Spot It and Stop It Before It Starts
For all the new, targeted drugs, for all the yellow LiveStrong bracelets, for all the healthy survivors, a cancer diagnosis is still a scary thing. For good reason: The disease killed nearly 290,000 men in 2002--almost a quarter of all deaths among men that year--mostly from lung, prostate, and colon cancer. Treatments are improving, but progress is incremental. And the idea of a single, silver-bullet "cure" has faded. Now doctors talk about managing cancer as a chronic disease.
Yet there is a potent, often underused weapon against cancer--stopping it before it even starts. "A pretty substantial proportion of cancers can be prevented," says Anne McTiernan, director of the prevention center at the Fred Hutchinson Cancer Research Center in Seattle. The poster child for prevention, of course, is lung cancer, the biggest cancer killer of American men, responsible for more than 90,000 deaths a year. You've heard it all before. Don't smoke. It's the single best thing a man can do to prevent getting cancer.
But given the aggressiveness of the disease, there is also plenty of interest in early detection, to find lung cancer before it is big or widespread enough to cause problems. Claudia Henschke, a radiologist at New York Weill Cornell Medical Center who is currently studying the benefits of screening the highest-risk patients (current or former heavy smokers who are age 50 or older), believes that a special imaging scan called a spiral ct can save lives by finding tiny tumors long before they do harm. The smaller the tumor, the less advanced the cancer, so removing those tiny growths drastically boosts the odds of survival, Henschke says.
The logic is there, and doctors say the idea has promise. Roman Perez-Soler, chief of oncology at the Montefiore Medical Center in New York, says that if he were a heavy smoker, he'd probably get the test himself. It was worth it for Ralph Reinhardt of Paramus, N.J., who smoked from high school until his early 40s. More than two decades later, in 2001, he heard about Henschke's study and had his first CT scan, which showed abnormal cells that were later biopsied and shown to be the earliest stage of cancer--and were promptly removed. "I had no symptoms whatsoever," he says. Now 67, Reinhardt has a scan every year and says he feels extremely fortunate to have had an early warning.
Needless worry. Yet, many experts say it's too soon to institute widespread screening (or to require that insurers pay for it). That's because the test may uncover cancers that would never have progressed into serious disease, causing unnecessary worry and requiring invasive treatment, with all the attendant risks. There's also the enormous cost of screening all those current and former smokers. Groups like the American Cancer Society haven't endorsed the test, saying there needs to be more conclusive scientific evidence that the test actually saves lives and does not just uncover early-stage tumors. The National Cancer Institute is sponsoring a large controlled study on just this point, but full results aren't due for several years.
Screening for prostate cancer, which kills more than 30,000 men annually, is also far from clear cut. There's a lot of controversy surrounding the prostate-specific antigen (PSA) test, the primary means of detecting prostate cancer. PSA tests, which the American Cancer Society recommends for men starting at age 50 (younger in high-risk men), are excellent at spotting cancer, but it isn't yet known how many of those cancers are worth treating. That is, many men who go through invasive biopsies, painful surgery, and unpleasant side effects like impotence would probably have died of something else had their cancer never been found, says Ruth Etzioni, an epidemiologist who studies prostate cancer at Fred Hutchinson. "We don't want to pick up the whole iceberg, just the cases near the tip," she says. Rather than scrapping the PSA, researchers are looking at variations of it--measuring the rate of increase, looking at different forms of PSA in the blood--to attempt to improve its forecasting ability.
Meanwhile, men need to discuss whether to get the test with their doctors, who in turn must help their patients understand the dangers of false-positive and false-negative results, says Michael Barry, chief of general medicine at Massachusetts General Hospital in Boston. "Some people want to do everything they can regardless if we are sure that it works, while other people say, 'If you can't prove it makes a difference, I'd rather not,'" he says. Developing an accurate screening test for prostate cancer--one that separates the "good" cancers from the "bad"--is key because there is no simple rule for prevention, beyond following general good health guidelines. You know the drill: maintaining a healthy body weight, avoiding too much alcohol, exercising regularly.
Superscreen. Avoiding colorectal cancer, on the other hand, is a no-brainer from a doctor's standpoint. Nearly 30,000 men die from it every year, and the vast majority of them shouldn't. Exercise may cut the risk of the disease in half, says McTiernan, and studies suggest that a diet high in fiber and vegetables and low in red meat, fat, and alcohol also helps. And unlike lung and prostate cancer screening, whose value is debatable, colorectal cancer screening--a fecal occult blood test, double-contrast barium enema, sigmoidoscopy, or colonoscopy--really works. In fact, because doctors are looking for precancerous polyps that are easily removed, screening actually counts as prevention. "One of the biggest risk factors for colorectal cancer is having no screening," says Thomas Weber, chief of surgical oncology at Montefiore.
Based on preliminary studies, it appears that colonoscopy is the most thorough and effective way to prevent death from colon cancer, says Ernest Hawk, director of the Office of Centers, Training and Resources at the National Cancer Institute. But any screening method is better than nothing, he says.
Michael Caputo, a 62-year-old music professor from Smithtown, N.Y., says his colonoscopy was no big deal, although he was anxious about the preparation, which involves drinking a lot of fluids. "I went right home afterwards," says Caputo, who had no polyps needing removal. "It was just like a normal day." If more people followed Caputo's lead--practicing a little prevention--the number of cancer deaths would drop dramatically, even if all those busy researchers in the lab never had another breakthrough.
On the Horizon
Researchers are optimistic about several cancer treatments and therapies:
Starving tumors of blood with a drug called Avastin, which is approved for use in advanced colon cancer, recently showed positive results against lung cancer. It may perform even better when coupled with epidermal growth factor receptor (EGFR) inhibitors, which arrest tumor growth.
Combo therapy. A recent study showed that combining high doses of vitamin D and low doses of nonsteroidal anti-inflammatory drugs (NSAIDs) curbed prostate cancer growth in the lab. Human studies have already begun. Researchers are also trying to figure out if aspirin or other NSAIDs might be used to prevent colorectal cancer. Recent research shows it works but also causes stomach bleeding. The hunt is on to see if adding other drugs to the mix might blunt those effects. -K.H.
This story appears in the September 26, 2005 print edition of U.S. News & World Report.