Posts Tagged ‘cancer prevention’

Skin Cancer Explodes

Tuesday, December 21st, 2010

3,5000,000! That is 3,500,000 new cases of skin cancer in the US in 2011.While the numbers are discouraging, the population, especially young people, continue to ignore warnings of unhealthy sun exposure and more importantly dangerous exposure to UVA and UVB radiation in tanning salons. This number also belies 40,000 new cases of malignant melanoma and more than 8,000 deaths from skin cancer in 2011.
There are many consequences of the escalation in incidence of skin cancer. Most obvious is the injury to the skin and subsequent necessity for surgery. Another is the huge cost incurred for diagnosing and treating skin cancer. Lastly there are the cottage industries which have arisen from inappropriate fears of the public. Many physicians have found a lucrative income in performing biopsies and removal of lesions that are not and have little chance of being malignant. Another, or the same? set of physicians make a handsome living removing lesions they “suspect” may become malignant in patients who have already had skin cancer. Many patients return to their physicians month after month and year after year for needless procedures and the track records of these physicians is somewhere between elected officials and the prognostic accuracy of weathermen. The cosmeceutical industry has reaped huge rewards for promoting herbs, vitamins, and proteins for the prevention of skin cancer. None of them, except for vitamin A, have demonstrated conclusive evidence of efficacy.
It is easy for me to become discouraged when I review the indifference of the public to this dynamic problem and the readiness for the medical and cosmeceutical industry to exploit it for profit. I remember the parable of the cave in Plato’s Republic. Plato tells us of a civilization of men and women living in a cave and chained to its walls. Each day light entered the cave from the outside and was reflected down the cave by a series of mirrors so that the perception of reality that the people experienced was a literal reflection of time and light, and not the real thing. Ultimately one of the inhabitants broke free and wandered through the cave to the outside where he saw the sun actually rise and set and observed the subterfuge that had been foisted upon the cave’s inhabitants. Breathlessly he hurried back through the cave to tell his people of the reality that awaited them in the outside world. As he told his story the inhabitants overwhelmed him; chained him again to the wall; and, ignoring his advice continued on with their labors as if nothing had happened.
And then I remembered the campaign against smoking which we have waged over the past 50 years. I remember when people argued over whether cigarette smoke could cause lung cancer. I remember the Marlboro man with his version of macho and his appeal to my generation. And I remember the cost to individuals and to society as we battled what was then the number one cancer and cancer killer. Yet today, smoking in the United States is less frequent; many cities and states ban smoking in public places and restaurants; and no one debates the health hazards of smoking.
Therefore I will once again reiterate that the World Health Organizaiton has found sun tan parlors to be the single biggest cause for the increase in malignant melanoma and skin cancer death. Also, people who have had skin cancer can prevent new cancers with judicious use of topical vitamin A and systemic administration of vitamin A analogues. Lasers combined with photosensitizing chemicals can treat some skin cancers and prevent many others; and neoadjuvant therapy in the form of application of topical chemotherapeutic agents can prevent others. Lastly, there is no proven benefit to constantly destroying lesions that might become cancerous. At the very least patients can request a second opinion before undergoing repeated procedures. And at a bare minimum, all patients should obtain a copy of their records and even more important, read and retain a copy of all pathology reports from removal of lesions of their skin.
Your physician is not the repository of responsibility of your skin health. Like it or not, the buck stops with each of us. 

