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Women and Cancer: A Thorough and Compassionate Resource for Patients
and Their Families, Runowicz, Petrek, and Gansler
Also by the American Cancer Society
American Cancer Society’s Healthy Eating Cookbook: A Celebration of Food,
Friends, and Healthy Living, 2nd Edition
Celebrate! Healthy Entertaining for Any Occasion
Kids’ First Cookbook: Delicious-Nutritious Treats to Make Yourself!
Published by
American Cancer Society
Health Promotions
1599 Clifton Road NE
Atlanta, Georgia 30329, USA
Copyright ©2003 American Cancer Society All rights reserved. Without limiting the rights under
copyright reserved above, no part of this publication may be reproduced, stored in or introduced into
a retrieval system, or transmitted, in any form or by any means (electronic, mechanical,
photocopying, recording, or otherwise), without the prior written permission of the publisher.
Printed in the United States of America Cover designed by Jill Dible, Atlanta, GA
Managing Editor
Gianna Marsella, M.A.
Editor
Amy Sproull Brittain
Copy Editor
Anneke Smith
Contributing Writer
Carol Clark
Editorial Review
Rick Alteri, M.D.
Ted Gansler, M.D., M.B.A.
Managing Director, Direct Channels
Chuck Westbrook
Director, Publishing
Diane Scott-Lichter, M.A.
Book Publishing Manager
Candace Magee
54321 03 04 05 06 07
Library of Congress Cataloging-in-Publication Data
Cancer: what causes it, what doesn’t.
p. ; cm.
ISBN 0-944235-44-1 (pbk.: alk. paper)
1. Cancer--Risk factors—Popular works. 2. Cancer--Etiology--Popular works.
[DNLM: 1. Neoplasms-etiology-Popular Works. 2. Neoplasms-genetics-Popular Works. QZ 201
C2149 2003] I. American Cancer Society.
RC263.C298 2003
616.99’4071--dc21
2003001116
A NOTE TO THE READER
The information contained in this book is not intended as medical advice and should not be relied
upon as a substitute for talking with your doctor. This information may not address all possible
actions, precautions, side effects, or interactions. All matters regarding your health require the
supervision of a medical doctor who is familiar with your medical needs. For more information,
contact your American Cancer Society at 800-ACS-2345 (www.cancer.org).
Contents
Introduction
CHAPTER 1 From Mummies to Molecular Genetics
CHAPTER 2 Who Is at Risk for Cancer?
CHAPTER 3 Why Does Cancer Develop?
CHAPTER 4 Making Sense of Scientific Studies
CHAPTER 5 The Dangers Around Us
CHAPTER 6 Dangers at Home and on the Job
CHAPTER 7 The Keys Are in Our Hands
Conclusion
Resources
Glossary
References
Index
Introduction
CAN YOU GET CANCER FROM DEODORANT, talcum powder, or cellular phones?
Which cancer “risks” should you be concerned about and which are just
rumors? What do your everyday activities and genetic makeup have to do
with your personal cancer risk? How does cancer start and why?
No one book can draw a complete picture of cancer—cancer has
perplexed humans for at least 5,000 years. Researchers discover new
information at such a fast pace that it would be a challenge for anyone to
absorb it all. It seems that the more answers we find, the more questions we
raise.
But this book shares much of what we know about the how and why of
cancer. As we dispel myths, explain risks, and explore the ins and outs of
cancer, we hope you’ll gain valuable understanding about cancer, what
causes it, and what doesn’t.
Information Overload
Cancer is in the headlines every day. Unsubstantiated rumors about cancer
hitch a ride on the Internet and rocket around the world in a matter of
hours. Daily news articles report on the potential risks of ordinary
substances we come into contact with, frightening us and making us rethink
our choices.
People shouldn’t panic when they hear that a new study shows a
substance causes cancer in mice—nor should they believe they are immune
from cancer because they eat well and exercise regularly, advises C. Everett
Koop, M.D., former U.S. Surgeon General and director of the Koop Institute
at Dartmouth Medical School in Hanover, New Hampshire.
“When you concentrate on the wrong information about cancer, you
don’t do the right things that could save your life,” Koop says.
This book will help you concentrate on the right information. We’ll clear
up some common misconceptions about the causes of cancer and give you
the facts you need to know about cancer risks you inherit and those you can
control.
