Cancers on the Rise: How We Can Stop Them in Their Tracks

By Michael A. Caligiuri, MD, Director, The Ohio State University Comprehensive Cancer Center, Chief Executive Officer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

Here’s a conundrum.

Recent statistics reveal some fantastic news: fewer Americans than ever before are being diagnosed with or dying from cancer. Couple that with the fact that nearly every day we are seeing advances in virtually every corner of cancer research, and the health horizon should be looking good.

 Yet as we mark the fortieth anniversary of the congressionally proclaimed “War on Cancer,” some cancers continue to defy our best efforts—and are actually affecting an increasing number of people. While diagnoses for breast, colon, and ovarian cancer are demonstrably lower, more Americans are receiving new diagnoses for thyroid, kidney, pancreatic, and skin cancers. Why in this era of research advances and more-successful therapies are we seeing a rise in these cancers?

 Part of the answer lies in the fact that no two cancers are the same. There is no routine cancer; there is no one-size-fits-all treatment. Her breast cancer is different from yours. Your uncle’s lung cancer is not the same as your neighbor’s. Knowing this is the beginning of unraveling the mystery of these “cancers on the rise.”

 Discovering the answers to the complexities of this multifaceted disease happens one person, one discovery at a time. And it happens because, once we realize there is nothing routine or run-of-the-mill about cancer, we can zero in on the root of each cancer, examine its building blocks, target the fuel that’s firing it, and create ways to defeat it.

 Knowledge is power—not only in the hands of the expert researchers and physicians who take up arms against cancer every day but in your hands, too. Some of the cancers that are on the rise are preventable. Addressing risk factors like smoking, obesity, sedentary lifestyle, and exposure to harmful environmental surroundings can go a long way toward improving your health and reducing your cancer risk.

 Here’s a look at what’s on the rise, which risk factors you can guard against, and some of the ways the experts are translating research into innovative, targeted cancer care.

Thyroid Cancer

The number of women diagnosed with thyroid cancer has been rising for the past 15 years. In fact, in the past eight years incidence rates have increased 6.6 percent annually—a pretty sobering statistic. Additionally, 80 percent of newly diagnosed patients are under age 65, which is remarkably different from most other cancers, which pose increased risk as we age.

 While some experts believe that the increase could be attributed to better screening (making it appear that thyroid cancer is on the rise when there may just be more cases detected), other experts assert that the ever-increasing number of diagnoses may be caused by obesity, radiation exposure, and diets low in fruits and vegetables—all factors that we can address and eliminate.

 Science is working on it, too, in some cases through large grants awarded by the National Cancer Institute (NCI) to comprehensive cancer centers for large interactive studies that address the disease at its most fundamental biological levels.1

 

Kidney Cancer

The first decade of the twenty-first century marked a significant increase in the number of people diagnosed with kidney cancer. Diagnosis of localized tumors increased the most, probably because of newer and better imaging procedures that can detect kidney cancer in its early stages. The good news is that we can help change these rising statistics.

 We’ve all heard stories about the neighbor’s grandma who smoked until she was 90 and never had a sick day in her life. The reality: she was a highly fortunate anomaly. Estimates show that nearly one in five women diagnosed with kidney cancer can attribute the disease to smoking.

 But there’s more. Obesity, another risk factor for the disease, accounts for a whopping 30 to 40 percent of all cases. High blood pressure, which can be managed with a combination of proper diet, exercise, and medication, is also a contributing factor for some patients.

 In addition to lifestyle changes, medical experts are working on new ways to prevent kidney cancer. For example, one multi-institutional effort funded by the NCI is addressing obesity and two of its primary causes—unhealthy diet and sedentary lifestyle—as risk factors not only for kidney cancer but for several other cancers as well, including uterine and breast.2

Melanoma

Diagnosis rates for melanoma and other types of skin cancer have been steadily increasing for decades, and these are now the most commonly diagnosed forms of cancer—and some of the most preventable.

