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REALITY CHECK

We want to know the formula for preventing cancer but there isn’t one

Reuters/Lisi Niesner
Some links to cancer are stronger than others.
  • Lauren Alix Brown
By Lauren Alix Brown

Director of Special Projects

Published This article is more than 2 years old.

Yesterday, I cringed while opening Aaron E. Carroll’s piece for the New York Times’ Upshot titled, “Helpless to Prevent Cancer? Actually, Quite a Bit Is in Your Control.” I wanted to know; but I didn’t want to know.

Was there something I could have done to prevent developing breast cancer two years ago at the age of 31?

I don’t normally ask that question because it’s irrelevant. I’m focused on living my best life and doing what I can to prevent a recurrence.

Yet people who are confronted with your diagnosis seem to become obsessed with prevention. My brother was convinced about the link between nutrition and cancer, and a date thought I should go vegan or risk a recurrence.

Understandably, we want to believe there’s a link between the disease and our behavior. But that’s not how cancer works.

A 2015 study published in Science found that cancer is largely out of our control, the result of errors in DNA replication. It was used to support the theory that cancer is a result of “bad luck” (though Carroll qualifies the finding with the fact that many cancers affect parts of the body, like the lungs, that don’t have rapid cell division, which is the mechanism for these mutations).

More recent research falls in the “it’s preventable” camp. A study in JAMA Oncology explores how preventable different types of cancer are in relation to smoking, drinking, obesity, and exercise. More than 78% of people could’ve prevented their lung cancer; 30% for pancreatic cancer; 4% for breast cancer.

I have no way to determine whether I’m in the 4% group that could’ve prevented my cancer through a lifestyle choice, but I feel some reassurance that I probably didn’t bring this upon myself.

Much research will continue to be published and likely fall into both frameworks, but it’s a fruitless battle.

Carroll wisely points out:

A bigger concern to me is that people might interpret these findings as assigning fault to people who get cancer. You don’t want to get into situations where you feel as if people don’t deserve help because they didn’t try hard enough to stay healthy. Much of cancer is still out of people’s control.

And even though we yearn for it, there’s no formula for guaranteeing a cancer-free life. There are too many variables and permutations among types of cancer, cells, and environments. We want a bright line for what we should and should not do when we’d be better off working to accept that uncertainty is inevitable and healthy living comes down to common sense.

Want to prevent cervical cancer? The HPV vaccination is a no-brainer. Don’t want lung cancer? Don’t smoke cigarettes, but be aware that as many as 20% of people who die of lung cancer never smoked.

At worst, cancer research becomes a tool for reductive healthy living claims, at best it presents a better understanding how these diseases behave. There’s so much oncologists still don’t know.

When I talked to Cliff Hudis, an oncologist who specializes in breast cancer at Memorial Sloan Kettering, he told me, “You’re constantly dividing and reducing your cells and you can almost marvel that you don’t get more cancer earlier in life. It’s almost miraculous it doesn’t go wrong immediately.”

But after recently reading Siddhartha Mukherjee’s The Emperor of All Maladies: A Biography of Cancer, I was struck by just the opposite. The thousands of mutations of DNA that have to occur over the years in just the right places for cancer to persist seems like such a freak occurrence.

Minimizing risk factors makes sense. What does not is embracing a belief that a behavior will simply cause cancer, that it’s either “bad luck” or preventable.

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