Return to Wholeness: Embracing Body, Mind, and Spirit in the Face of Cancerby David Simon M.D.
Beautiful. . . . If you are facing cancer or any other serious illness, I encourage you to allow the wisdom contained within these pages to nurture, guide, and support you.-Deepak Chopra, M.D., from his foreword
Return to Wholeness is a revelation. David Simon breaks new ground with the innovative, holistic mind-body approaches developed at the Chopra Center for
Beautiful. . . . If you are facing cancer or any other serious illness, I encourage you to allow the wisdom contained within these pages to nurture, guide, and support you.-Deepak Chopra, M.D., from his foreword
Return to Wholeness is a revelation. David Simon breaks new ground with the innovative, holistic mind-body approaches developed at the Chopra Center for Well Being. The guiding theme in this book is wholeness, as Dr. Simon demonstrates to readers the value of integrating the best of traditional and alternative medicines with ancient Eastern, Ayurvedic principles and practices in order to forge the most effective path to wellness.
Return to Wholeness features advice and recommendations on every aspect of living with illness, including designing a simple nutritional program to purify, rejuvenate, and provide balance; benefiting from the healing properties of vitamins, minerals, phytochemicals, and herbs; facing the toll exacted by chemotherapy and other medical techniques; incorporating various kinds of meditation, creative visualization, and aromatherapy into the larger Return to Wholeness program; and weathering emotional cycles through art therapy, journaling, laughter, and music.
"Return to Wholeness is magnificent. Reading this book made me feel embraced and uplifted by all that is healing and true. Return to Wholeness should be kept on the nightstand of everyone who has cancer or another illness or who is afraid of becoming ill." - Christiane Northrup, M.D. author of Women's Bodies, Women's Wisdom
"Return to Wholeness is the perfect book for anyone facing the diagnosis of cancer. . . . Powerful, powerful teachings you will not read elsewhere from a medical doctor." -Wayne Dyer, Ph.D., author of Manifest Your Destiny
"Gentle, compassionate, and yet thorough . . . a book that awakens the inner healer in all of us." - Louise L. Hay, author of You Can Heal Your Life
"An excellent source of information and guidance to help one integrate one's life and approach to cancer."
-Bernie S. Siegel, M.D., author of Love, Medicine, and Miracles
"In every great challenge of life, we need guides who can show us the way. Dr. David Simon is a wise, compassionate physician who can help anyone on the journey through the experience of cancer." -Larry Dossey, M.D. author of Prayer Is Good Medicine and Healing Words
- Turner Publishing Company
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- First Edition
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Read an Excerpt
Through the Windows of Modern Science and
the Timeless Healing Traditions
The merging of intuition and reason will provide wisdom for the resolution of the struggle in which we are engaged.Jonas Salk
As a young child, I used to imagine a bogeyman living under my bed. I was certain that this beastly troll waited to materialize until my parents turned off my bedroom lamp. I envisioned him hungrily anticipating my placing one foot onto the floor, eager to devour my tender, though meager, body. If I needed to empty my bladder after I had been officially tucked into bed, I would go to elaborate extremes to avoid touching the floor, climbing over dresser tops and bounding across cushioned chairs to the doorway. I could not even consider the idea of looking under the bed to see if there was really something there to stoke my fears. On some level I enjoyed the danger and the challenge of outwitting my fearsome goblin.
It would be wonderful to believe that cancer could be avoided if we were only clever enough to sidestep its underhanded ways. Although cancer is in many ways the bogeyman of our society, this disease cannot be evaded by illusion or delusion. Cancer challenges us at every level of lifeenvironmentally, physically, emotionally, intellectually, and spiritually. If we are to understand and move beyond cancer, we must be willing to look into its face and resolutely commit to hearing its message.
Cancer is a disease of our age. Every time I release exhaust fumes from my car, purchase a tomato that does not have a trace of insect damage, or fail to recycle a plastic container, I contribute to our collective risk for cancer. It has been estimated that over 80 percent of cancers are environmentally influenced. This includes not only obvious environmental factors such as tobacco, asbestos, and ultraviolet radiation but also takes into account the risks of the high-fat diet that is the staple of most Americans. And it is almost impossible to account for the harmful effects that modern stress has on our immune system's ability to recognize and eliminate malignant cells.
