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Part One
The Anticancer Age
Chapter One
The Anticancer Revolution
As director of the Integrative Medicine Program at MD Anderson Cancer Center in Houston, I have spent much of my career working to incorporate evidence-based, unconventional treatment modalities and lifestyle changes into the medical community's thinking and alongside conventional practices. As more research has emerged showing a clear link between our mental and physical state and lifestyle factors and our ability to avoid and survive cancer and other diseases, even the more skeptical within the medical community have begun to take notice. Over the years, more times than I can count, cancer doctors across all disciplines have confided in me that they have long suspected that their patients' mental state and lifestyle plays an important role in their ability to survive a cancer diagnosis and restore themselves to wellness. What is becoming increasingly evident based on solid science and our improved ability to measure and document the biological effects of lifestyle changes is this: comprehensive lifestyle change, combined with conventional cancer care, is powerful medicine that can help control, and potentially prevent, cancer.
Living with Cancer
Once, a cancer diagnosis was basically a death sentence. Although it could, with a lot of medical might, be beaten back, it would rarely be defeated. Over the past couple of decades, however, this has begun to change. Cancer is now, for many, considered a serious, chronic disease. What this means in practical terms is that more people are living longer with cancer. And this is very good news. But survival raises new questions: Are these people who are living longer with cancer better feeling!-healthy and well-even if they are not cured?
Some oncologists might wonder why, if the patient is surviving, this question is relevant at all. In my area of expertise, the world of integrative medicine, this question is everything. I spend my workdays helping cancer patients make choices so that they will feel healthy-even as they undergo difficult, sometimes debilitating, treatments-because it's precisely these lifestyle changes that will also increase their odds of survival. And while I focus on their quality of life, my colleagues continue to better understand how cancer cells work, guiding the move from a one-size-fits-all approach to more nuanced, personal treatment. Much of this shift from a "hit it hard and fast" mind-set to more of what is being called "precision medicine" is due to the relatively recent breakthroughs we've made in understanding how our genes and cells work. We're also developing and harnessing technologies that allow us to detect many cancers earlier-and the earlier a cancer is found, the better the prognosis and treatment outcome.
These innovations are incredibly important, and alongside these advancements are exciting discoveries being made not by scientists in labs or surgeons in operating room suites but by regular people in their kitchens and homes; on jogging trails; and in grocery stores, yoga studios, gyms, and wellness centers. Everyday lifestyle choices give us a surprising amount of control and influence over the trajectory of a cancer diagnosis and of our cancer risk. By making simple changes to the way we live, we can diminish the side effects of conventional cancer treatments, extend (and sometimes shatter) expected survival rates, decrease the chance for recurrence of disease, and potentially prevent the onset of cancer diseases in the first place. It's an exciting time to be in the realm of integrative care, but it took us a very long time to reach this point, and it's taking even longer to get the word out that lifestyle change is legitimate, effective medicine to help prevent and control cancer.
Are the Odds Really Stacked Against Us?
During the last fifty years, tremendous advances have been made in frontline treatments such as surgery, chemotherapy, and radiation therapy. These treatments, along with the innovative developments in targeted therapies (aimed at the abnormal proteins controlling cancer growth) and immunotherapy, have saved or prolonged the lives of millions of people. In fact, our success rate at keeping people alive after a cancer diagnosis is better than ever.
Yet despite these medical advances, nearly 1.7 million Americans are projected to receive a cancer diagnosis in 2017. During that same twelve-month period, cancer will claim the lives of more than six hundred thousand people in the United States. Around the world, cancer remains a leading cause of death, and new cases are expected to increase by 70 percent in the next two decades. In 2015, the disease took the lives of 8.8 million people globally.
Based on current models, one-third of all American women and half of all American men will receive a cancer diagnosis in their lifetimes. Worldwide, nearly one out of every six deaths is due to cancer. This means that the odds are extremely high that both you and I will one day join the more than 15.5 million Americans who are currently living with cancer and the tens of millions of cancer survivors around the world.
