FEAR OF DYING

Warning: worrying too much about cancer may be injurious to your health

W. GIFFORD-JONES, MD August 1 1975

FEAR OF DYING

Warning: worrying too much about cancer may be injurious to your health

W. GIFFORD-JONES, MD August 1 1975

FEAR OF DYING

Warning: worrying too much about cancer may be injurious to your health

W. GIFFORD-JONES, MD

Canadians suffer from an overwhelming fear of cancer. According to a Canadian Cancer Society survey, one in four people think the disease is incurable. In fact, cancer is more often cured than many diseases. New surgical techniques, radiotherapy and chemotherapy are continuing to give doctors greater success in treating forms of malignant disease. Above all, twice as many people die from heart disease as from cancer, and accidents and the flu are not far behind cancer on the World Health Organization’s list of death causes in advanced countries.

Yet every year, more victims of cancerphobia run frantically to the doctor. If he is a good doctor, he will allay their fears. But many patients go on worrying needlessly.

One probable cause of cancerphobia is that more people are dying of cancer today than in former years — not because cancer has suddenly flared up like an infectious epidemic but because people are living longer than they used to. Instead of being carried off in their youth by a ruptured appendix or pneumonia, they are succumbing to the degenerative diseases of old age, and cancer is in part a disease of old age.

Another cause of fear is the Madison Avenue-style campaign mounted to warn people of cancer’s dangers. The war against malignancy has become big business, with millions being spent on advertising, as well as on research into the disease itself. Cancer societies have done a tremendous job raising those millions, and thousands of dedicated volunteers have put in long hours working for the cause. But in their zeal they have oversold their product. This is understandable. There is no sure cure for cancer unless it is diagnosed and treated early. So the cancer societies, with the best intentions, believe it is vital to see your doctor if you have abnormal bleeding, a lump, a persistent sore that does not heal, abnormal discharge, and so on.

But these symptoms may also be due to benign problems. Most men with rectal bleeding have hemorrhoids not cancer. And the vast majority of women with abnormal bleeding have polyps, cervicitis (a rawness at the opening of the uterus), fibroids, infection or increased thickness of the lining of the uterus. Persistent discharge is almost always due to vaginal infection, and it can also be simply an increase in the normal discharge. Most breast lumps, too, are benign. Unfortunately, this message is not conveyed to the layman with the same Madison Avenue expertise.

Like most things, cancer is not white one day and black the next. We don’t suddenly develop flat feet, nor does our hair turn grey overnight. It usually takes years for those things to happen. The body’s cells act in the same way, undergoing a series of definite changes on the way to cancer. Modern tests enable doctors to pick up even small changes long before the cells turn cancerous, giving them plenty of time to treat the patient before outright cancer develops.

The cancer societies’ advice is therefore sound, but perhaps there would be less cancerphobia if they also pointed out that the symptoms they publicize are usually due to non-cancerous problems. The only way to find out for sure is to see your doctor immediately.

Another major cause of cancerphobia, undoubtedly, is the vast amount of publicity in recent years linking lung cancer to smoking. I have no wish to condone smoking; there is no magical way that inhaling smoke can be good for your lungs or your health generally. It certainly aggravates many lung problems, such as bronchitis, bronchiectasis and emphysema, and like most doctors 1 resent the millions spent annually to persuade our children that smoking is the acceptable thing to do. Most of us former smokers also resent attending meetings where our colleagues blow clouds of smoke at us with gay abandon. But does smoking really cause cancer?

For some people, the case is closed. They accept the U.S. Surgeon-General’s report as gospel. The more you smoke, the report said, and the longer you have been doing it, the greater your risk of dying from lung cancer. But the committee that produced the report carried out no new medical research. Instead, it conducted retrospective studies, in which people with lung cancer were questioned about their smoking habits, and prospective studies, which involved apparently healthy men and women, some of whom later contracted the disease. More than a million people were monitored over several years; 37,000 later died of various diseases, and their smoking habits were then compared.