Cancer is a complex process, which involves some factors that we can control and others that we cannot. Like the prayer for Alcoholics Anonymous, it's helpful to know which things we can change, which things we can't, and how to tell the difference. The foods we eat, the toxins we knowingly ingest, the ways we use our five senses, and how we express our emotionsall are under our control. We can choose to accept only life-affirming influences and eliminate toxic ones.
Our genetic constitution, which includes our inherited vulnerability to illness, is beyond our conscious control. Similarly, the air we breathe, the water we drink, the chemicals in our soil, the toxins in our workplace, and the electrical fields that surround us are for the most part not within our personal control but represent our collective tolerance for toxicity in our environment. Awareness of our intimate relationship with the ecology of our earth is reawakening, and soon we will have a critical mass of people committed to improving the quality of life on our planet. As this unfolds, our standards for personal and environmental purity will be transformed, and cancer will be understood in a new light.
My brilliant friend, Dr. Candace Pert, one of the pioneers in the field of mind-body medicine, uses an amusing slide in her medical presentations. It features the tombstone of a person who lived for ninety-five years, with the inscription "You see, it wasn't psychosomatic!" I see many people each year whose fear of cancer erodes their day-to-day quality of life. A woman who watched her mother's battle with breast cancer believes it is only a matter of time before she suffers a similar fate. A man whose older brother had colon cancer becomes obsessed with his bowel function, certain that every episode of constipation portends a malignancy. People who have a heightened fear of cancer seem to take one of two routes. In one, they torment themselves about every bodily symptom, certain that it is heralding a serious problem. They frequent their physician's office, convinced that this time they will receive the bad news they have been anticipating.
The other approach is to deny the problem, hoping that by ignoring a symptom it will disappear. A woman with fibrocystic breast disease feels a small swelling but refuses to bring it to the attention of her doctor. She worries about it constantly but avoids dealing with it directly. Much more often than not, the mammogram she finally agrees to is completely normal, and she realizes she has expended months of needless anguish.
The anxiety associated with this illness can be as devastating as the illness itself. I recently saw a woman at the Chopra Center who was convinced that she had thyroid cancer. She tearfully told me that ten years earlier her family doctor had noticed a slight swelling in her neck. Although he had not raised the possibility of cancer, she became convinced that this was her problem and avoided any medical care from that point on, terrified that her fear would be confirmed. When I examined her, I could not find any problem. When I asked her how long ago she had last felt the lump, she stated that it had been almost ten years ago! Despite the complete absence of any physical abnormality, this woman had lived her last decade in misery, afraid that her life was going to be shortened by cancer.
Throughout this book I will be advocating a middle path. As we enter the twenty-first century, denying the value of modern medical advances is as regrettable as denying the healing value of herbs. Although this book is dedicated to using holistic approaches to help people who are directly facing cancer, I fully support the use of the early detection technologies we have available. Regular physical examinations, mammography, prostate specific antigen (PSA) levels, cervical Pap smears, skin examinations, and rectal examinations with tests for occult blood are important tools for detecting cancers at earlier and more treatable stages. If you notice a change in your body, pay attention! Denial and delay do not ultimately serve the healing process. If something is awry, find out what it is and what therapeutic options are available to you. Most important, find a health care advisor you can trust to guide you compassionately and expertly through the thicket of choices available. Despite how scary it may feel to face our challenges directly, it is ultimately the only path to true healing.
Looking at Cancer from a Consciousness-based Mind-Body Approach
Later in this chapter, I'll explain the current scientific understanding of what cancer is, how it develops, and what is usually done in modern medicine to combat it. First, I'd like to look at cancer in a different way. This new approach seeks to understand the message cancer is bringing to us as individuals and society. This perspective generates a series of questions that we need to explore openly if we are to move beyond the suffering that cancer brings.
What is the deeper meaning of this illness that creates so much anguish? What is cancer telling us about the way we are living our lives? What can we do to change the impact cancer is having on us, as individuals and as a community?
