W. W. BAUER, M. D.
"Many cancers are curable," says this writer . • • Medical science can save thousands of Canadians’ lives if they seek treatment early enough
JOSH BILLINGS, homespun philosopher, used to say that “it ain’t so much what a man don’t know that makes him ign’rant, as it is what he knows that ain’t so.”
What do we know about cancer, and how much of it “ain't so?” If we used what we know to its fullest possibilities, could we change the cancer situation without any new knowledge whatsoever? Is cancer inherited? Is it contagious? What is the cause of this disease? How can it be recognized? Can cancer be treated successfully? Is there a cure? Is it on the increase? Why?
In the answers to these questions lies more hope for the cancer victim than most people outside the medical profession dream of. The answer to the very first question is that much of what we know, or think we know, about cancer, definitely is not so. Much of it used to be, but not any more. And because it is not so any longer, it is possible to say, simply and earnestly, without exaggeration or sensationalism, that many cancers arc curable.
More than 20 years ago a nurse worked with me in a public health project. A lump was discovered in one of her breasts. Being a nurse she knew that it required medical attention. The surgeon made a diagnosis of cancer and an extensive operation was performed. She is living today and in good health. She is the mother of two fine strong boys approaching the age for military service. She has survived a definitely identified and proved cancer because she did two things that were essential. She recognized it in time, and she did something about it at once. Her doctor did the rest.
I know a doctor whose home I visited almost eight years ago. At that time he had already survived, for more than five years, an operation which cost him half his stomach, removed because of a cancerous growth. His wife was living, two years and a half after an operation for the removal of a serious internal cancer. Today that doctor has survived his cancer for 13 years, his wife for a little more than 10. Both are not only living but active in their professional and social life.
Two women lived in a village, attended the same church. One was considerably older than the other, and they had little in common except the one item which gives them a place in this story. Each had a spot on the skin of the bridge of her nose; a little spot that came out scaly, and peeled off and seemed to go away, and came back again in the same place. The older woman decided it was nothing of consequence; it just had to be powdered a bit more thickly so it would not show. The younger woman went to see a physician specializing in diseases of the skin. He examined the little patch of scaly skin, not much bigger than the head of an ordinary pin, and advised its removal with radium. It had the characteristics of a skin cancer. The older woman did nothing. The patch on her nose grew, until she had to use a dressing to cover it. Finally
she retired from public contact altogether because of her appearance, and within three years she was dead of a spreading cancer which destroyed wide areas of tissue in the face and head. During a large part of those three years she might have been saved.
Such stories could be multiplied over and over again. I have visited cancer hospitals and seen the late and hopeless stages of cancer in a dreary succession of eases presented by the surgeons there, who chafed at their helplessness in many instances where they might have had success if they had been able to do their work earlier. The important point, on which everything else hinges, is that cancer may be cured if it is recognized early enough and treated with sufficient promptness, skill and boldness. Everything else is secondary.
if we are to cure curable cancers, we must, as Dr. Frank L. Rector has said in his “Cancergrams,” cease fearing the end of cancer, and fear its beginning. What did he mean? I know from my own experience exactly what he means. My mother’s brother died of cancer; when she found out what his condition was she came home from the hospital and announced it in a tone of hopelessness I shall never forget. And it was indeed too late then. Only two years later my father died of cancer. It was too late when his condition was recognized, too. If I had been at home, instead of at medical school or in the Army, I might have been able to save one or the other, but I am by no means sure. We knew less about cancer then than we do now, but, even more important, we had a different attitude toward cancer then. We were resigned to the inevitable. That is the attitude of too many people today. Until it is changed we will get nowhere in any effort to improve the cancer situation. We have much hopeful knowledge. We can and must use it hopefully, even militantly. The cancer slogan is, “Fight Cancer with Knowledge.” The important word is “Fight.”
The first job is to dispose of knowledge that is “not so.” We must get rid of the misconceptions and the half-truths of the past to make room for the constructive knowledge of today.
First, is cancer contagious? The answer is NO. While certain research work has begun to indicate that perhaps a virus may have some part in certain types of growth resembling cancer, especially in plants, we have no information that would suggest that cancer in human beings is contagious. No cancer has been produced experimentally by methods through which infection is ordinarily spread. There is no known case of anyone who caught cancer from a patient, not even when such a person may have had long and intimate contact such as goes with nursing care. For all practical purposes we can dismiss any idea that cancer is contagious.
