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Risk Assessment

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Illustration by Stefano MorriThe statistics reveal a sobering truth: Each year, more than 1.4 million Americans are diagnosed with cancer. One in four of them will die. Only heart disease kills more people.

If you’re over 65, your risk of getting cancer—and dying from it—is even greater. How much greater is something scientists are just beginning to figure out, largely due to limitations in reporting long-term data and the drawbacks in treating older patients in clinical trials.

Regardless, no one disputes the fact that cancer is a disease of aging—and its presence will only increase in magnitude as people live longer. Age-related research on the subject is particularly relevant today, as the medical community prepares for the onslaught of elderly baby boomers. Indeed, the 65-plus set is expected to double in size from 35 to 70 million by 2030.

The National Institutes of Health recently concluded a five-year, $25 million cancer-prevention initiative. It marks the first time the NIH’s National Cancer Institute and National Institute on Aging have joined forces to study the relationship between aging and cancer. Research focused on eight different areas and every conceivable subcategory, from possible age bias in early detection services to older people’s drug-absorption rates.

The study concluded that cancer risk for people over 65 is 10 times that of younger people—and the morality rate is 16 times greater. While the NCI researchers have singled out age 65 as the turning point, most cancer-prevention programs prefer the term “middle age.” The American Cancer Society notes that about 77 percent of all cancers diagnosed today occur in people who are 55 or older.

To understand why cancer is more prevalent in older people, it helps to see it as a disease that disrupts the normal process of cell renewal. Over a lifetime, the process is repeated many times: Cells become old or damaged, eventually die, and are replaced with new ones.

Scientists know that cancer develops when cells don’t go through the normal renewal process. They may become “rogue” cells that divide and multiply until they destroy their “host.” Or cancer could be symptomatic of a cellular disorganization that also involves healthy cells. No one is sure which theory is more valid.

Age issues aside, cancer is a complicated disease. A diagnosis typically sets off a chain of agonizing decisions, second opinions, and multiple calls to insurers.

“People’s knowledge varies greatly—but even so, it requires a lot of different information, depending on what type of cancer it is and how it progresses,” says Stephanie Raivitch, director of Fox Chase Cancer Center’s Resource and Education Center.

Fox Chase offers a live Internet help line manned by professional health educators. It was established in 2003, partly in response to the growing number of patients and family members doing their own research on the Web.

Fox Chase staffers spend part of their workweek reviewing online resources, including the latest headlines and cancer research. “We get many calls about nutrition needs during cancer treatment and treatment options, such as clinical trials,” says Raivitch.
 

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Fox Chase offers about 170 trials at any one time. The studies are a viable option for any patient willing to try new or experimental treatments.

An expert on community education, Linda Fleisher heads a program at Fox Chase for the underserved population, many of whom have financial concerns. “Older adults on a reduced income may have trouble making decisions about screening,” says Fleisher. “They’re worried about their co-pay, or they may not understand what tests are involved.”

For all those who seek out the center, there’s often a reluctance to ask the right questions—often for fear of learning the hard truths of cancer progression. “We help people understand and learn about the questions they might want to ask their doctors,” Raivitch says.

Understanding how cancer cells can exist in the body unharmed—and even hidden by tissue-cleansing lymph fluids or disease-fighting white blood cells—may help solve some of the lingering mysteries of the disease and lead to better detection measures. It may explain, for example, why some men can live for many years with prostate cancer, and why a PSA blood test isn’t always accurate in gauging the level of prostate cancer cells.

Another development has brought to light the connection between hormones and the proliferation of cells leading to genetic mutations and cancerous tumors.

This news—and the fact that alcohol can induce long-term increases in circulating estrogen—bolsters the theory that more than two drinks a day can substantially increase your risk for cancers of the breast, mouth, pharynx, larynx, esophagus and liver.

Considering that there are more than 100 different types of cancers, it’s understandable that prevention experts would think in terms of lifetime risk and relative risk—as when they weigh genetics and smoking in determining the relative risk for contracting lung cancer. Or when the American Cancer Society reports that more than 70 percent of colorectal cancer cases might be averted with a healthy lifestyle that includes staying active and eating a high-fiber diet.

When the “war on cancer” began more than 40 years ago, scientists understood older people’s vulnerability. But their focus was on the disease’s many anomalies and growth factors, not necessarily on age-related triggers. In fact, advocates of the rogue-cell theory believe that such cells might remain in a sort of sleep mode until a trigger—an injury, a blow to the breast, an operation—reactivates them, causing a previously benign tumor to become malignant.
 

More story and Cancer’s Early Warning Signs on page 3 …
 

Lately, the most important developments in cancer research have focused on how cancer spreads in conjunction with the body’s own defense mechanisms. One idea—still in the experimental testing phase—is that normal cells surrounding a lethal tumor may play a role in either blocking cancer or letting it escape to the rest of the body. Related to this theory is the rather revolutionary contention that staying young may begin on the cellular level. It’s based on research that reinforces what cancer-prevention experts have been telling us all along: Stay away from high-calorie, fatty diets, alcohol and tobacco.

A study of young, sedentary men and fit, active 50-something runners suggests that the cells of the former group age faster than the latter. Expect more research in this area, especially now that three Americans won the 2009 Nobel Prize in medicine for their discovery that the cap-like ends of a DNA strand (called telomeres) may well serve as what amounts to a clock, counting down—and controlling—a cell’s allotted life span. The older we get, the shorter the telomeres become, slowing the process of cellular renewal.

If cancer was a logical disease, it would make sense that its growth would actually be inhibited in older people, not the other way around. Cancer, however, has always defied logic.

To learn more, visit nia.nih.gov and download “Cancer Facts for People Over 50.” Fox Chase Cancer Center’s live chat can be found at fccc.edu/cancer/livehelp.html.

Seven Cancer Facts

1. After heart disease, cancer is the second leading cause of death for Americans over age 65.

2. While death rates are highest among those 65 and older, about 64 percent of all cancer patients are still living five years after their first diagnosis.

3. Cancer cells can damage or destroy nearby tissues, but the disease itself is never caused by an injury or bruise.

4. Cancer occurs when the normal process of cell renewal goes awry. Old cells form a mass of tissue called a growth or tumor. But not all tumors are cancerous.

5. There are more than 100 types of cancer. Most are named for where they originate.

6. Doctors order blood tests and evaluate changes to the lymph nodes for a reason: Cancer that isn’t spread through the bloodstream winds up in the lymphatic system, a network for carrying tissue-cleansing lymph fluids and disease-fighting white blood cells.

7. Cancer causes many different symptoms. One thing it doesn’t do is cause pain in its early stages.
 

Cancer’s Early Warning Signs

Early detection is crucial for most cancers. See your doctor if you experience any of the following:

1. A sore that doesn’t heal.
2. Throat hoarseness, a persistent cough or difficulty swallowing.
3. A new lump, swelling or thickening in the breast or any other part of the body.
4. Chronic indigestion or discomfort after eating.
5. Changes in bowel or bladder habits.
6. Unexplained changes in weight loss or weight gain.
7. Unusual bleeding or discharge.
8. The appearance of a new mole, or obvious changes in the size of an existing mole or wart.
9. Chronic fatigue or weakness.
 

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