These are big questions without easy answers. However, searching for the meaning of cancer is a worthy quest that offers potential treasures that may be unimaginable to you at this time. My hope is that throughout this book, the questions raised will motivate you to look deeply into your own mind, heart, and soul to discover the meaning of the challenge cancer brings.
Let's first explore what's happening when the body functions in a healthy manner. It's really a miracle that the trillions of cells in our body, all derived from a primordial fertilized egg, are able to carry out their millions of life-sustaining functions in a coordinated fashion. Each cell has a very specific role, while simultaneously contributing to the wholeness of the mind-body physiology. Our liver cells are capable of detoxifying our blood, storing and releasing sugar molecules, and metabolizing cholesterol while at the same time monitoring the levels of dozens of hormones, digesting hemoglobin pigment, and reproducing daughter cells. Just a short distance away, our colon cells are absorbing fluid, propelling the residue of yesterday's lunch along, and monitoring the concentration of bacteria. Throughout the body, our cells, the fundamental building blocks of life, are performing their myriad tasks in a coordinated manner that is beyond our conception of organizational power.
In every timeless healing wisdom tradition is the recognition of a life force that unifies and coordinates biological intelligence. In Traditional Chinese Medicine it is referred to as chi and is described as life energy that circulates through subtle channels known as meridians. This is the basis of acupuncture treatments designed to remove obstacles to the free flow of this vital force. In Ayurveda, the primary energy that creates and sustains life is known as prana, meaning "the primary impulse." As long as prana is flowing, life is maintained. When the body is no longer capable of functioning in the coherent way that supports the flow of life force, the individual life ends. A body immediately before and after death is composed of the same set of biochemicals, but life contains the unifying vital force that animates our molecules into a living, breathing being.
What is this unifying force that organizes a complex set of biochemicals into a human being with awareness and the ability to think, feel, and act? This question is at the heart of the new paradigm of life and health that is blossoming in our society as we undergo the transition from a material to an information- or consciousness-based perspective. After two hundred years of a worldview that considered only physical reality to be worthy of attention, the dawn of the information age is heralding a new vision that embraces consciousness as a real force. As these new principles permeate society, a new approach to health and illness is emerging.
On my first day of medical school almost twenty-five years ago, I began my study of health by dissecting a human cadaver. The implicit message that my colleagues and I received was that the key to understanding health begins with the understanding of death and illness. I say implicit because in most modern medical schools there is only limited discussion of the basic philosophy of life and death, health and disease. Rather, most institutions make the assumption that future doctors of medicine understand their role to be master technicians of disease. According to the prevailing model taught in medical colleges, life is the product of complex chemical reactions that generate awareness, ideas, and emotions as by-products of molecular reactions. Death is then viewed as the inevitable end of a faulty biological machine (the human body), similar to the breaking down of an old automobile.
The problem with this material approach to life is not so much that it is wrong, but that it is incomplete. The most brilliant scientists of our time tell us that the world is not as solid as it may seem. Through the insights of the great physicists of the twentieth century, we now understand that underlying the facade of matter is a very mysterious nonmaterial world. Although to our senses the environment appears as a collection of individual solid objects, we now know that the atomic building blocks that comprise this domain of forms are mostly emptiness. The relative distance between an electron and the nuclear core of an atom is as vast as the distance between stars in our galaxy. Even the subatomic particles that make up atoms are ultimately nonmaterial, for as soon as we try to precisely locate them in space, they vanish into a cloud of probability. According to the timeless tradition of Ayurvedic science, the entire universe of forms and phenomena is a temporary consolidation of a nonmaterial field of energy and information. All this matter is ultimately nonmatter.
The Ayurvedic message and the message of modern physics are remarkably resonant with one another. Albert Einstein cognized the formula E = [mc.sup.2], convincing the world that matter and energy are interchangeable. As scientists continue delving into the quantum soup that underlies the world of perception, we are learning that an invisible potential reality gives rise to the building blocks that structure our universe. The womb of creation is beyond the limits of time and space, but its nature is to give birth to time and space. Physicists have referred to this nonmaterial field of potential energy and information that gives rise to the world as the unified field, or the vacuum state. Ayurvedic scientists call it the field of pure potentiality, the field of pure consciousness, or in Sanskrit, Brahman. We can also call it the field of infinite possibilities, because all that was, is, or will be arises from this field.
