YOUR CAN­CER ODDS ARE 50/50

De­cod­ing the dis­ease’s shock­ing stats

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Last year, the Cana­dian Can­cer So­ci­ety an­nounced that nearly one in two Cana­di­ans would get can­cer in their life­times. Scary stu . Surely, there’s more story be­hind the head­line, no? Health writer Anna Shar­ratt is on the case. Here’s what she dis­cov­ered.

SANDY KRUSE’S DAUGH­TER IS THE “ONE” IN THE scary stat that says one in two Cana­di­ans will get can­cer in their life­time. Sandy is the “two.”

Kruse’s daugh­ter was just five when a sar­coma, a soft­tis­sue can­cer, was dis­cov­ered in her arm. As her daugh­ter went through treat­ment at Toronto’s Sick­Kids hospi­tal, Kruse en­dured the most stress­ful year of her life.

So when she de­vel­oped a mi­graine with an aura in Au­gust 2011, she chalked it up to stress. But a doc­tor felt such in­tense headaches should be in­ves­ti­gated. He or­dered tests, which re­vealed that Kruse had five nod­ules grow­ing on her thy­roid. Fur­ther test­ing by an en­docri­nol­o­gist re­vealed that one of the five nod­ules was pap­il­lary car­ci­noma.

Be­cause she had bi­lat­eral thy­roid nod­ules, she un­der­went a thy­roidec­tomy — the com­plete removal of the thy­roid. “The surgery wasn’t that bad,” she said, though tak­ing thy­roid hor­mones to re­place the lost gland was chal­leng­ing. As she strug­gled with the right com­bi­na­tion of thy­rox­ine (T4), she had “zero en­ergy, brain fog, fa­tigue and hair loss.”

Doc­tors ex­per­i­mented with the hor­mones and found a combo that worked. And Kruse changed her lifestyle, in­cor­po­rat­ing daily work­outs and eat­ing clean. Fast-for­ward seven years and both Kruse and her daugh­ter are can­cer-free. “I’ve changed how I eat, how I live,” says Kruse. “I’m a to­tally dif­fer­ent per­son than I was.”

CAN­CER'S CHANG­ING FACE

When the Cana­dian Can­cer So­ci­ety an­nounced last spring that nearly one in two Cana­di­ans would get can­cer in their life­times, it sent shock waves through the pop­u­la­tion. The re­port re­vealed that Cana­dian men have a life­time can­cer risk of 49 per­cent, while Cana­dian women

have a life­time risk of 45%. Does this mean that sto­ries like Kruse’s will be­come more com­mon­place? Does it mean that there is no sense in liv­ing a clean lifestyle?

THE REAL STORY

Well, not so fast. In fact, there are ex­pla­na­tions be­hind these alarming num­bers that help re­duce the panic. For one thing, the data re­flected a change in method­ol­ogy, which was new for 2017 — the re­sult of ex­ten­sive con­sul­ta­tion with the so­ci­ety’s ad­vi­sory com­mit­tee. Pre­vi­ous anal­y­sis by the Cana­dian Can­cer So­ci­ety, The Pub­lic Health Agency of Canada and Sta­tis­tics Canada had only fo­cused on peo­ple who hadn’t yet de­vel­oped can­cer — the new data in­cluded can­cer sur­vivors, ex­plains Dr. Leah Smith, se­nior man­ager, can­cer sur­veil­lance at the Cana­dian Can­cer So­ci­ety.

Another big fac­tor in the new sta­tis­tics is Canada’s ag­ing pop­u­la­tion. “The pop­u­la­tion is getting older,” says Dr. Smith. “[And] it’s im­por­tant to un­der­stand that can­cer is a dis­ease of the ag­ing.” As peo­ple live longer, they are at higher risk of can­cer with each pass­ing year. “Eighty-nine per­cent who are di­ag­nosed are over 50,” she says.

Dr. Smith stresses that the “over­all rates of can­cer have not in­creased in Canada.” And that the 1 in 2 risk is com­pa­ra­ble to the life­time risk in coun­tries such as Australia, the U.S. and the U.K.

Dr. Anthony Miller, pro­fes­sor emer­i­tus at the Dalla Lana School of Pub­lic Health at the Univer­sity of Toronto, agrees that there’s no rea­son to sound alarm bells. “I don’t think it’s alarmist,” he says — it’s re­al­ity. “There’s been a re­duc­tion in heart dis­ease,” he says, sug­gest­ing that if heart dis­ease isn’t al­lowed to set in, can­cer in­vari­ably will.

Dr. Miller says can­cers are be­ing in­creas­ingly di­ag­nosed be­cause they’re be­ing dis­cov­ered — the re­sult of physi­cians pre­scrib­ing more di­ag­nos­tic tests. Tests of­ten pick up in­ci­den­tal can­cers, which may not have acted ag­gres­sively or spread. But be­cause they have been found, and doc­tors can’t pre­dict how they will be­have, they are treated.