The Case for Cancer Neurosis

Sunday, October 10th, 2010

The blessing and the curse of being a cancer patient is the very present knowledge that today may be one’s last on earth. The blessing is that God gives most of us some warning and we can plan the rest of our lives as we see fit. “Why me” makes no sense since we have not only lived the blessing of life, we are now given the privilege of enjoying what is a finite time left on earth. This is different than the person who’s sudden and untimely death occurs in an inopportune moment and there is no time to say good-bye, no time to make peace with the present and the past. It is the sense of knowing a recurrence of cancer can occur at any time just as it did the first time that gives us a sense of living in the present and the fear that we may have to leave.
This is the plight of the cancer patient. This is the cancer paranoia that each of us lives with in some degree of consciousness. A friend once said to me that only the paranoid Jews survived the Holocaust. The others blindly ignored their fate. So it is with the cancer patient. The subtle pain in the back, the indigestion following dinner, the recurrent cough – all may portend the recurrence that signal a resetting of priorities, a new allocation of time.
In 2002 I had pancreatic cancer and for reasons too ethereal for my understanding I survived. With due credit to my magnificent doctors there is some luck involved. The cancer was in the right spot to cause the jaundice to alarm my office manager who rushed me to the emergency room and on and on and the rest is my history. Several times in the past 8 years I have relived the fears and concerns as symptoms once considered inconsequential now become portents of my future. And so my indigestion and back pain led me to repeat my CAT scan 3 months ago with the disappointing news that there was a spot in my liver that could not be explained. What followed was the mandatory 3 month wait until I could repeat the scan to see if the lesion was real or ephemeral, was one that would realign my reality or would be followed by an all-clear signal. And so my wife and I waited and we waited and much of the time we put all of these thoughts out of our mind. But of a quiet moment, when we had time to reflect and to be thankful, the dark possibility always returned. Last week the repeat scan took place and to our relief and gratitude the “spot” was not present.
This is the fate of the cancer patient. This is our reality. We hope that groundless fears and neurotic pre-occupation will help protect us and at least serve as an early warning system. At worst it will give us time to share what is important and dispense with the rest. This hyperawareness is the domain of all who have brushed death and felt what might have been an imminent demise. This is the domain of all who are undergoing treatment or who support loved ones traversing the space of potential terminal illness.
I hope you will understand my sharing. I thought you might want to know.

John Wayne Fights Skin Cancer

Wednesday, August 25th, 2010

Whoah!. Little Lady …(inflection as spoken by John Wayne to Janet Leigh).
Did you see them figures on the rise of skin cancer in the latest publication of The Skin Cancer Foundation? Between 1994 and 2009 the number of yearly skin cancer cases in the US has risen from 1 million cases per year to 2 million cases per year. Malignant melanoma now kills 8600 Americans per year – up from 8000. Indoor tanners have 4.44 times the risk of malignant melanoma as non-tanners (confirmed by the World Health Organization). Window glass filters UVB radiation but allows more than 60% of UVA to penetrate. So much for the ridiculous protests of the tanning industry . The federal government now taxes tanning parlors but classifies the tanning booth as a Class I medical device. Elastic bandages and tongue depressors are also Class I medical devices and I never heard anyone imply that they cause cancer and death.
Now I am not going to get smokers to stop smoking, alcoholics to stop drinking, and tanning addicts to stop tanning. But what about your kids! In Australia every child born will have at least one skin cancer in his lifetime. Right now the odds are something like 1 in 7 children born in the US will have skin cancer at least once in his lifetime and we will achieve Australian status soon. It seems to me that this epidemic will only be controlled by educating young people on the risks and rewards of sun exposure. Yes sunlight is essential for mental well being. Yes, it is an important factor in producing Vitamin D. Yes, I thank God every morning I step out of the house and the sun is shining (I am serious). But enjoying the gifts of Earth does not imply endorsing self-abuse. I see no value in cutting off skin cancer after skin cancer as if that is good medicine although it provides a great living for dermatologists and plastic surgeons.
So here are some ideas:
1. Talk to your kids and grandkids about the need to avoid too much sun and especially sunburns
2. For children under the age of 2 use protective clothing and umbrellas and do not smother them in sun screens which can penetrate their young skin and go into which organ???
3. Sun screens are screens. They let UV light through!! They must be applied every two hours to be effective and they must form a reservoir in the skin to be effective.
4. Do not use combination sunscreens and insecticides. They usually don’t work and they may be harmful.
5. If you have had skin cancer you have 100% chance of another cancer if you live long enough
6. Get on the adjuvant band-wagon. Ask your doctor to help you prevent skin cancer.
7. Take oral vitamin A 10,000-20,000 units daily and get a blood test once a year to make sure you don’t overdose.
8. Apply tretinoin (vitamin A) to your face every night for the rest of your life. Topical and oral vitamin A may provide up to 98% protection from new skin cancer.
9. If a lesion suddenly appears or changes in size, shape, color, or bleeds, see a dermatologist.
10. Don’t give double messages to your kids! If you take care of yourself they may take care of themselves. If they don’t get the message have the kids see me. Sometimes the message gets clearer when presented by someone outside the family- or by an uncle.