A consciousness-based approach takes another step here, suggesting that the same field of intelligence that underlies the world around us is the basis of our own awareness. The steady stream of thoughts and feelings that we experience consists of impulses of intelligence emerging from a nonlocal field of awareness. The field of pure potentiality that gives rise to subatomic particles, rainbows, and galaxies gives rise to our creativity, ideas, and emotions. Rather than consciousness being the byproduct of molecules colliding in our brain, our thoughts and cells are both expressions of this underlying field of intelligence. Our physical body is a field of molecules; our mind is a field of ideas, but underlying both our mind and body is a field of consciousness that gives rise to both. In the timeless wisdom traditions, this field of consciousness is also referred to as spirit.
Our life force is the expression of the infinite organizing power of spirit that provides the unifying coherence to the cells of our body. Our connection to the universal field of intelligence enables each of our cells to express its unique properties while simultaneously supporting the wholeness of our physiology. However, when there is some interference in the free expression of the intelligent vital force within us, the coherence between our cells becomes disrupted. The memory of wholeness is forgotten, and individual cells begin acting as if they are disconnected from the body as a whole According to a consciousness-based model, this is the origin of cancer. Due to the accumulation of toxic influences or cellular misunderstandings, an individual cell assumes a level of self-importance that disregards its cellular community. The cancer cell reproduces, failing to recognize that in its uncontrolled expression of power it is sowing the seeds of its own destruction.
Searching for Meaning
Let's revisit the first question raised earlier, "What is the deeper significance of this illness that creates so much anguish?" I suggest that all persons who are affected by cancerwhether as patient, family member, friend, or health care providerask this question in their own minds and listen to the answers from their hearts. At the Chopra Center, the procedure we have found most helpful is to have people close their eyes, allowing their attention to go inward to their heart. Then the question is quietly asked and each person silently listens to the response that emerges from within his or her own awareness. Ideally, try this exercise with someone who is going through your journey with you. Sit quietly with your eyes closed, centering your awareness in the region of your heart. After a minute of silence, have your partner softly whisper in your ear, "What is the deeper significance of this illness?" every fifteen or twenty seconds. Listen without preconception to the information that emerges. The more innocent you can be in listening to, rather than forcing, a response, the more your inner wisdom will emerge. After hearing the question and listening to your inner message several times, take a few minutes to write down what you learned.
Your first thought may be that there is no deeper significance to this terrible disease and that you simply want it to vanish from your life as rapidly as possible. This is fully understandable, for no one consciously chooses to incur an illness. However, most people who perform this exercise receive some insights that begin the process of regaining meaning and wholeness in life. Often, people with cancer, as is true with most people on this planet, can identify some aspect of their life that is incomplete in some way. That is, they know that there is something missing but they have been unable or unwilling to address this lack directly and make the necessary choices to improve the situation. It may be that you are languishing in a job that provides little nourishment or challenge. It may be that you are harboring resentment or bitterness from a past or current relationship. It may be that you have a desire to spend more time with your family members but other priorities always seem to win out. Perhaps a change in diet or a new exercise program has been calling you, but you have done everything in your power to tune out the message. It may simply be some hobby such as painting, writing, or dance that always brings you great joy, yet you never seem to have time for it. Almost all of us would make different choices if we really believed that our time here was limited. For many people, learning that they have a serious illness offers the opportunity to look honestly at what is missing and to begin choosing to fulfill that need.