The results allegedly proved that the death rate for lung cancer was 10 times as high among smokers as among nonsmokers. The figures seemed so convincing that no one apparently wanted to disagree with them. But the great weakness of the report was that it was a statistical study, and statistics can be misleading. In fact, it was the statisticians who proved the loudest critics of the findings.

For while the report showed that more smokers than nonsmokers died from stomach cancer, still other statistics indicated that as cigarette smoking has increased deaths from stomach cancer have decreased. And, since people who have never smoked make up only a small part of the total population, how does one explain the disparity between the large number of smokers and the rarity of lung cancer? Nor has it been demonstrated that heavy smokers are stricken with lung cancer earlier in life than light smokers, which you might expect if smoking were actually the cause.

CopyrightÍ7 1975 by W. Gifford-Jones Limited. From the book, The Doctor Game, by W. Gifford-Jones, MD, published by McClelland and Stewart.

There is a vast difference between saying that smoking aggravates a problem such as bronchitis and saying that smoking causes it. Why do nonsmokers die of the same diseases as smokers? Why is lung cancer found in animals? The white South African male has been the world’s heaviest smoker for years, yet his rate of death from lung cancer is lower than either that of Great Britain or the United States. And Great Britain, which has a higher lung cancer rate than the United States or Canada, has a lower per capita scale of smoking. Indians and Eskimos are heavy smokers but they seldom get lung cancer. Some scientists speculate that these marked differences in susceptibility are more likely related to atmospheric pollution. In general, the death rate from cancer is twice as high in cities as in the country; but it doesn’t follow that dirty air is the culprit — some highly industrialized areas have a low rate of lung cancer.

Indians rarely get lung cancer

Even in research laboratories, experiments are anything but convincing. The British Medical Council carried out experiments in which mice and hamsters were exposed to strong concentrations of cigarette smoke for five years. None developed lung cancer. In similar tests, U.S. researchers found that animals, like humans, developed smoker’s bronchitis, but it did not progress to cancer. And if the exposure to smoke was stopped for a few months, the bronchitis cleared up.

Supporters of the smoking-lung-cancer theory frequently refer to experiments in which skin cancers are produced in mice by repeatedly painting their skins with tar. But medical journals have severely criticized these experiments. The amount of tar needed to produce cancer is fantastically higher than that found in cigarette smoke; to expose yourself to an equivalent amount, you would have to smoke something like 100,000 cigarettes a day.

One question that must be asked is: do scientific hang-ups play a part in the seemingly pure inquiries? Some statisticians claim the U.S. Public Health Service set out from the beginning to incriminate smoking even if it could be proven scientifically that smoking was not harmful. It was just a matter of getting 10 blue-ribbon scientists to put a collective stamp of approval on a preconceived notion that smoking was injurious to health. And, these statisticians say, the scientists chosen were the types who wear their rubbers whether or not it’s raining. That aside, the result was a report that was politically safe: they could not condone smoking, so they had no option but to condemn it, even if they were later proved wrong.

Ironically, while the U.S. SurgeonGeneral’s report has apparently had no significant effect on smoking, it has made more people “hypochondriac smokers,” worrying that they are further along the road to cancer with every puff. But it is important to look at the total picture. The report devotes 387 pages to condemning smoking, but only a few lines to its possible psychological effects. What would happen to 90 million North Americans if by some miracle they all stopped smoking? Would the removal of this “comforter” cause stomach ulcers, hypertension, heart attacks or colitis? What would happen to older people deprived of the consolation of a quiet smoke? Has the scare taken away the pleasure? In a word, has cancerphobia done more harm than smoking?

Life can end in many ways. Smoking may hasten that end — but to deny that it produces pleasure, to say it invariably causes diseases such as cancer, is to assume a dogmatic, unscientific attitude. It has been said that each person goes to hell in his own way. If smoking is the worst of those ways, one should not become too excited — one should consider the alternatives. The vast amounts of money that financed the Surgeon-General’s report could have been more wisely spent on basic cancer research, or on other worldwide problems such as pollution, the energy shortage or overpopulation. It is impossible to take all the risk out of living, so it may be a good idea not to pass up all the pleasure.