 Who’s at risk? Everyone. But those at the highest risk include people who sunburn easily, are excessively exposed to the sun (or have a history of excessive exposure), use tanning booths, are fair-skinned, have light hair and/or light-colored eyes, or have a disease that suppresses the immune system.

 But decreasing risk is within our control. With simple fixes like regularly using sunscreen (even on cloudy days and in the winter), wearing protective clothing, staying in the shade, and eliminating visits to the tanning booth will dramatically reduce your chances of getting skin cancer. And by regularly examining your skin for any changes in moles or any kind of skin growth or lesion, you can deliver a preventive blow.

 On the medical front, clinical researchers are studying advanced treatment options that include immune-based therapies for melanoma as well as other cancers.

Esophageal Adenocarcinoma

This is a cancer of the esophagus, the tube that moves food from the mouth to the stomach, and the number of people afflicted with esophageal cancer continues to climb.

 Those diagnosed often suffer from chronic stomach acid reflux. A common trigger for that? Excess body weight. And patients whose esophagus has been damaged by stomach acid may also be diagnosed with Barrett’s esophagus, a disease that increases esophageal cancer risks.

 The good news is that losing weight can help as can taking antacids or other medications your doctor recommends. One intriguing study has shown that eating strawberries may be a way to help people at risk of esophageal cancer protect themselves from the disease.3

Liver Cancer

While liver cancer in men is increasing in higher numbers than in women, women are not escaping the diagnosis, and their numbers continue to climb.

 In addition to manageable risk factors like diabetes and avoidable risk factors like alcohol-induced liver disease, smoking, and obesity, other risk factors include chronic hepatitis B (HBV) and hepatitis C (HCV) infection, which can lead to fibrosis and cirrhosis—both of which increase liver cancer risk. The lifetime liver cancer diagnosis rate for those with HBV is 10 to 25 percent, and—even morshocking—those with HCV account for nearly half of all liver cancers in the United States.

 What to do? The HBV vaccination is recommended for all children and also for adults who are at risk (healthcare workers and those who inject drugs). Plus, because both HBV and HCV can be sexually transmitted, practicing safe sex is vital. Patients with chronic HBV or HCV should be on an antiviral treatment, which has been shown to decrease the chance of developing liver cancer.

 On the medical front, an exciting recent discovery may help scientists develop new targeted treatments for liver cancer. In a current collaborative study, researchers are showing that it is possible to target and block particular molecules that are important in this disease—a finding that might lead to a new therapy.4

 

HPV-Related Head and Neck Cancers

Your oropharynx includes the back third of your tongue, the back of the roof of your mouth, your tonsils, and the side and back walls of your throat. Cancers in this area are primarily related to the human papillomavirus (HPV, the virus that causes cervical cancer) or to tobacco and alcohol use.

 The incidence rate for HPV-related oropharyngeal cancers continues to increase by about 2 percent per year among white women but with no significant change in incidence among women of other racial or ethnic groups.

 What can both women and men do to minimize risks of the disease? Safe sex practices, especially with oral sex, are highly important to preventing the spread of HPV.

 The medical community is also investigating this area, with research under way to tell us if the HPV vaccine, which is recommended for boys and girls ages 11 to 26, helps reduce the number of HPV-related oropharynx cancers diagnosed. Additionally, a study has proven that the presence of HPV in tumors is the most important predictor of survival for people diagnosed with oropharyngeal cancer.5

Pancreatic Cancer

Diagnosis for pancreatic cancer—the fourth-leading cause of cancer-related death among both men and women—continues to increase at a small but steady annual rate of about 1 percent in women. While some risk factors cannot be modified (for example, having a genetic disorder, pre-existing diabetes, or a history of pancreatitis), a full 25 to 30 percent of diagnosed cases are related to a preventable lifestyle choice: smoking.