What’s en­cour­ag­ing, he says, is that sur­vival of many can­cer pa­tients is in­creas­ing, as they’re be­ing found at ear­lier stages and treated with ever-evolv­ing treat­ments.

The power of pre­ven­tion also shouldn’t be un­der­es­ti­mated. “There’s a lot we can do to pre­vent can­cer,” says Dr. Smith, such as not smok­ing, eat­ing healthy, ex­er­cis­ing, main­tain­ing a healthy weight and lim­it­ing al­co­hol. “Cana­di­ans need to act on this knowl­edge.”

CER­TAIN CAN­CERS ARE ON THE RISE

While the news on the can­cer front is gen­er­ally en­cour­ag­ing, there are sev­eral can­cers that are in­creas­ing in in­ci­dence — par­tic­u­larly among younger Cana­di­ans. While this is oc­cur­ring for myr­iad rea­sons, it’s a trend that war­rants at­ten­tion, say ex­perts.

Three can­cers that have seen sig­nif­i­cant in­creases in di­ag­no­sis are thy­roid, col­orec­tal and uter­ine. Here’s what you need to know to pro­tect your­self.

THY­ROID CAN­CER

“There’s been a dra­matic in­crease in thy­roid can­cer rates,” says Dr. Smith.

Be­tween 1970 and 2017, thy­roid can­cer in­ci­dence rates in­creased in women from 3.9 to 23.4 per 100, 000 and in men from 1.5 to 7.2 per 100 000 while mor­tal­ity rates have re­mained sta­ble at around 0.5 per 100, 000 for both sexes, ac­cord­ing to a 2017 study in The Cana­dian Med­i­cal

As­so­ci­a­tion Jour­nal. The big­gest surge was seen in women aged 40–60 years, though it is the most com­monly di­ag­nosed can­cer in peo­ple aged 15–29.

Dr. Sam Wiseman, as­so­ciate pro­fes­sor in the Depart­ment of Surgery at the Univer­sity of Bri­tish Columbia, at­tend­ing sur­geon St. Paul's Hospi­tal and direc­tor of re­search in the Depart­ment of Surgery at Prov­i­dence Health Care in Van­cou­ver, says the surge in di­ag­noses are be­lieved to be re­lated to more in­ci­den­tal pick­ups caused by an in­crease in imaging and the avail­abil­ity and uti­liza­tion of neck ul­tra­sounds. Di­etary and en­vi­ron­men­tal fac­tors aren’t out of the ques­tion ei­ther. Ex­po­sure to ra­di­a­tion, cer­tain ge­netic con­di­tions, a fam­ily his­tory of thy­roid can­cer, obe­sity, cer­tain be­nign thy­roid con­di­tions and be­ing tall are all risk fac­tors.

He says that with the use of so­phis­ti­cated and com­monly-used imaging, such as CT, MRI and PET scans, the nod­ules are found dur­ing scans for other health in­ves­ti­ga­tions — as in Kruse’s case. “There’s in­creased de­tec­tion of these can­cers — many of which, though not all, would have re­mained clin­i­cally in­signif­i­cant in a per­son’s life.” Dr. Wiseman says that most nod­ules (95 per­cent) are be­nign and even if can­cer is di­ag­nosed — be it pap­il­lary car­ci­noma or fol­lic­u­lar car­ci­noma — sur­vival rates are high. “The vast ma­jor­ity of thy­roid can­cers have an ex­cel­lent prog­no­sis.” He says that more lethal forms do ex­ist but are rare. These in­clude poorly dif­fer­en­ti­ated car­ci­noma, anaplas­tic car­ci­noma, and medullary car­ci­noma.

Ac­cord­ing to Dr. Wiseman, ag­gres­sive treat­ment is now weighed more care­fully than in the past. If a nod­ule is found that’s less than a cen­time­ter in size, ac­tive sur­veil­lance is rec­om­mended. “Fol­low-up with ul­tra­sound is an op­tion for those peo­ple,” he says. For can­cers, pa­tients gen­er­ally need a por­tion, or all of, their thy­roid gland re­moved — and may also need ad­di­tional treat­ment with ra­dioac­tive io­dine. “It hinges upon the char­ac­ter­is­tics of the pa­tient’s tu­mour,” he says.

The best news is that de­spite the steady in­crease in di­ag­noses, “over­all mor­tal­ity has re­mained un­changed,” says Dr. Wiseman. Net sur­vival for thy­roid can­cer at five years is 98%, ac­cord­ing to the Cana­dian Can­cer So­ci­ety. And sur­vival rates are higher for those di­ag­nosed un­der age 40.

Re­gard­less, if some­one finds a lump or swelling in the neck, no­tices hoarse­ness or other voice changes, has dif­fi­culty swal­low­ing or breath­ing, ex­pe­ri­ences a sore throat or cough that doesn’t go away, or has a per­sis­tent pain in the front of the neck, they should see their doc­tor.