Find Out the Real Risks
Compelling reports about the role of genetics in cancer, the effects of
powerful environmental carcinogens (chemicals and other exposures that
cause cancer), and the possibility of radiation leaks from nuclear power
plants sometimes obscure a key cancer issue: Two-thirds of all fatal cancers
are associated with lifestyle choices. So while some cancer risks are out of
your hands, some are squarely in your control. Factors as basic as what you
eat and drink can affect your cancer risk.
“We really have an enormous amount of control over our risks,” says
Eugenia Calle, Ph.D., the American Cancer Society’s director of analytic
epidemiology. “If everybody maintained a lean body mass, didn’t smoke, ate
a lot of fruits and vegetables, protected their skin from the sun, and
exercised every day, we would live in a different society. It doesn’t mean that
cancer would be gone. But it would have a huge, huge impact on the rates of
cancer.”
Cancer: Past, Present, and Future
Today cancer is a disease that can often be diagnosed early and treated
successfully, allowing more and more people to call themselves cancer
survivors. But even before we had a name for cancer, it was claiming lives.
In chapter 1, we retrace the history of our struggle to understand cancer,
from the mysticism of ancient Egypt to the many new directions molecular
science is taking. We’ll relive the dramatic discoveries that have saved lives
and that have implications for discoveries still to come.
In chapter 2, we clarify who is at risk for cancer, expose how scientists
gather information about cancer in certain populations, and discuss how
demographic factors (like age, race, and socioeconomic status) affect your
cancer risk.
We travel inside the cellular structures of DNA in chapter 3 to reveal
how cancer develops and what role genetics and family history play in
cancer.
The information in chapter 4 will help you make sense of scientific
studies and allow you to become a more informed consumer of medical
research.
Environmental hazards like radiation and pesticides are discussed in
chapter 5—along with information on whether you really need to worry
about them. Chapter 6 tackles cancer risks you might encounter while at
home and on the job.
Chapter 7 reveals that most cancers can be prevented by making healthy
lifestyle choices, like eating right, staying active, and cutting out tobacco.
Finally, we conclude with a discussion of what the future may hold for
cancer research.
In just the last 50 years, we’ve uncovered most of what we know about
what causes cancer, revolutionizing our ability to screen, diagnose, and treat
cancer, and saving hundreds of thousands of lives. Just imagine what
discoveries the next 50 years will bring.
CHAPTER 1
From Mummies to Molecular Genetics
I N THE SUMMER OF 1953, Anne Talley was preparing for her wedding. The
21-year-old native of Memphis, Tennessee, had just graduated from
college and was engaged to Irvin Fleming, another young Memphis native
about to enter medical school.
For weeks, Talley had occasionally felt a nagging pain in her left arm.
“When something would hit my arm accidentally, I felt some pain but not
enough to stop all my activities,” she says. Two weeks before her wedding
date, Talley fell and fractured her left humerus. The emergency room x-rays
revealed why her bone was so weak—a large malignant tumor was growing
in it. She had what was then called reticulum cell sarcoma (now known as
non-Hodgkin’s lymphoma), a cancer of the blood-forming organs that is
linked to problems with the body’s immune system.
Chemotherapy was not available at that time and Talley had only one
viable treatment option—amputation of her arm, all the way up to her
shoulder socket. She underwent the surgery and two weeks later, Anne
Talley and Irvin Fleming got married. “I was released from the hospital on a
Wednesday, and I was married on a Saturday,” she says. “My wedding dress
was kind of high necked, but you could see the bandage through the lace
and I just tied the left arm up. It was kind of dramatic.”
Today non-Hodgkin’s lymphoma of the bone can be treated with
chemotherapy and radiation therapy instead of surgery. But researchers still
do not know what causes it, or why incidences of it have been increasing
through the years.
Meanwhile, Anne and Irvin Fleming are looking forward to their fiftieth
wedding anniversary. She keeps busy as a dog show judge. Irvin Fleming,
M.D., a past president of the American Cancer Society (ACS), is now a
professor of surgery at the University of Tennessee and the director of the
Methodist HealthCare Cancer Center in Memphis.
He is hopeful that with the explosion of new cancer detection and
research technologies, valuable insights about non-Hodgkin’s lymphoma
and other types of cancer will be gained soon. “We’re on the threshold of a
new research approach, based on a lot of new genetic information that is
coming out,” Fleming says. “It’s a whole new science that’s developing.”
