For the cancer patient, the effort has paid off in new facilities, new medical equipment and sophisticated treatment. To a great degree, the hurdles described by Dr. del Regato - geography, organization, skill and the rest - are down. Worldwide, 680 research and treatment institutions in 82 countries serve the potential or actual cancer victim. In the United States, more than 90 per cent of the population lives within 200 miles of one of the institutions described by the National Cancer Institute as cancer centers, which offer the most up-to-date cancer treatment and also carry on research into new methods of treatment. And in any hospital specializing in cancer care, a patient can expect certain standardized, effective models of diagnosis and treatment.

The rigor and thoroughness of these models can be seen in the sequence of steps, called a protocol, in the treatment of cancer of the colon or lower intestine. To begin with, a doctor takes a look at the interior of the colon, using an instrument called a sigmoidoscope or colonoscope. If he finds a tumorous growth, he calls upon specialists to perform a biopsy - to remove a piece of it for laboratory analysis to determine whether it is benign or malignant. Usually, he will want the growth cut out in either case.

If the growth is a polyp, or small tumor and is located near the rectum, the doctor himself may remove it. To treat a growth further up the colon, he will call in a surgeon, who also proceeds according to the steps of a protocol. The surgeon generally removes a benign tumor by simply cutting it away at its base; when operating on a malignant tumor, he removes a portion of the colon above and below the growth as well. If the portion is relatively small, the severed ends of the colon are sewed together; if it is large, an opening is made in the wall of the abdomen to let the patient pass bowel movements into a plastic pouch. Finally, to complete the protocol, surgery is generally followed by chemotherapy or by a combination of radiation therapy and chemotherapy.

Such treatments are the work of skilled scientists and craftsmen - the professional soldiers in the war against cancer. The ranks of such professionals range from the field marshals who direct the national and international campaigns, down to the foot soldiers who run tests in laboratories. By comparison, the potential cancer victim is a civilian, who may seem helpless while the battle rages. But this civilian can prevent the battle by simply avoiding the disease. A handful of common cancer-causing agents is responsible for most of the cancer in the world. Armed with knowledge and prudence, the civilians in the cancer war have it in their power to deny cancer most of its chances to attack.

[+/-] Read more...

[+/-] Read more...

In the course of studying epidemiology, the epidemiologists have developed two main branches of their science, one essentially retrospective and the other prospective. Retrospective epidemiologists follow Pott's method, but at a much higher level of thoroughness and sophistication. Having identified a group especially high in a specific cancer or in cancers generally, they probe the lives both of the victims and of those who have escaped the disease. They analyze medical records and personal histories, and the personnel and health records kept by employers. Survivors are questioned on every conceivable detail of their working and living habits, and the investigators search through death certificates to identify earlier cases. 

In one typical retrospective project - conducted in 1981 - a team of researchers led by Dr.Brian MacMahon of the Harvard School Of Public Health studied 369 victims of pancreatic cancer and 644 subjects who were free of that cancer. The epidemiologists asked all the subjects about their use of tobacco, alcohol, tea and coffee, in an attempt to  discover whether any of these factors increase the risk of developing the disease. One important connection emerged: pancreas cancer patients were more likely to be coffee drinkers than were the controls. Neither alcohol nor tea increased the risk; cigarette smoking increased it only slightly. What was more, the more coffee a person drank, the greater the risk. Those who drank one or two cups a day were twice twice as likely to develop pancreas cancer as those who drank no coffee at all. Those who drank five or more cups tripled their risk. Obviously, the effects of such a study can be vital to cancer prevention. In the United States, more than half of the population over the age of 10 drinks coffee every day, and Dr.MacMahon estimated that more than half of all pancreas cancer could be linked to coffee drinking. 

Unlike Dr.Macmahon - who worked backward from existing records - prospective epidemiologists follow large numbers of people into the future. These people are not necessarily ill when the project starts. The epidemiologists simply records their medical histories and their life styles in great detail, then waits to see what happens to them. The waiting is expensive; hundreds or even thousands of technicians may keep close track of the subjects for decades. But the findings - based upon identical - exhaustively detailed observation of many people over a long period, are especially valuable.

[+/-] Read more...

[+/-] Read more...

Cancer plays favourites, certain forms strike more virulently in certain places. Although most of these geographical concentrations remain to be explained, they often provide clues to a custom or climate that causes the peculiarly local disease. One form of cancer traced to specific causes, Burkitt's lymphoma, is linked to environment. Six other factors fairly conclusively established as causes of distinctive cancers are illustrated on the following pages. These causes are surprisingly diverse: local foodstuffs or food-preparation techniques, personal habits and a parasite that lives mainly in the Nile River. Among the most puzzling cancer pockets are those where breast cancer is unusually prevalent. The disease is apparently influenced by many factors - heredity, childbearing, possibly viruses and, according to some authorities, a diet high in fats. None of these suspected causes, however, explains why in all the United States, breast cancer is most common around the Great Lakes.

The concentration of lung cancer in Great Britain and the Southern United States is attributed to cigarette smoking - an almost universal habit - and to industrial pollution in those areas. But no one knows why the states of Georgia and South Carolina should suffer so from esophageal cancer - a widely scattered disease whose suspected causes elsewhere have been isolated. In the Transkei (region of South Africa) many Bantu men contract this cancer because - it is speculated - they drink a maize beer that contains a cancer-causing nitrosamine. Alcohol cunsumption, perhaps in combination with smoking, may be the reason for esophageal cancer in France. And among Iran's nomadic Turkomans, the cause could be their regular fare of sooty bread.

[+/-] Read more...

[+/-] Read more...