable.  There is a small impact if any from estrogen replacement therapy.  But even if estrogen replacement therapy were completely stopped, carcinoma of the breast is still a major contributor to cancer mortality and morbidity in our society.  Very clearly, early detection is the key to dealing with this type of tumor.  Specifically, if a lady has a breast tumor develop and it is detected by mammography the cure rate is over 80%.  If instead, the lady waits until the tumor can be felt as a distinct mass in her breast, the cure rate is only 40%.  The most effective screening method for dealing with cancer problems in our society is mammography.  It is recommended that women over age 50 have a mammogram done every year.  If a lady has a history of breast cancer in first degree female relatives, it is recommended that screening mammography be started at age 40.

     Pap smears for detecting cervical cancer and endometrial cancer have been highly effective in decreasing the mortality from these conditions.  Early detection of cervical or endometrial cancer with pap smears has reduced death rates from these conditions to less than 2% of all cancer deaths in our society.  A woman at age 60 who has not had an abnormal pap smear for 10 years may cease further screening but tests are recommended every year at least through age 50 and every two years after age 50.

     For men detecting cancer of the prostate early can be lifesaving.  It is recommended that men begin at age 45 to have a blood test called a PSA test done annually.  In addition, a digital rectal exam on an annual basis is recommended.  For both men and woman, flexible sigmoidoscope exam of the colon is recommended beginning at age 50 and every 5 years thereafter.

     As mentioned above, at least 2/3 of all cancers occur without known risks factors other than heredity.  In a family that has a known history of cancer of the colon, cancer of the breast, cancer of the pancreas or several others, a more intensive screening is a warranted step.

     Skin cancer is an infrequent cause of death that can be very disfiguring.  It is another type of problem that is benefited by early detection and removal of skin cancers.  Annual review of the skin along with avoidance of excessive sun is strongly recommended.

     The healthcare professionals at your local clinics are well aware of the problems that arise from various types of cancer.  They can help in early detection and referral for appropriate treatment once a tumor is found.  Annual review of health status with attention to cancer screening is strongly recommended.