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Beyond the Mammogram and PSA Debates: Real Cancer Prevention

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By DAVID SERVAN-SCHREIBER, LORENZO COHEN and DONALD I. ABRAMS

Op Ed Posted in the Houston Chronicle 12/06/2009

The debate about how often and at what age women should have mammograms or men PSA tests has become a national conversation. However, a major issue is being missed in the back and forth argument about costs and individual medical freedom. The reason the U.S. Preventive Services Task Force issued new guidelines is because of a ground shift in the very understanding of cancer.

Cancer is not the ominous downhill process it has been feared to be for several decades. Yes, cancer starts with genetically abnormal cells that begin to grow wildly. The evidence now shows, however, that many small collections of cancer cells may be perfectly well contained by our body's natural defenses, and often even disappear on their own. Cancer, we now know, is not a one-way street. In some cases, small tumors may appear, grow a bit and then stop, or even go away.

What this means is that lifestyle choices that weaken or strengthen the natural defenses that protect us against cancer may play a major role in whether some early tumors develop, or not, into a dangerous disease.

Yet, over the past 30 years, "early detection" has been the primary and almost exclusive mantra of our medical institutions when it comes to breast and prostate cancer prevention. The recommendation for these rather expensive mammograms and biopsies were based on the assumption that cancer inevitably progresses, and had become a largely unchallenged practice. Even though most experts have known for some time that the benefits of these screenings have limits, and that the downsides of overtreatment are significant, they have been frustrated by lack of an alternative strategy for prevention.

Missing from this debate is the fact that modifiable lifestyle factors are known to prevent and/or reduce the risk of a majority of cancers. Most experts now agree that over 50% of cancer is preventable through appropriate lifestyle choices.

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