Cancer Not Inherited
SF1COND, is cancer inherited? We can say at once that in the usual sense cancer is not inherited. No one, even with cancer on both sides of his family, need necessarily fear that he must therefore die of cancer. But the answer is not quite as simple as that. Cancer itself is not inherited, but the ability to have cancer may be. Work with mice shows that after generations of careful breeding, certain strains can be produced which are more cancer-resistant than others, and still other strains become less cancer-resistant after many generations of selective breeding.
In considering the inheritabilitv of cancer, we come to an important fact not commonly enough recognized, namely, that cancer is not a disease; it is many diseases. There is a vast difference between slowgrowing, relatively harmless skin cancers and the swiftly destructive pigmented tumors which occur behind the eye. Two such equally dangerous bur totally different conditions, a cancer in the stomach and leukemia, differ widely in many ways. The nature of a cancer Ls determined by the tissues from which it springs. Most observers believe that the inheritabilitv of cancer is not increased for the individual who may have one type of cancer on the maternal side and another type on the other side of the family tree. Even if both are in the immediate line of descent, and as
close as parents and grandparents, his chances are about the same as those in the general population; that is, about one chance in eight. Besides that, if he knows about it, he can probably do something about it through watchfulness and prompt action.
Is cancer on the increase? The figures certainly say so. It is second only to heart disease as a cause of death. For 20 years each annual report of vital statistics has shown a slow but steady climb in the cancer rate. Deaths from cancer in Canada were 14,114 in 1943; in the United States about 165,000. How can the increase be explained? Several reasons may he advanced. Statistical information is more reliable than, say, 50 years ago and it may be that more cancer deaths appear in the returns now. Perhaps there is no more cancer than in previous years, but medical diagnostic methods are better and cancers are better recognized than formerly. 'There i:; little doubt that this is true. Another factor is the ageing of populations on the North American continent; more so in the United States than in Canada but fairly universal throughout these two nations. More people escape death due to diseases operating in early life and so more of them live to the age when cancer is most prevalent. In other words today there are more people capable of having cancer than ever before. Cancer is primarily a disease of middle life and beyond, but it can occur at any age. In all probability not one of these factors, or two, but all are in operation.
Many think that these factors put together are not sufficient to account for the increasing mortality from cancer. At any rate it makes little practical difference. The point is that there are more cancer deaths than need be.
Cause Still Uncertain
WHAT is the cause of cancer? There is no final answer at this time but there are many partial answers. Without going into highly theoretical possibilities, we can say that the cause of cancer is bound up with the cell growth of the living body, human, animal or plant. No one knows exactly what causes growth. We have learned much about how cells behave while they are growing, hut as yet we do not know why certain cells always turn out to be skin cells, others bone, others muscle, no matter how many times they divide and reproduce themselves.
What it may he that goes wrong with normal growth we cannot say as yet. We are not able to explain why in most injuries an adequate scar forms, then ceases, while an occasional scar keeps on growing until it becomes a problem. We do not know exactly why a group of cells in a certain location starts to grow, and grows wildly out of all control, crowding out competition, destroying whatever stands in the way, stealing nutrition from normal tissues, poisoning the body finally with products of its own malnutrition and deterioration. “Gangster cells,” such growth processes have been called.
We do not know the basic cause of cancerous growths, but we do know some factors that favor cancerous development in persons whose tissues are liable to become cancerous. Observations gathered from all over the world have been fitted into a pattern. In Oriental lands where long flowing robes are worn charcoal burners or braziers are carried under the robe in cold weather for warmth. They often burn or irritate the skin; when this occurs repeatedly at the same place, skin cancers have been reported. Among chimney sweeps, who had repeated contacts with greasy carbon in chimney soot, skin cancers were common. Cancers of the lip often appear in long-time smokers of pipes, especially clay pipes; habitual tobacco chewers develop cancers at the spot in the cheek where the quid is customarily held. Jagged teeth and badly fitting plates have resulted in numerous cancers in the mouth. Mothers who fail or refuse to nurse their babies or for other reasons must have their breasts artificially dried up are more liable to cancer than those in whom nursing proceeds normally.