Given these staggering numbers, it's unlikely that we'll eliminate cancer anytime soon, though this will not stop us from trying. Also unlikely is the discovery of one drug or treatment-a magic bullet-that will eradicate this increasingly complex range of diseases. What is more likely-as we are beginning to see now-is that we'll continue to understand how cancer cells respond to various stimuli and learn to slow or "turn off" their progression. Similarly, we hope to better understand the processes that trigger cancer's growth and target them with effective treatment. We're already seeing compelling evidence that lifestyle factors may be the missing ingredient of the existing cancer treatment model.
Cancer, first and foremost, is a disease of aging: our odds of getting most cancers rises significantly each decade we live past the age of fifty. This puts us in a bit of quandary, since we are-thanks in no small part to modern medicine-living longer and longer lives. The onset of diseases such as cancer adds a terrible burden to the already great challenges of aging, as our cells become more vulnerable to damage and corruption.
Although most cancers strike when we're older, there are some types (including colorectal and breast cancers) that are striking people at increasingly younger ages, and these cancers are often quite aggressive and fiercely resistant to treatment. In fact, recent data suggest that younger people are not only being diagnosed with colon cancer more than ever before but also dying of the disease in higher and higher numbers. Some childhood cancers are also on the rise.
So far, the medical establishment's response to the uptick appearing in the young has been to call for earlier screening, which is, of course, a prudent place to start. But early detection, we've found, isn't always the best or only answer. There are instances of early detection with some cancers, such as early-stage, low-grade prostate cancer and very-early-stage breast cancer, that lead to overtreatment with no demonstrable survival benefits. In fact, the current recommendations have changed from "all men over fifty need to be screened to prostate cancer" to "all men over fifty should have a conversation with their physician about prostate screening." Could there, then, be a better way to prevent or delay the onset of cancers, including the aggressive types that seem to strike people so young? I believe the answer is yes.
Current cancer statistics can be sobering, even frightening, but the larger picture offers good news. There has been a positive, almost radical shift in cancer survival rates. Fifty years ago, only one in four Americans survived cancer for more than a decade; today that ratio is one in two-a doubling in overall survival rates. Is this because treatments and technologies have improved? In part, yes. Absolutely. But now we're beginning to understand that medical advances are not the only reason for improved outcomes.
Still, it is the unpredictable nature of cancer that often makes us feel powerless. Despite all we know of the disease and all the money that has gone into research and treatment, cancer has a way of defying our expectations and striking those who seem least likely candidates for a diagnosis. There is the singer who never smoked a day in her life who is diagnosed with lung cancer. Or the vegan runner who has been lean and fit his whole life and prides himself on his "clean" diet, only to be diagnosed young with stage IV colon cancer. And, most cruelly, there is the very young child who must battle an aggressive form of leukemia before she even has the words to describe what it all feels like. Why is it, we can't help but wonder, that my body, anybody's body, would let this happen? What could trigger such an awful disease within us?
It is perfectly normal to run the gauntlet of these thoughts and feelings and ask ourselves all these questions, but it is even more important that we don't beat ourselves up or blame or shame ourselves into resignation or passivity. Meg Hirshberg is a friend, breast cancer survivor, and the founder of the Anticancer Lifestyle Program, a nonprofit, evidence-based lifestyle program for people diagnosed with cancer. She recently spoke to me about why it's so important to resist blaming yourself if you get cancer: "Our message is always, 'Begin now. Don't look back. We have no idea what caused your cancer and we never will. But we do know that there are things you can do differently that will make a radical difference in how you feel. There is also scientific evidence that shows how these lifestyle changes will positively influence the results of your treatment.'" For Meg and the people who go through her program, this forward focus is accompanied by active education about the healing power of making lifestyle changes and the healing benefits of a loving community. As she continues, "Knowledge is power and, where cancer is concerned, knowledge has the power to enable survivors to lower the odds of cancer recurrence. There is data to back this up and we want to share that science with our community in ways that make people feel more hopeful, more powerful, more inspired, and more alive."
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