Why “Early Detection” Alone is NOT The Best Protection
We have all heard the slogan, “Early detection is the best protection.” As a matter of fact, as a health professional, I find that I can seldom sort through my weekly medical mail without having that slogan staring at me from nearly a dozen different postcards and other mail received from a myriad of local health facilities and hospitals. Notwithstanding that, in this post, I challenge conventional wisdom vis-à-vis this slogan, and ask you to consider another crucially important perspective on this matter.
If you are a woman and concerned about becoming a victim of breast cancer, your doctor might advise you to get regular mammograms for the purpose of “early detection.” Similarly, if you are a man, and are concerned about prostate cancer, your doctor may ask you to get a “PSA” or Prostate-Specific Antigen test. While “early detection” as represented by these tests is valuable and important, and does indeed save lives from the standpoint of early treatment, it does nothing to prevent anything; that is, you cannot prevent breast or prostate cancer by early detection! If you “detect” cancer or even pre-cancerous changes in the body’s tissues, it clearly means that either the cancer, or the pre-cancerous condition, has already occurred. In other words, you are now obligated to address a problem that has already manifested itself; you have not prevented it in the first place. Here is my perspective in this matter — I believe that True Prevention can and should occur long before the possibility of disease detection, and a really solid nutrition and lifestyle-based prevention plan might help us make the actual detection of a good percentage of certain cancers irrelevant by putting the effort and emphasis on pro-actively and aggressively preventing these cancers from occurring in the first place.
Now, before you tell me that not all chronic diseases such as certain cancers are preventable, I must interject by asserting that a significant percentage of cancers are in fact preventable. Research suggests unequivocally that only 5-10% of all cancer cases can be attributed to genetic defects, whereas the remaining 90-95% have their roots in an individual’s environment and lifestyle (1). Here is the official breakdown of known factors linked to cancer for all cancer-related deaths:
- Almost 25-30% are due to tobacco use
- As many as 30-35% are linked to diet
- About 15-20% are due to infections
- The remaining percentage is due to other factors such as carcinogenic exposures, stress, lack of physical activity, environmental pollutants, etc, i.e. “environmental factors.”
Research also suggests unequivocally that cancer prevention requires:
- Smoking cessation
- Increased ingestion of fruits and vegetables
- Moderate or no use of alcohol
- Caloric control
- Minimal meat consumption
- Whole grain consumption
- Avoidance of direct sun exposure
- Regular physical activity
- Prudent use of vaccinations as needed
The bottom line? We can no longer say that we have no control whatsoever over preventing cancer. The vast majority of cancers are in fact preventable, but they do require major lifestyle changes for most individuals. Two critical factors, that have been studied very extensively through research, give support to the preventability of cancer:
1. The link between diet and cancer is revealed by large variations in the rates of specific cancers in various countries, and the changes observed in the incidence of cancer among those who migrate. For example: Asians have been shown to have a 25 times lower risk of prostate cancer and a ten times lower risk of breast cancer than do residents of Western countries, and the rates of these cancers increase substantially after Asians migrate to the West (2).
2. Extensive studies with identical twins have suggested that genes are not the source of most chronic illnesses. For example, the concordance between identical twins for breast cancer has been found to be only 20% (3). Data suggest that instead of our genes, our lifestyle and environment account for 90-95% of most chronic illnesses.
The reality is this – The weight of scientific evidence that has emerged especially in the last two to three decades from academic centers globally has convincingly and unequivocally established the potent link between nutritional/behavioral choices and good health. Given this evidence, it would be folly, in fact even fatal, for us to ignore what True Prevention-based efforts can do for us. Dr. Walter Willett, Professor of Nutrition at The Harvard School of Public Health recently stated, “With careful attention to the foods we eat, combined with not smoking and regular physical activity, we find that over 80% of heart attacks and greater than 70% of certain cancers can be avoided (4).” From this statement, it seems reasonable to conclude that while we may not be able to wipe out all of cancer with the strategy of True Prevention, we ought to wipe out the 70% or more of cancer that we can, and so also obviate the 80% of heart attacks that are preventable.