About one and a half years ago, a frightened woman with breast cancer came to see me, understandably distraught because her cancer had recurred nine months after a malignant breast mass had been surgically removed. After her operation, her surgeon told her that her chances for a cure were excellent, and she declined further treatment. Unfortunately, a lump that was at first felt to be scar tissue from the surgery continued enlarging, and a repeat biopsy showed more malignant cells. After her first round with cancer, she did her best to put the experience behind her as quickly as possible, treating the whole episode as a bothersome inconvenience. She continued to smoke cigarettes, made no changes in her fastfood diet, and remained in a less than nourishing relationship with her boyfriend, even though he was unable to provide emotional support for her when her illness was discovered. When she discovered that the cancer had returned, her emotional defenses were overwhelmed, and she was terrified that she was going to die. She was prepared to do anything that might improve her chances. Working with her oncologist, she began a program of radiation, chemotherapy, and hormonal therapy, along with several mind-body approaches. She learned meditation, improved her diet, and gave up smoking. When she asked herself what was the deeper significance of her illness, her quiet inner voice told her that her cancer represented a lack of love for herself. Recognizing a long-standing pattern of one-sided relationships, she made a commitment to herself that she would no longer tolerate emotional toxicity in her life. A year and a half later, she is disease-free, in a healthy relationship with a wonderful man she met at a cancer support group, and happier than she has been in many years. In retrospect, she sees her cancer as a gift that impelled her to make choices honoring her spirit.
I will be reminding you throughout this book to give yourself permission to nurture your innermost desires and live your life as if every moment was a gift. We each have a responsibility for our own well-being, and in order to create health, we need to restore the wholeness that is our birthright. Responsibility is not the same as blame. We often hear from people with cancer that well-meaning friends attempt to convince them they are choosing to create their illness, implying that if they simply chose differently, they could spontaneously eliminate their illness. This is neither useful, compassionate, nor accurate. Regardless of the specific choices we make in our lives, one thing is certainno one chooses to suffer. Even people who smoke two packs of cigarettes a day are not choosing to get sick; rather, they are choosing a behavior that fulfills a need they have not found another way to satisfy. People are often willing to dispense with life-damaging habits when life-supporting alternatives are offered.
Whenever my patients raise the issue of what they did to cause their cancer, I feel a tremendous amount of humility and compassion. First, they may not have done anything on a conscious level to incur their illness. Children of Hiroshima who developed leukemia, adults with thyroid cancer who were radiated for swollen tonsils as children, and women with vaginal cancer exposed in their mother's womb to the hormone diethylstilbestrol (DES) can hardly be held personally accountable for their cancers. These reflect our collective choices more than any one individual's. Second, there are many types of cancer for which we do not understand how any of our conscious behaviors contribute to their development. Although there may be statistical correlations between certain types of environmental influences and specific cancers, for many malignancies we simply don't have the "why" answers. This is certainly the case for the many people I see with brain tumors. Third and finally, there is no value in creating any sense of blame in people who are now facing the most important challenge of their lives. I suspect that by assigning a simplistic cause to an effect ("Of course he got colon cancer, he ate red meat!") we protect ourselves from the fear that serious illness raises in us. If my friend who works too hard gets sick, I can feel some security that since I do not indulge in that behavior, I am protected from a similar fate. In my experience, humility and compassion are the qualities that truly benefit friends when someone is facing cancer or any other serious life challenge.
More important than assigning blame is assuming the responsibility to create an opportunity for healing. By responsibility I mean the ability to respond in a creative way that is different from the past and open to new possibilities. Only through escaping the limitations of the past can we access our full creative potential. This means looking at every aspect of our lives and honestly evaluating whether we are maximizing nourishment or tolerating toxicity. Through honest self-evaluation we gain the power to make the changes that will bring about greater happiness and well-being in our lives. This is true whether or not we are currently facing a serious illness. Acknowledging our limitations or weaknesses does not mean that we are flawed; rather, the recognition that we are multifaceted human beings allows us to embrace the paradoxical aspects of our nature. Cancer can be viewed as a dramatic wake-up call to us as individuals and society. In our reawakening, we can restore wholeness to our lives.
What Is Cancer?
Since I will be using medical terminology throughout this book, I'd like to familiarize you with a few basic definitions. Recognizing that the language we use to describe something determines our relationship to it, I will be introducing new ways of describing cancer that will help shift our interpretation of cancer. But I think it is useful to understand the prevailing terminology of this illness.
