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    Is Cancer a "Lifestyle" Disease?

    By Heather Millar

    patient talking to doctor

    Maybe I’m the last person in the world to notice this, but lately I’ve been seeing all kinds of references to cancer as a “lifestyle disease.” Frankly, I have found this description annoying. It seems to imply that somehow my breast cancer was my fault, that if I’d managed my “lifestyle” better I never would have become ill.

    Through two decades of science, health and environmental writing, I’ve joked that the last sentence of any story about any disease could almost always be written, “If you eat right, exercise, get enough sleep, manage stress, and avoid toxins, you’ll reduce your risk of fill-in-the-blank affliction.”

    But my mother—rearing me in the hippy capitol of California at the height of the crunchy granola 1970s—didn’t allow white bread, dessert or snacks. As a grownup, I’ve eaten a generally healthy diet. (I do like wine and fried things, but I don’t go overboard.) I’ve always exercised, though with varying intensity. I have never smoked. I don’t use drugs. I drink moderately. I use sunscreen. I’ve been blessed with a remarkable degree of control over my work and personal life. I don’t snort asbestos; I avoid sketchy plastics; I live in an area with clean air and water. Yet still, I got cancer.

    So what was it? Despite my annoyance about the “lifestyle disease” label, was the cancer my fault somehow? Was it the two years I lived in polluted Beijing? Or the 14 years I spent in smoggy New York City? Was it because I waited until my late 30s to have a child? (Some studies show being an older mother increases your breast cancer risk.) Was it because I did two cycles of in-vitro fertilization (IVF) to conceive my daughter? (I don’t think anyone knows the long-term effect of the massive doses of hormones you take during IVF.) Was it those Hostess Ho Hos and Ding-Dongs that I wolfed down behind my Mom’s back when I was a kid? Was it the Bisphenol A in the plastic kitchen gear that I used in my 20s?

    Hmmm. These questions have been part of my internal dialog since I was diagnosed, but I rarely express them out loud, let alone write them down. If some small part of me didn’t suspect that the cancer was my fault, why would I wonder all those things?

    Maybe it’s part of the puritanical strain in American culture: You’ve got a problem? We’re all sinners, so what did you do to bring on your cancer?

    Or maybe it’s because we all know someone whose cancer seems pretty clearly linked to his or her behavior. My husband’s best friend from high school died miserably from throat cancer in his late 30s. He had, sadly, grown into a heavy smoker and a raging alcoholic. The cause of his throat cancer seems pretty clear.

    This week, we’re mourning the death of Terrie Hall, who did this graphic spot for the Centers for Disease Control’s “Tips from Former Smokers” campaign. Hall was diagnosed with oral cancer at age 40, and with throat cancer not long after that. She quit smoking after the second diagnosis, and became a tireless advocate for smoking cessation.

    Hall is probably best known for the CDC ads, in which she allowed herself to be filmed putting in her teeth, her hands-free artificial voice box and her wig as she got ready for the day. She talked about how sad she was that her grandson would never hear her real voice. Hall, who was 53 when she died, blamed her cancer on a smoking addiction that began in high school. The CDC estimates that the graphic ad campaign helped 100,000 smokers to quit.

    So of course, sometimes you can draw a straight line between behavior and cancer. But I think for millions and millions of cancer patients and survivors, it’s much more murky.

    Different things—extra weight, or diet, or tobacco or alcohol—introduce different risks of different types of cancer. Chapter 3 of the 2003 book, Fulfilling the Potential for Cancer Prevention and Early Detection, edited by the National Cancer Policy Board, lays out much of this in detail: It explains what research shows about diet, or tobacco or whatever and particular types of cancer.

    It’s pretty complicated, but here’s the important thing to remember: The risks outlined are very different for different kinds of cancer. They’re different for different kinds of patients. And the picture is far from complete.

    If you click around media and medical websites, there seem to be two definitions of “lifestyle disease:”

    • A disease that’s brought on by a particular lifestyle activity, i.e. smoking. Some holistic website exclaim that 95 percent of cancers could be prevented by making lifestyle changes. I think that’s pretty debatable, and I hate to think of the self-loathing and guilt it undoubtedly inspires in many patients.
    • A disease that becomes more common as societies become richer and people live longer. A hundred years ago, most people died quickly of infectious diseases like pneumonia. Now they live longer and end up dying of things like heart disease and cancer. In this definition, cancer may also be called a “disease of civilization,” the price paid for living in a developed society.

    Which of these apply to my case, or to your case? The first? The second? Both? Neither?

    It seems to be a human imperative to look for causes, to make connections, to create a narrative to make sense of our lives. What could be a more compelling question than, “What caused my cancer?”

    For many of us, I think, the answer to that question is basically unknowable. As with so many things, cancer is the result of mind-bendingly complex interactions between our genes, our environment, and the things (food, alcohol, tobacco smoke etc.) that we introduce into our bodies.

    Did your lifestyle cause your cancer? It may be impossible to know. But I guess it wouldn’t hurt to eat right, avoid smoking, drink in moderation and exercise.

    What do you think?


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