Cancer in the Ancient World
Anne Fleming’s story illustrates how far we’ve come in the past few decades,
and how much scientists have yet to learn about what causes cancer. But
cancer is not only a recent concern. The mysteries of cancer have plagued
humans for at least the past five millennia. Although we now know that
cancer is a group of diseases that causes cells in the body to change and grow
out of control, the desire to understand the deadly disease exceeded our
predecessors’ limited knowledge about the human body. In order to come to
terms with the unknown, they developed many theories about what causes
cancer.
Cancer Goes on Record
The ancient Egyptians recorded their medical knowledge and left behind
surgical handbooks, outlines for medical lectures, and case notes on papyrus
manuscripts. Two ancient papyri, written about 1600 B.C. but believed to
date from sources as early as 2500 B.C., describe surgical, pharmacological,
and magical treatments for cancer. These records are the first known
documentations of cancer.
Ancient Egyptians believed supernatural forces caused illnesses like
cancer. Rosalie David, Ph.D., a paleopathologist and keeper of Egyptology at
the Manchester Museum, notes, “Ancient Egyptian medicine was
sophisticated, but they mixed rational methods with magic—the two went
side by side. If they couldn’t see the obvious cause of an internal disease,
they often attributed it to evil spirits, the bad wishes of your enemies, or
even to the powers of the dead.”
In addition to their medical records, the ancient Egyptians provided
modern cancer researchers with another legacy—their own bodies. In an
effort to achieve immortality, the pharaohs of ancient Egypt were embalmed.
Some of the earliest evidence of cancer has been found in the remains of
these mummies.
Two ancient Egyptian papyri that describe cancer were discovered and deciphered in the 1800s. Image
courtesy of the National Cancer Institute.
Unwrapping the Medical Mysteries of Mummies
Studying mummies helps modern scientists learn about ancient diseases. Photo courtesy of The
Manchester Museum, University of Manchester.
Egyptologists and forensic specialists at the Manchester Museum in
Manchester, England, are unwrapping the medical mysteries of
mummies to trace the ancient history of a disease known as
schistosomiasis. Urinary schistosomiasis, left untreated, can lead to
bladder cancer.
Schistosomiasis is caused by a type of flatworm called a fluke that
penetrates the skin of swimmers in the Nile River. People can also
become infected by drinking contaminated water. The worms grow
inside a human’s blood vessels and produce eggs that can travel to
different parts of the body, damaging the liver, intestines, lungs, and
bladder. One ancient papyrus describes the symptoms of urinary
schistosomiasis and attributes these symptoms to a disease called aaa.
Using modern forensic and clinical techniques that enable scientists
to analyze small samples of tissue and leave the mummies intact,
researchers have been able to detect the fluke worms that cause urinary
schistosomiasis in the urinary and bladder tissue of ancient mummies,
says Rosalie David, Ph.D., who also directs the Schistosomiasis
Investigation Project.
Researchers will compile the data extracted from mummies with
data about current schistosomiasis cases in Africa, where the modern-
day incidence of bladder cancer can be up to 32 times higher than the
rate of bladder cancer in the United States. By examining how
schistosomiasis has developed over the past 5,000 years, researchers
hope to gain new insights into the links between schistosomiasis and
cancer.
The Black Bile Theory
After the decline of the Egyptian empire, the great doctors of Greece and
Rome became powerful forces in medicine. The Greek physician
Hippocrates, known as “the Father of Medicine,” recorded cases of
malignant tumors of the breast, uterus, stomach, skin, and mouth in about
400 B.C. He named this condition karkinoma, Greek for “crab-like growth.”
Modern physicians use the term carcinoma to refer to malignant tumors that
grow in the tissue that covers or lines external and internal body surfaces.
Hippocrates’ approach to medicine was based on the theory that the
human body was composed of four humors, or body fluids—blood, phlegm,
yellow bile, and black bile—that affected a person’s health. These body
humors were the biological counterparts of the four elements—air, fire,
earth, and water. His theory held that an imbalance in these four humors
caused diseases. Cancer was believed to be the result of an excess of black
bile, curable only in its earliest stages.
The Roman physician Galen was probably the most influential figure in
medicine from the Roman Empire to the Renaissance. Galen wrote over 400
works on a huge range of medical topics; many of these treatises were still
considered authoritative 1500 years later. Like Hippocrates, Galen believed
that cancer was caused by an excess of black bile. He gave fleshy tumors the
name sarcoma (fleshy growth). Today, physicians use the same term to
describe malignant tumors arising in the connective tissues.
