Episode 3 of 7 in our series on Top Threats to Good Health

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Cardiovascular disease may be the leading cause of death for US adults, but cancer could be the most feared. 

Cancer is the second leading cause of death among US adults, and one reason it may be so feared is that it seems so random.  Cancer can lurk beneath the surface and arise when least expected and devastate your hopes and dreams about the future.  Treatment is complicated and may not be curative. 

We could go on, but let’s not stoke the fires of anxiety here.  Like we did in Episode 2, The Heart of the Matter, let’s look at the epidemiology, risk factors, preventive approaches, and treatments for cancers so that we have knowledge, which is power, to reduce the impact on your health.

If you have read the preceding Educational Posts, you’ll recall that at Paradigm Health our strategy is one of Medicine 3.0. This means that we don’t wait around to find out what lies beneath; we are proactive in discovering what our risks may be so that we can take a preventive approach to health.


— Paradigm Shift —

taking that first courageous step to uncover threats to your own health so that you can do something about them


While we shift the paradigm of medicine, we want you to shift the way you look at your health and the health of your loved ones. It takes courage to look into the diseases you may be at risk for. It takes courage to do something about it, to talk about it, to tell someone else about it. It may cause anxiety to think about it. We all need to remember that how we approach our health is up to us as individuals. If you are ready to shift, read on.


Epidemiology

  • In 2024, ~1,900,000 U.S. people will be newly diagnosed with cancer
  • In 2024, ~609,000 U.S. people will die from cancer
  • The most common types of cancer in the U.S. collectively add up to 50% of all cases and include:
    • Breast cancer (15%)
    • Prostate cancer (15%)
    • Lung cancer (12%)
    • Colon and rectal cancer (8%)
  • The other 50% of cancer cases are from skin, kidney, bladder, liver, blood leukemia/lymphoma/myeloma), pancreas, and others.

Image source: NIH: National Cancer Institute


Lung Cancer: the leading cause of cancer-related deaths among both men and women in the US, primarily due to smoking and exposure to carcinogens such as radon and asbestos.

Breast Cancer: the most frequently diagnosed cancer among women and the 2nd leading cause of cancer-related deaths.  But survival rates are very high when detected and treated early.

Prostate Cancer: 2nd most common cancer in men, with a relatively high survival rate when detected early.

Colorectal Cancer: 3rd in both incidence and mortality among men and women. Screening for colorectal cancer can significantly reduce the risk of death through early detection and treatment.

Skin Cancer: Skin cancer, including melanoma and non-melanoma types, is highly prevalent but often curable when detected early.

While breast, lung and bronchus, prostate, and colorectal cancers account for almost 50% of all new cancer cases in the United States, some of these have relatively effective treatments available.  The pie chart on the right in the image above demonstrates that cancer deaths show a different distribution.


Risk Factors

We’re going to go out on a limb here and guess that we all have risk factors for cancer.  We’re human, in the same boat so to speak, faced with the many of the same challenges in life. Because this is true, we are in it together and need to support each other in the face of our infirmities.   

There are many risk factors that contribute to the development of cancer.  For some of us, it’s in our genes. For others, we were exposed to known and unknown environmental toxins that lead to cancer. Other diseases we have can lead to cancer, and some lifestyle choices we make can lead to diseases that lead to cancer. It helps to make a list to see which risk factors we can do something about (modifiable) and which we can’t (non-modifiable such as age or genes).


Prevention

A Medicine 3.0 approach to health is to identify risk factors early, seek ways to reduce the risk by modifying those risk factors that you can, in order to prevent developing the disease in the first place. Our approach at Paradigm is:

  1. Screening and Early Detection: Regular cancer screening tests can detect cancer at an early stage when treatment is most effective. Screening guidelines vary by cancer type and individual risk factors. Examples include mammograms for breast cancer, Pap smears for cervical cancer, colonoscopies or stool sample tests for colorectal cancer, and PSA tests for prostate cancer.  As technology is advancing quickly in this area, better (and less invasive!) screening tools are becoming available every year.
  2. Promoting Healthy Lifestyles: A balanced diet is better than a non-balanced diet (hearty vegetables with that barbecue) when it comes to reducing the risk for cancer.  Likewise, some exercise is better than no exercise for the same reason.  The better the better, for sure.  Encouraging healthy eating, an active lifestyle, limiting alcohol, and avoiding excessive sun exposure are behavioral things that will lower the risk of cancer. 
  3. Genetic Counseling and Testing: Individuals with a family history of cancer or known genetic mutations associated with cancer risk may benefit from genetic counseling and testing to assess their risk and make informed decisions about preventive measures and ongoing screening. Being aware of the risk, and then detecting cancer early, makes it much easier to treat and cure.
  4. Vaccination Programs: Vaccines against human papillomavirus (HPV) and hepatitis B virus (HBV) can prevent infections that are associated with an increased risk of certain cancers, including cervical, anal, and liver cancers.
  5. Tobacco Use: You can almost eliminate the exceptionally high risk of lung cancer by quitting tobacco smoking. This is not easy. Individualized smoking cessation programs are the most successful though. The first step is the shift.

A Deeper Dive Into Screening

Early detection is key. If you want to take this threat to longevity head-on, you need to detect any cancer you may get early and get it taken care of.  Look at this list of screening methods. Those that apply to you, just do. When there are better tests, we’ll all do those. We’ll also consider newer tests that help us detect cancers even earlier. 

  • Mammography (X-ray exam) used to screen for breast cancer in women is the gold standard test and typically recommended starting at age 40 and repeated at regular intervals.  The latest evidence would suggest that combining this with ultrasound and possibly MRI is most effective is detecting breast cancer early when treatment is associated with a very high rate of cure.
  • Pap smear test is used to screen for cervical cancer by collecting cells from the cervix to detect abnormalities or precancerous changes.  Appropriate use of this test has greatly reduced mortality from cervical cancer.
  • Colonoscopy is the gold standard for detecting colorectal cancer.  Recently stool-based tests like ColoGuard have been developed for patients with a low/average risk of colorectal cancer.  It is not for patients at high risk.
  • PSA blood test is used as a screen for prostate cancer, although controversy exists regarding its utility due to concerns about overdiagnosis and overtreatment.  Very recently several new blood tests, urine tests, and use of MRI have been reported to greatly increase the accuracy of prostate cancer risk and whether biopsy should be performed.

Treatment

The treatment landscape for cancer is vast as Montana; there are continual advancements in surgery, radiation therapy, chemotherapy, immunotherapy, targeted therapy, and other modalities improving the chances for cure. Your chances to detect, treat, and outlive cancer are much better now than they were even 5 years ago.


New Screening Tests To Consider

Many new tests are being developed and used to detect cancer earlier.

  • multi-cancer detection (MCD) tests
  • whole genome sequencing
  • whole body (or focused) MRI  

Multi-cancer detection tests: MCDs, such as the GRAIL Galleri test, offer promise in early cancer detection by analyzing blood samples for multiple cancer types simultaneously. These tests rely on advanced genomic and proteomic techniques to detect circulating tumor DNA and protein biomarkers associated with various cancers, potentially enabling earlier diagnosis and treatment.


Genome sequencing to evaluate the presence of cancer-associated genes in your DNA is also a new alternative that is becoming more affordable. 


Additionally, whole body or targeted MRI in asymptomatic patients is available and may be useful…

…but there are caveats. 


These tests are not perfect.  There can be false negative results (there is cancer, but it was missed by the test), or false positive results (there is no cancer, but the test says there is).  Either scenario is bad.

  • You should know these words:
    • False-negative tests – the test failed to detect the cancer
    • False-positive tests – the test was positive, but there really was no cancer

With a false negative test, the cancer would still be there, and you would not know.  Periodically repeating the tests or using another kind of test will make it more likely to detect a cancer that is actually there.

With a false positive test, there is unnecessary anxiety and perhaps unnecessary invasive tests chasing a cancer that is not really there. Again, repeating a test or using another kind of test can reduce the chance for a false positive result.


Optimization

  • Pillar 1 is prevention. 
  • Pillar 2 is treatment. 
  • Pillar 3 is optimization.

Optimization for cancer avoidance and survival means working on being healthier tomorrow than you are today. It means sleeping and eating well. It means building your physical fitness, your social connectedness, stabilizing your mood.  And it means having a healthcare team that knows you, can assist you with coordinating care, with pre-habilitation and rehabilitation around the time of surgery, and provide symptomatic care.


Cancer is a formidable foe, so don’t go it alone. As we said before, we’re in the same boat.

In it with you,

Dr. Matt and Dr. David