 Smokers are about two times more likely to be diagnosed with pancreatic cancer than nonsmokers.

 The other highly preventable risk factor? Obesity. People considered clinically obese are 20 percent more likely to get pancreatic cancer than those who are considered to maintain a normal weight.

 So concerned is the National Cancer Institute about pancreatic cancer that it has sounded the alarm for a national call to action against the disease, citing a need for more clinical trials and greater patient participation in those studies.

 Numerous research projects are under way, including a multi-institutional study that assesses patients with recurrent or metastatic pancreatic cancer who have received a cancer-killing virus called Reolysin® along with standard chemotherapy drugs.6

It is only through research that we can better understand all types of cancer and their risk factors. While researchers will continue to make discoveries and create better treatments, it’s up to you to understand your risks and make choices that help minimize them. Through these combined efforts, we are on our way to a cancer-free world.  _

References

1. NCI Awards Ohio State Scientists $11.9 Million [news release]. Ohio State University Wexner Medical Center website. Available at: http://medicalcenter.osu.edu/mediaroom/releases/Pages/NCI-Awards-Ohio-State-Scientists-$11.9-Million.aspx. Accessed June 27, 2012.

2. Faith-Based Initiative to Promote Health in Appalachia. Ohio State University Comprehensive Cancer Center (OSUCCC-James) website. Available at: http://cancer.osu.edu/research/cancerresearch/reviewcommittee/guidelines/Documents/Example%20of%20Prevention%20Intervention%20Protocol.pdf. Accessed June 27, 2012.

3. Strawberries May Slow Precancerous Growth in Esophagus [news release]. OSUCCC-James website. Available at: http://cancer.osu.edu/mediaroom/releases/Pages/Strawberries-May-Slow-Precancerous-Growth-in-Esophagus.aspx. Accessed June 27, 2012.

4. Anti-sense Might Make Sense for Treating Liver Cancer [news release]. OSUCCC-James website. Available at: http://cancer.osu.edu/mediaroom/releases/Pages/Anti-Sense-For-Treating-Liver-Cancer.aspx Accessed June 27, 2012.

5. Tumor Virus Is Best Predictor if Throat Cancer Survival [news release]. OSUCCC-James website. Available at: http://cancer.osu.edu/mediaroom/releases/Pages/Tumor-Virus-Is-Best-Predictor-Of-Throat-Cancer-Survival.aspx Accessed June 27, 2012.

6. Ohio State University to Lead New Pancreatic Cancer Trial [news release]. OSUCCC-James website. Available at: http://cancer.osu.edu/mediaroom/releases/Pages/Ohio-State-University-To-Lead-New-Pancreatic-Cancer-Trial.aspx. Accessed June 27, 2012

How You Can Manage Your Risk

There is no such thing as a routine cancer. And while no two cancers are the same, many of them share some risk factors. You can’t control your age or family history, but here are some risk factors you can control:

Maintain a healthy weight. People who are overweight or obese are at a higher risk for many cancers, including breast, colon, thyroid, kidney, esophageal, pancreatic, and ovarian.

Be active. A sedentary lifestyle puts you at higher risk for breast, colon, and other cancers.

Eat a well-balanced diet. Minimize red and processed meat and increase your intake of fruits and vegetables.

Make other lifestyle changes. If you smoke, quit. Smoking can lead not only to lung cancer but to many other cancers as well. Limit alcohol to no more than one drink per day. Avoid using tanning booths, use a broad-spectrum sunscreen with a sun protection factor (SPF) of 30, and wear protective clothing with an ultraviolet protection factor label.

Resources

American Cancer Society, Cancer Facts & Figures 2012, cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2012

National Cancer Institute, Cancer Trends Progress Report—2009/2010 Update, progressreport.cancer.gov

Centers for Disease Control and Prevention, United States Cancer Statistics: 1999–2008 Incidence and Mortality Data, cdc.gov/uscs