Let's consider a common scenario. You become concerned about a swelling under your arm and see your doctor about it. He examines the lump and labels it a tumor, which simply means a swollen collection of cells. The question in both your and your doctor's minds is whether the tumor is benign (most likely harmless) or malignant (potentially serious). If your doctor is unable to confidently determine the nature of the swelling by feeling it, he will probably recommend a biopsyan operation to take all or a piece of the tumor so it can be examined under a microscope.
You obviously hope the lump is benign. Benign tumors are usually slow-growing, don't spread throughout the body, and are unlikely to shorten life. They have well-defined boundaries, separating them from surrounding healthy tissue. When an operation is performed to remove a benign tumor, none of the cells in the lump are usually left behind.
You fear that the tumor is malignant. This implies that it is more rapidly growing, has a tendency to invade healthy tissue, can spread, or metastasize, and may be threatening to life. Because malignant tumors do not heed the normal boundary rules of the body, it may be more difficult to determine where the lump ends and normal tissue begins.
If the biopsy shows only an increased number of normal cells, the lump is declared benign and no further treatment is required. If, however, the microscopic examination shows cells that seem to be multiplying beyond normal controls, the scary diagnosis of cancer is applied. The term cancer is derived from the Greek word karkinos, meaning crab, because malignant tumors tend to hold onto surrounding tissues like a stubborn crab.
If the tumor is malignant, you will probably be referred to a doctor who specializes in the treatment of people with cancer, known as an oncologist. Most modern treatment offered by an oncologist falls under one of three categories: surgery, chemotherapy, or radiation therapy. The goal of a surgical procedure is to remove as much of the cancerous tissue as possible, minimizing the damaging effect it has on surrounding normal tissue. Chemotherapy involves the use of potent medicines that damage cells that are rapidly growing. Since cancerous cells tend to reproduce more quickly than normal healthy cells, chemotherapy drugs are designed to affect malignant tissues more than normal ones. Because there is not an absolute distinction between the way normal and cancerous cells grow, it is normal for people receiving chemotherapy to experience some side effects. Radiation therapy involves directing beams of energy at cancerous tumors, which alter their genetic material, leading to cell death. As with chemotherapy, the goal with radiation treatments is to maximize the effect on cancer cells while minimizing injury to normal cells. Two modalities that hold promise for the future are immune therapies that enhance our body's ability to identify and dispense with cancer cells and genetic treatments that seek to correct the abnormal signals that stimulate cancer cells to grow. The newest approach on the horizon uses substances known as angiogenesis inhibitors that may treat cancer by preventing the development of new blood vessels. If a tumor cannot augment its blood supply, it cannot grow. Preliminary research in animals using these agents is promising, and the cancer community eagerly awaits studies in human beings.
Many cancers are effectively treated with modern medical approaches, but because medical doctors are reluctant to use the term cure, people who have a good response to treatment are usually referred to as going into remission. In complete remission, all evidence of cancer is gone; in partial remission, the cancerous tissue may be lessened but still detectable at some level. A tumor that seems to have stopped growing or is growing much more slowly than expected may also be considered to be in partial remission. By reducing the burden of cancer cells with modern medical treatment, your body's natural healing system has a better chance of taking care of the remaining malignant cells.
Over the past several decades scientists have tried to understand how toxic substances can lead to cancer when they enter our bodies. The term carcinogen is applied to an agent from the environment that may stimulate the uncontrolled growth of cancer cells. For most carcinogens, a minimum exposure is necessary before a person develops cancer. For example, many soldiers fighting in Vietnam were exposed to Agent Orange, a poison used to destroy forests. Limited exposure to the chemicals contained in Agent Orange, known as dioxins, rarely led to cancer, but workers heavily exposed to the herbicide where it was produced have shown a higher risk for a number of malignancies. Even with the same carcinogen exposure, human beings demonstrate a wide range of susceptibility to developing cancer, based upon both our genetic makeup and our overall state of health. We can't do much about our heredity, but we can do a lot to improve our overall health.