The concept of pro-actively preventing deadly diseases such as certain cancers is not an idealistic fantasy. Statistics suggest that every 13 minutes, a woman dies from breast cancer, and increasingly, we are seeing cancer (such as that of the breast) occur in younger women. In light of these facts, we need to take a much more pro-active stance in preventing this disease to the maximum extent possible. Instead, I find that here in the West, too many of us have resigned either to doing our best to detect cancer “early,” or simply to wait for the “Magic Bullet” that will one day wipe out cancer. The point is that while it is incumbent upon us to continue to “race for the cure,” is it sensible not to put to good use the volumes of scientific data that clearly suggests that several common cancers can be prevented through diligent lifestyle modifications? I believe that failing to incorporate research- and evidence-based nutritional and lifestyle modifications as early as possible in life is tantamount to adopting a “reactive” rather than a “pro-active” stance towards this formidable disease, that may result in the death of millions.
In light of the above, I strongly believe that early nutritional and lifestyle interventions (and not early detection alone), coupled with educational initiatives to build awareness of environmental and other carcinogenic exposures, are the true keys to eventually winning the battle against deadly chronic diseases such as cancer. And, while admittedly these interventions may not help us conquer all of cancer, they can decidedly help us conquer a very significant percentage of it. I also believe that while early detection is advisable and should continue in order to help us save the lives of those who may have already become the unfortunate victims of a cancer, or a pre-cancerous condition, we should bear in mind that we are never going to prevent new cases of cancer from emerging if we don’t also get serious about True Prevention. I believe that reassuring millions that “early detection is the best protection” is tantamount to giving these individuals a false sense of security that they are doing “their best” to protect themselves, whereas in reality early detection cannot prevent cancer at all – it can only help us treat cancer as early as possible once the cancer or pre-cancerous conditions have already become existent. Thus, our best efforts to truly protect ourselves from cancer call for a lot more than early detection; they call for early prevention.
This year, more than 1 million Americans, and more than 10 million people worldwide, are expected to be diagnosed with cancer. This disease continues to be a worldwide killer and accounts for about 23% of total deaths in the U.S., being the second most common cause of death after heart disease, and in 2010 it is expected to rise to the rank of the first most common cause of death. Given these numbers, it is past time for us to be encouraged not just to detect cancer(s) early, but to learn all we can and do all we can to prevent cancer(s) from occurring in the first place – at least to the maximum extent possible.
There will always be – and should always be – an important emphasis on catching any disease early. However, the point of this post is this: Given the vast and increasing reach of cancer even in the face of decades of diligent research, it is simply not enough anymore for us to “detect” or “catch” it early. While we must do that, we must simultaneously also work committedly at preventing it early. Perhaps, it is best put this way: Early, committed and diligent efforts to prevent cancer coupled with early detection – are a better strategy than early detection alone. Conventional doctors are in a position truly to guide and encourage their patients to understand this reality and to help them pro-actively prevent cancer to the greatest extent possible. Whether we are academics, physicians, or lay individuals, it’s time to embrace a mindset and a culture of True Prevention. Indeed, doing so and catching the spirit of this idea will involve a revolutionary change in how we approach the treatment of chronic diseases, especially cancer. I dedicate this post to that end.
Notes
(1) Anand, et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharm Res. 2008; September 25 (9): 2097-2116.
(2) Food, Nutrition, Physical Activity and the Prevention of Cancer; Diet and Cancer Report
(3) A.S. Hamilton and T.M. Mack. Puberty and Genetic Susceptibility to Breast Cancer in a Case-Control Study in Twins. New England Journal of Medicine 348: 2313-22 (2003)
(4) Third Annual Great Issues in Medicine and Global Health Symposium, 2006. Linking our Food Choices to Cancer Risk, Dartmouth Hitchcock Medical Center.
RESOURCES
Anand et al. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Cytokine Research Laboratory, Dept. of Experimental Therapeutics, The University of Texas M.D. Anderson Cancer Center.
