Cancer

Is it possible to prevent or reduce your risk of cancer?

DEAR DOCTOR K: Is it possible to prevent, or at least reduce, your risk of cancer?

DEAR READER: Absolutely, it is. It is possible both to reduce the risk that your cells will turn cancerous, and to catch cancer early and prevent it from causing suffering. But first let's define some terms. What does it mean to say that a "cell turns cancerous"? Cancer is uncontrolled cell growth. Most cells "grow" not by becoming larger, but from dividing. (An exception: Fat cells grow not only by dividing, but also by becoming larger.) One cell becomes two, two become four, four become eight, and so on.

Do you suggest HPV testing or Pap smears for cervical cancer screenings?

DEAR DOCTOR K: I am 31 years old and have always had normal Pap smears. I just read that HPV testing might be better. What do you suggest?

DEAR READER: Screening for cervical cancer has led to a dramatic decrease in the disease. Until fairly recently, all cervical cancer screening was done by Pap smear. But the FDA recently approved the use of a new screening tool -- the HPV DNA test -- that may eventually take its place.

Why delay treatment for slow-growing prostate cancer?

DEAR DOCTOR K: I was recently diagnosed with prostate cancer. My doctor says my cancer is slow-growing and that we should just monitor it for now. Why not treat it right away?

DEAR READER: I know this will sound odd, but cancer is not always bad for your health. There are types of cancer that can cause no symptoms, that grow slowly (if at all) and that are unlikely to spread. There are types of cancer that you will never know you had. You will die with these cancers, but you won't die from them.

What are pulmonary nodules — can they cause lung cancer?

DEAR DOCTOR K:I saw my doctor because I've been getting short of breath. He did an X-ray and CT scan that found three small "pulmonary nodules." Do I have lung cancer?

DEAR READER: There are few things more frustrating, for both you and your doctor, than when the doctor says: "Well, it's almost surely nothing to worry about ... but there is a small possibility that it's bad." How often does that happen? Pretty much every day, in my experience.

Does eating fish help prevent prostate cancer?

DEAR DOCTOR K: Does eating fish help prevent prostate cancer?

DEAR READER: You've certainly heard me encourage readers to eat plenty of fish, particularly fatty fish such as salmon and mackerel. That's because many good studies have found that people who eat fish frequently have lower rates of many serious diseases, including heart disease and several types of cancer. A recently published study from the Prostate Cancer Prevention Trial (PCPT) was described in the media as coming to the opposite conclusion. I don't agree, but to explain why, I first need to talk about the substances in fish that are thought to be beneficial for humans.

As a longtime smoker should I be screened for lung cancer?

DEAR DOCTOR K: I'm a longtime smoker. Do I need to be screened for lung cancer even if I don't have any symptoms?

DEAR READER: Until recently, my answer would have been "no." In the not-too-distant past, screening of people without symptoms -- even smokers who were at high risk -- was judged useless for lung cancer. That's because screening for lung cancer involved using standard chest X-rays, and they produced too many "false positive" results: They identified "spots" in the lungs that were harmless.

Do I have colon cancer if my doctor found a polyp during my colonoscopy?

DEAR DOCTOR K: During a screening colonoscopy, my doctor found a polyp in my colon. Does this mean I have cancer?

DEAR READER: Colon polyps are common, non-cancerous growths of tissue inside the colon, or large intestine. Some of them are benign. However, other colon polyps can progress into colon cancer. These are called adenomatous polyps.

Why does marriage have such a positive effect on patients with cancer?

DEAR DOCTOR K: I read about a study that said married cancer patients do better than those who aren't married. Why does marriage have such a positive effect?

DEAR READER: You're probably talking about a study that was published earlier this year in the Journal of Clinical Oncology. The study included about 735,000 people diagnosed with 10 different types of cancer. Married men were 23 percent less likely to die of cancer than those who were single, widowed or divorced.

Does having dense breast tissue increase my risk of breast cancer?

DEAR DOCTOR K: After my last mammogram, the doctor told me I have dense breasts. Does this increase my risk of breast cancer?

DEAR READER: A woman's breast contains different types of tissue, including fat. Women with dense breasts have relatively less fat in their breasts. Specifically, if more than 50 percent of your breasts is made up of other breast tissue (as opposed to fat), then by definition you are said to have "dense breasts." It's not uncommon: About 40 percent of women have dense breasts.