Cancer, Lifestyle, and Culture
As a life insurance actuary, Thomas knew that his pack-per-day cigarette habit was placing him at some health risk, and each year he made a resolution to stop. However, his day-to-day life stresses always provided a good reason why today was not the right day to begin enduring the anticipated nicotine withdrawal symptoms. Although annoyed by his chronic cough, he avoided seeing his doctor until one morning when he was startled to see his urine appearing pink in the toilet bowl. Anxiously describing his discovery to his family doctor on the telephone, he was scheduled to see a urologist that afternoon. After a series of studies, he was given the diagnosis of bladder cancer. Fortunately, it was small, localized, and very treatable.
A year later, Thomas is a changed man. He smoked his last cigarette on that fateful day, lost thirty unwanted pounds, now exercises four times a week, and regularly enjoys family vacations. He looks back with a sense of gratitude on the experience that helped him reset his physical and emotional priorities.
Almost any tissue in our body can be the site of cancer, because everywhere our cells grow there is the potential for them to lose normal control and reproduce in a disorganized manner. The most common tumors in any given culture or community reflect the prevailing popular lifestyle. For example, lung cancer is the most common malignancy in the United States because of our society's addiction to tobacco. If no one smoked cigarettes, lung cancer would be a rare disease. Unfortunately, as more women in our society choose to smoke, what was previously a rare malignancy in women is now common. Equally tragic, the incidence of tobacco-related cancers is growing worldwide as citizens of developing countries emulate our Western lifestyle.
Our digestive system is almost continuously exposed to carcinogens in our environment through the food we consume. Nearly half of all cancers in the United States arise within the digestive tract, with the large intestines the most common site. High dietary fat intake and low fiber consumption are associated with slower movement through our gut, which seems to increase the exposure of our colon to potential cancer-causing substances. Diet has a major effect on this type of cancer, as shown by the fact that the rate of colon cancer in North Americans and Western Europeans is as much as ten times higher than in natives of Asia, Africa, and South America! In Seventh-Day Adventist communities, where members tend toward vegetarianism, the incidence of colon cancer is much lower. Native Japanese have a high incidence of stomach cancer, apparently related to the large amount of salted, pickled, and smoked foods that comprise the typical Japanese diet. Japanese people who move to Hawaii or California and change their diet to a more characteristically American one show a decrease in the incidence of stomach cancer but a rise in their risk of colon cancer.
Our modern lifestyle not only raises the risk of some cancers; it lowers the risk of others. Liver cancer is relatively rare in North America, where it is usually related to long-standing alcoholism. However, developing countries in Africa and Asia have a very high incidence of liver cancer. Malnutrition, exposure to toxins produced by food contaminated by fungus, and a variety of viral and parasitic infections may all contribute to the phenomenal 8 percent incidence of deaths due to liver cancer in southern Africa. We can fairly easily reduce the risk of liver cancer through lifestyle choices in North America. The societal changes required in the poorest developing countries are much more challenging.
Breast and prostate cancer are of major concern in North America. Although we do not understand why we are having epidemics of these cancers, they seem to be related to our lifestyle. Both breast and prostate cancer are much less common in Asia. As with colon cancer, when women move from Japan to America, the risk of breast cancer rises, as does the risk of prostate cancer in Asian men who move here. The rising rate of breast cancer in America has been tied to a diet rich in animal fat, and this has also been confirmed in studies on animals. We know that women who never have children or who have their first child after the age of thirty have a slightly higher risk of breast cancer. Women on estrogen replacement therapy are also at mildly increased risk. These trends are more common among Western women, accounting in part for the increased breast cancer we see here. There has also been recent concern about toxic chemicals known as endocrine disruptors. A variety of environmental agents may mimic or alter our natural sex hormones, possibly contributing to breast, prostate, and testicular cancer. The Environmental Protection Agency is sponsoring studies to more carefully assess the role of these common chemicals in our most common cancers.
Although environmental factors have been identified in many cancers, there is still much we don't understand. A thousand people may be working in the same chemical plant, but only a handful will develop cancer. Millions of people smoke packs of cigarettes each day, but not everyone develops lung, mouth, or throat cancer. This is where two other important issues come into play: genes and immunity.
Meet the Author
DAVID SIMON, M.D., is Medical Director of the Chopra Center for Well Being. He was formerly chief of staff at the Sharp Cabrillo Hospital in San Diego and is a frequent speaker throughout the country.
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