Workers in paraffin oil industries develop cancers where the oil-soaked clothing rubs continuously against the skin. Injuries in childbirth, if neglected and allowed to become chronic sources of inflammation, may end up as cancers. Experimentally, cancers have been produced in animals on numerous occasions by the application of tars or other irritating substances. In a few instances tight binding of the breasts has been followed by cancerous growth. Warts or moles which are subject to constant rubbing, as by the edge of a collar or by frequent shaving over them, may become cancerous, and so may such blemishes if they are subjected to treatment, for removal, which causes inflammatory reaction without destruction. This long list, which might be made longer if necessary to
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establish the point, adds up to just one thing—chronic irritation
Chronic irritation may be chemical, mechanical or inflammatory. Often it takes a long time for chronic inflammation or mechanical irritation or the effects of chemicals to induce the transition from normal tissue reaction to cancerous growth; in some individuals this never happens. Why we face one sequence in certain persons and another in others remains unexplained. That explanation will be welcome when it comes, and will probably lead to more effective preventive and treatment measures. But until it does come we need not sit back and wait and hope while people die of cancer. We have enough knowledge now to prevent 50% of the I cancer deaths which occur each year.
\ That means over 7,000 Canadians who may die this year unless something is i done about it. Who is going to do it?
Signs to Watch for
Responsibility for the prevention and ¡ treatment of cancer rests squarely upon two persons — patient and doctor. Patient first! The doctor can do nothing unless he sees the patient and sees him while there is yet time to do something constructive. We need to care for the hopeless patient and relieve him of pain. But that is a discouraging job. What we really want to do is to keep cancer patients out of the hopeless stage by preventing cancer, wherever possible, or treating it effectively. And we have enough knowledge to do it in many instances if doctor and patient work together.
First, what is the patient’s part? It is to know about cancer, to care for himself intelligently. Out of what has already been said comes the first principle of cancer prevention: prevent chronic irritation by removing its causes. What these causes are should be sufficiently evident from preceding paragraphs to make repetition needless.
The patient’s second responsibility is to learn what are the danger signs of cancer. Most of these have already been suggested, but for convenient memorization here they are in a nutshell. When any of the following appears see your doctor without delay:
(a) A lump where no lump belongs.
(b) A mole or wart that grows or
changes in character.
(c) A sore that fails to heal or heals
(d) Abnormal discharges, especially
blood, from any body opening.
(e) Vague indigestion or intestinal
disturbance, persistent and
without apparent cause.
They do not always indicate cancer but they do demand investigation. Prompt action is the thing. Promptness in relation to cancer means the very first chance you get to see your doctor—today if possible, tomorrow if you must, not later than this week in any case.
The third responsibility of the patient, one which is so obvious as to need nothing more than mention, is to follow the doctor’s advice and to lose no time needlessly in doing so. It is important for the patient to know that, even in the absence of a cure for cancer in its advanced stages, there is much that the doctor can do. First of all he requires no elaborate equipment for the recognition of most kinds of cancer or of the precancerous conditions which may be corrected so that cancer may be prevented. The doctor’s eyes, ears, and hands, with the aid of simple instruments found in every doctor s office, can detect the large percentage of cancers which can be seen or felt.
In men, for example, large percen-
tages of cancers occur in the mouth; in women the breasts and the generative organs are the most common sites. These localities, as well as the lower bowel in both sexes, are accessible to touch, and may be looked into with the aid of instruments. Internal cancers are more difficult to identify, but with X-rays and the newly developed gastroscope, a variation of the periscope principle by which the lining of the stomach can be inspected visually and even photographed in color, the early detection of cancers or precancerous indications in the stomach and intestines should be favored more and more.
How Treatment Works
What about treatment? Well, we have nothing that the cancer patient can take in a spoon, nothing to inject, no magic medicine, no cancer “cure” in the accepted sense of that word. But we have effective treatment based on knowledge of certain characteristics of cancer. This is a disease that does not start all over the body; it starts in one place. It spreads through the channels of the circulation. But if we find it before it starts spreading, and remove it completely, in most cases that is the end of the cancer. The aim of treatment, then, is to achieve complete removal in time. There are two ways in which this may be done. Surgical removal is the surest way when the growth is so located that surgery can be performed without doing too much damage to other structures. In circumstances where surgery is not suitable, or in certain types of cancers, there is another agency—radiation. Radiation includes both X-ray and radium.
X-ray is the emanation of rays from an electrical source which have the power to destroy tissues or to stimulate them; large doses destroy, smaller doses stimulate. Radium gives forth the same sort of rays. Whether X-ray or radium is chosen depends on the convenience with which one or the other can best be employed in a given case. The value of radiation in cancer treatment lies in the fact that cancer cells are more easily destroyed by this exposure than are normal cells. It is possible to administer a dosage that will destroy the cancer cells and not destroy the normal cells, though it may have some temporary effect on the latter. Some cancers respond so well to radiation that this method is chosen in preference to surgery; sometimes radiation is used where surgery cannot be used; sometimes radiation and surgery combined constitute the best treatment. By these means many cancers can be completely and finally removed. But the treatment must be applied while the cancer is still local.
