Could it be cancer?' What to do when fear gets ahead of facts
Fear of cancer is everywhere. It can strike you without warning, when you feel you are well, or when you are sick but are hoping it is something more fleeting like a virus.
Whenever a celebrity has cancer, the public eye turns in that direction. It can either cause us to over-personalize our own risk, or it can teach us how to approach cancer with courage and resolve. I am impressed with how the royals, Princess Kate and King Charles, have handled their cancers, even if we still don’t know the exact etiology in either case. They have both handled their unexpected diagnoses with aplomb and have shouldered on. A lesson in class for everyone who is watching them.
With Defense Secretary Lloyd Austin and his diagnosis of prostate cancer and subsequent complications, the lesson is a bit different. He wasn’t as forthright early on, and one has to wonder if he was concerned about being stigmatized. Black men are much more likely to delay screening or treatment for prostate cancer, despite the fact that the disease is more than twice as common in Black men and more than twice as likely to be aggressive.
Fear of cancer is everywhere, in part because it can strike you without warning, when you feel you are well, or when you are sick but are hoping it is something more fleeting like a virus.
I have always called cancer the personal terrorist, meaning that our fears of cancer go beyond the actual risk, which is, of course, not to say that the risks of the number two killer in the U.S. (over 600,000 deaths per year) aren’t quite real. Cancer is the most feared of all diseases, which is not to say that cancer and our approach to it hasn’t changed. Cancer is no longer the universal death sentence that it once was. This is due to earlier diagnoses, nimble robotic surgeries, advances in genetic and immunotherapies. On the horizon there is much more.
David Ropeik, renowned risk expert and reporter, author of the comprehensive and provocative new book, "Curing Cancer-Phobia," tries to put cancer in perspective, pointing out that not all cancers inevitably grow or spread. He cautions that excessive screening programs are not automatically lifesaving and can sometimes lead to unnecessary interventions. He reminds us that cancer is predominantly a disease of aging, that we need to look out for it more and more as we age, and that though environmental substances are carcinogens, we can have a much more of an impact on cancer risk by lifestyle changes including diet, exercise, and sleep.
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Ropeik describes the negative impact of excess cancer phobia, where some people are so afraid of cancer that they don’t want to accept the reality that they have it, and crucial follow-up care is delayed.
At the same time, as Ropeik pointed out to me on "Doctor Radio Reports" on SiriusXM recently, many times just the knowledge that one is harboring a cancer, no matter how low grade and non-threatening it may be, may lead a patient to demand instant removal because of the fear. Of course, the treatment itself has side effects. For prostate, it may lead to urinary incontinence, erectile dysfunction, whereas for breast cancer it may mean scarring and disfigurement.
But despite Ropeik’s warning, I believe that screening remains crucial. With a screening for colonoscopy, for example, a gastroenterologist can directly visualize polyps that may have over a 25 percent risk of becoming cancer and can remove them before they ever do so. With prostate cancer, a skilled urologist can combine the PSA and pre-test risk factors, prostate exam, advanced MRI imaging, and sometimes targeted biopsies to monitor a patient without a knee-jerk prostatectomy but a careful assessment over time.
The same is true for high resolution chest CT scans and lung cancer, where low grade lesions on the adenocarcinoma spectrum are monitored over time and not automatically removed. In the right hands, early screening doesn’t mean automatic removal. But screening remains crucial.
I always believe that it is better for a physician and their patient to know what they are dealing with and to learn to overcome harmful associated fears which may delay or alter both screening and treatment.
Cancer fears are quite real, but so is cancer, and it is best dealt with calmly and expeditiously.