COL­OREC­TAL CAN­CER

First the good news: “Colon can­cer is very rare un­der the age of 50,” says Dr. Prith­wish De, direc­tor of Sur­veil­lance and Can­cer Registry, Can­cer Care On­tario (CCO).

That said, when CCO re­searchers looked at national data on col­orec­tal can­cer from the mid 1990s un­til 2010, they dis­cov­ered that the big­gest in­creases were among those aged 15–29. “There was about a 7% in­crease per year [in in­ci­dence] from the mid 1990s to 2010,” says Dr. De. Per­plexed, the re­searchers looked at other trends in this de­mo­graphic. “A 7 per­cent in­crease is quite large, says Dr. De. “We tried to ex­plain that look­ing at the lifestyle risk fac­tors.”

How­ever, Dr. De says that most risk fac­tors for colon can­cer — in­ac­tiv­ity, a diet high in red meat and lit­tle fi­bre, smok­ing and drink­ing — were not sus­pected as driv­ers of the spike in these colon can­cer cases, since there hadn't been a no­table in­crease in the preva­lence of these risks for that age group. “Food and veg­etable in­take has been go­ing up, peo­ple have be­come more phys­i­cally ac­tive, al­co­hol in­take hasn’t changed much and smok­ing has been de­creas­ing in all age groups,” says Dr. De. In­stead, the team fo­cused on body mass. “The one that stood out in terms of sig­nif­i­cant in­creases was obe­sity,” he says.

Dr. De says sci­en­tists are now look­ing at how diet and body weight af­fect the de­vel­op­ment of colon can­cer.

In the mean­time, he sug­gests min­i­miz­ing the risk of colon can­cer, and mon­i­tor­ing symp­toms such as a change in bowel habits, blood in stool, ab­dom­i­nal pain, ex­ces­sive gassi­ness, or nar­rower stool. He also sug­gests younger pa­tients with these symp­toms take ac­tion. “Doc­tors don’t tend to con­sider can­cer among young peo­ple very of­ten,” he says. “They should be more vig­i­lant.”

UTER­INE CAN­CER

Uter­ine can­cer di­ag­noses are on the rise. It was the most com­monly di­ag­nosed re­pro­duc­tive sys­tem can­cer in 2010, with a rate of 30.3 new cases per 100 000 women, ac­cord­ing to Sta­tis­tics Canada. That in­ci­dence rep­re­sented the high­est rate of uter­ine can­cer since 1992.

There are two main types of uter­ine can­cer. En­dome­trial car­ci­noma, which starts from cells in the lin­ing of the uterus (called the en­dometrium), is the most com­mon form of this can­cer. There are also uter­ine sar­coma, which de­vel­ops in the sup­port­ing tis­sues of the uterus, and car­ci­nosar­coma, which some­times de­vel­ops in the uterus.

What’s driv­ing the in­crease in di­ag­noses? Dr. Lil­ian Gien, a gy­ne­co­logic on­col­o­gist at the Odette Can­cer Cen­tre, Sun­ny­brook Health Sciences Cen­tre, says that obe­sity may play a part. “There’s an in­crease in the rate of obe­sity.” When you have a lot of ex­tra body fat, that ex­tra es­tro­gen can change the lin­ing of the uterus, she says.

It’s for that rea­son that most cases of uter­ine can­cer are di­ag­nosed in women who are in menopause. The me­dian age group of pa­tients with en­dome­trial car­ci­noma is 61 years with 75–80 per­cent be­ing post-menopausal. Only 3–5 per­cent of women who de­velop it are un­der 40.

Risk fac­tors in­clude hav­ing Lynch Syn­drome, a ge­netic con­di­tion that also in­creases the risk of col­orec­tal and stom­ach can­cers, be­ing over­weight, hav­ing ab­nor­mal pe­ri­ods and be­ing di­a­betic, says Dr. Gien.

She says hav­ing ir­reg­u­lar pe­ri­ods means that the lin­ing of the uterus is not shed­ding each month. If this oc­curs, tak­ing low-dose con­tra­cep­tives can make you have more reg­u­lar pe­ri­ods and re­duce the risk of devel­op­ing en­dome­trial can­cer. A hor­mone-re­leas­ing IUD can also help thin the lin­ing of the uterus and pre­vent it from turn­ing into can­cer, she says. For women who do de­velop uter­ine can­cer, sur­vival rates are high: 84 per­cent of those di­ag­nosed will sur­vive for at least five years.

“Don’t think that there’s noth­ing you can do about it,” says Dr. Gien.

“DE­SPITE THE STEADY IN­CREASE IN DI­AG­NOSES, ‘OVER­ALL MOR­TAL­ITY HAS RE­MAINED UN­CHANGED.’”

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