How do we know when a cancer is cured? The criterion is time. There is no infallible means of examination which can assure us that none of the original cancer cells has wandered to remote parts of the body (doctors say metastasized) before the original tumor was removed. But we do know that recurrences in remote regions usually occur within two years and almost certainly within five. So the rule has been established that if five years elapse and no secondary cancers appear the patient may be regarded as probably cured; if 10 years elapse, the cure is a virtual certainty. In rare cases relapses have occurred after five yeats, even more rarely after 10, but for all practical purposes these exceptions do not invalidate the rule. A second cancer independent of the first is fortunately an extreme rarity.
On the roster of five-year-survival cancer cases kept by the American College of Surgeons, 39,318 cases are
recorded of persons who have survived five years or more (some úp to 20 years) after successful treatment of a proved cancer. Dr. Bowman C. Crowell, in charge of this roster, says that no estimate has ever been attempted of what percentage this represents of the total actual survivals, but he is convinced that the percentage of cases reported is very small in proportion to actual survivals of which a conservative estimate would be in the hundreds of thousands in the past 20 years.
Beware of the QuacKs
Cancer, being so linked with attitudes of despair, has been a lush field for the quack and the charlatan. When doctors have been compelled in all honesty to give up, patients or their families, unwilling to relinquish hope, have grasped at straws, and have fallen victims to any smooth-tongued rascal who had the effrontery to promise them what their hearts so ardently desired, a cure. There can hardly be conceived any lower form of duplicity, any more contemptible evidence of total depravity, than the traffic in lives and hopes and sufferings of human beings of which cancer quacks have been guilty. How is one to tell a cancer quack when one meets him? Easy. Any “doctor,” real or bogus, who advertises, who claims secret cures, who pretends to exclusive knowledge, who plays upon morbid fear of operation (“the knife”), who offers anything by injection, who proposes to use local applications, salves or pastes, who wants to be paid in advance for a course of treatments, should be looked upon with suspicion either as to his motives or his judgment. Even if the treatment itself is harmless—and by no means all are— time is being lost, and time is what counts in the race against cancer.
The best weapon against cancer is knowledge. Knowing about cancer enables us to take appropriate measure to protect ourselves. And knowledge helps to banish fear. Fear of cancer has killed as many as the disease itself, if not more. Here are some of the fears and false ideas we must banish:
“I don’t want to go to a doctor because if I have cancer I don’t want to know it.” Knowing it is the only hope. Cancer, like Hitler, is something you can’t live with. You have to root it out or you die.
“I would never have the courage to
face the operation.” Facing the operation takes much less courage than facing the end stages of an incurable cancer.
“What’s the use—there’s no cure for cancer.” We have answered that one already. Our job now, to quotg Dr. Rector again, is not to find a cancer cure but to find cancers while they are curable.
“It’s probably too late.” It will be if you wait long on that basis.
“It doesn’t hurt—it can’t be serious.” If only cancers were painful in their early stages the battle would be half won. Cancer usually does not hurt until it is too late to do anything about it.
“My friend was cured without operation.” If he was he didn’t have cancer. Many a deadly cancer looks more innocent than an ugly but selflimiting infection which is much less dangerous.
“My friend died on account of the operation.” No. And again no. He died because he waited too long, until no operation could save him.
Let’s get rid of these fears and mistaken ideas and replace them with the knowledge outlined here. And let’s banish all panicky fear of late cancer, replacing it with wholesome and constructive fear of the early precancerous conditions about which we can do something if we will. A beginning has been made with cancer education in high schools. This may sound illogical in view of the preference of cancer for older persons. Not so. These young people are preparing for life. They are in a position to carry cancer information home and thus save lives. Information about this can be had from the Canadian Society for the Control of Cancer, 24 Bloor Street, East, Toronto. It is worth while to start your own community schools functioning along this line if this has not already been done.
Again, the slogan of the anticancer movement Ls, “Fight Cancer with Knowledge.” The fighting word in that slogan is the significant one, the one that marks the difference between our attitude today and that of yesterday. Seven thousand Canadians threatened with death from cancer this year can be saved. The people of Canada and their doctors can save them.