February, 2015

Chance of a Lifetime

By Michael J. Katin, MD

On January 20, the American Society of Clinical Oncology released the 2015 Annual Report on Progress Against Cancer, including a section on Advances in Prevention and Screening. Shockingly, Dr. Oz and Suzanne Somers were not mentioned, but credit was given to interventions such as low-dose CT screening for lung cancer and the potential for chemoprevention, such as anastrazole to reduce the risk of development of breast cancer. ASCO again called attention to the importance of lifestyle adjustments, including increasing activity, maintaining a "healthy" weight, eating a balanced diet, and avoiding smoking and ultraviolet light exposure.
Nothing was mentioned about more recent threats to our health, such as e-cigarettes, physical intimacy, and Starbucks, three things that millions of people today will have difficulty giving up (in order of difficulty).

Obviously, the situation is much more complicated than that, or else Charlie Sheen and anyone who smoked habitually would all have cancer. Now it turns out there's no protection.

Even before the 2015 ASCO proclamation of progress in cancer treatment and prevention, a paper in Science on January 2 called attention to the fact that cancer risk may be related to the number of divisions of cells in tissues that are continually self-renewing to maintain an intact human. The conclusion was that perhaps only about one-third of cancers were related to environmental factors, but the rest resulted from bad luck (the authors' term). This was somehow picked up by the non-scientific media and had two results: sales of cigarettes and incidents of physical intimacy increased dramatically, and multiple responses were generated by the scientific community. Tomasetti and Vogelstein, authors of the publication in Science, had unintentionally unleashed waves of anxiety among researchers and, especially, grant applicants, who could see their livelihoods threatened by a thought that, regardless of what they do, most people get cancer because of ill fortune. Even the World Health Organization felt threatened, stating that "nearly half of all cancer cases worldwide can be prevented." There were also more conciliatory responses, suggesting that the paper had been taken too literally and that, in fact, review of the information presented did not lead to that conclusion. This then switched the blame to the journalists, rather than to the report. Things will undoubtedly settle out and probably not much will change in the long run, even though Tomasetti and Vogelstein's work would seem to make early detection seem even more important than ever.

Should we all be fatalistic that, whether you live in Winnepeg, Canada, in London , in Germany , or in Ahvaz , Iran, that luck is still at least as important as location in whether you might get cancer? This could lead to an influx of people into Linfen, China, or even Chernobyl (note: real estate investment opportunity!!). The same for lifestyle choices -- maybe smoking cigarettes is ok if you're lucky, and, if you're lucky enough, you can get away with just about anything. The trick then is to know how your luck is going to run. Is it good luck, bad luck, hard luck, dumb luck, or are you SOL? Even if you have good luck, it can turn on you.

Regardless, it's distressing to think that we used to think that our survival was a game of "Let's Make a Deal." Now it turns out to be "You Bet Your Life."

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including February 1, 2015, this leaves 6,544 days to his goal.