An Expert Answers 37 Most-asked Questions About Cancer (Nov, 1954)

A six page article about cancer and this is the only reference to smoking:

Q. Can you tell us something helpful about factors outside our own bodies, things we come in contact with, that might induce cancer? There have been scare stories about smoking—an impressive large-scale statistical study by the American Cancer Society had a lot to do with that, as you know, Doctor—and we hear about dangers of air pollution, auto-exhaust fumes, occupational exposures to chemicals, etc.

A. The widely publicized report—and it was only a preliminary report, at that—of the society’s smoking study seems to indicate an association between smoking and heart disease and cancer. But surely much work needs to be done to determine the nature of this association as well as the role of exhausts, air pollution, asphalt highways, and so forth, before anyone can make an accurate statement on the cause of cancer.

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An Expert Answers 37 Most-asked Questions About Cancer

IN A TAPE-RECORDED SESSION, Dr. Brewster S. Miller (right), for more than six years director of professional education of the American Cancer Society, gives the vital answers to author Donald G. Cooley’s comprehensive queries. A world-famous cancer authority, Dr. Miller was a delegate to the 1954 International Cancer Congress, held in Sao Paulo, Brazil.

Q. Dr. Miller, it is kind of you to consent to this interview, and I want to thank you on behalf of readers of Cosmopolitan Magazine, who will feel they are sitting across a desk from you, as I am, getting authoritative answers to questions that are of grave concern to all of us. Cancer is a word that frightens everybody. What does it mean? What is cancer?

A. Well, Mr. Cooley, that is a very difficult question to answer. The body, as you know, is composed of billions of cells that grow, divide, grow, divide, and die. Normal cells follow regular patterns. Their growth is orderly and slows down after achieving its purpose—that is, the forming of muscle, skin, bones, etc. On the other hand, the characteristic feature of cancer cells is rapid division. Here the growth is not orderly, does not stop when its purpose has been achieved, but continues in competition with normal cells.

Q. What makes a cancer cell so dangerously different from a normal cell?

A. The cancer continues to grow until it encroaches on other organs and interferes with their nutrition and function. Possibly most important of all, the cancer spreads from its original location to other parts of the body. When it does so, the cancer cells “smother” normal cells and the normal cells die. The cancer cells take over, cause inanition, malnutrition, and lower the body’s resistance to infections.

Q. How do cancer cells get started in their dangerous departure from normal processes of growth?

A. We don’t know the answer to that, unfortunately, although we do have a great many clues. Much work is being done in studying the metabolism of the normal cell—how it is constructed, how it grows and divides to make two cells, what physiological reactions occur in this orderly division of normal cells. Investigators are looking for differences between the life processes of normal cells and those of cancer cells, with the hope of finding new ways of destroying cancer cells without injury to normal cells.

Q. Dr. Miller, could a blow, an injury, a wound, make normal cells go wild and cause cancer? That is a fairly common belief.

A. At present, there is no authoritative evidence that blows or injuries directly cause cancer. We believe that when a cancer appears at the site of a previous injury, the injury may have started the cancer to grow rapidly but did not start the malignant process, which was there all the time.

Q. Then if all cancers don’t grow at the same rate of speed, are there some cancers that are much less dangerous than others?

A. Indeed, that is so. We know many people possibly have cancers that never become serious because they grow very slowly and don’t encroach upon normal tissues. The common skin cancer—the “basal cell” tumor—takes years to grow large enough to become ulcerated and almost never spreads, yet cancer of the blue-black mole spreads quite rapidly through the blood stream while it is still quite small locally.

Q. Is it possible, then, that some people live to an advanced old age and die from some quite different cause although they have harbored an unsuspected cancer through the years?

A. That’s quite possible. Routine post-mortem examinations in many hospitals have shown a surprisingly high incidence of prostate cancer in men who have died of heart disease, tuberculosis, pneumonia, and other conditions completely unrelated to cancer. The same is true of cancer of the uterus and intestinal cancer. So the biological behavior of a particular cancer is a most important characteristic.

Q. You said that skin cancer takes years to grow and almost never spreads. Does that mean a person with skin cancer has every reason to expect complete cure?

A. Skin cancers do have a very high rate of cure. We know that by prompt, early detection and adequate treatment we can cure up to ninety-five per cent of all skin cancers. This approaches the cure rate we have in measles, mumps, and diphtheria. Barring very unusual forms, there’s almost no reason for a fatality from skin cancer except sheer neglect.

Q. Next I have a very big question: is cancer hereditary? We’re generally told cancer can’t be inherited. Yet many of us have lost more than one close relative to cancer. Can you tell us something to clear up this confusion, Dr. Miller?

A. That is a difficult question. In many patients, we find there has been cancer in the mother or father or in some previous generation. On the other hand, many patients come to us with absolutely no cancer in their background. However, in laboratory animals we can make cancer hereditary —for example, by breeding purebred strains of mice. Cancer will occur in a predictable percentage of the offspring. But it is impossible to get purebred strains of humans, and the techniques of studying hereditary aspects of cancer in purebred animals cannot be applied to human beings.

Q. Can you give some protective advice to people with a history of cancer in their family?

A. Such people should certainly have a thorough medical checkup by their family doctor every year. They should also keep alert for cancer’s danger signals, such as any sore that does not heal, any change in a wart or mole, persistent indigestion or difficulty in swallowing, persistent hoarseness or coughing, any change in normal bowel habits, and in women, any lump or thickening in the breast or any unusual bleeding or discharge.

Q. Should one be especially watchful for symptoms in a particular organ responsible for cancer deaths in the family?

A. We don’t know enough to say that. All we can say is that if yon have a history of cancer in your family you should he especially conscientious about seeing your doctor periodically for a general checkup.

Q. How can doctors be sure a suspicious growth or area of tissue is actually malignant?

A. The most practical method is biopsy—taking a piece of the living tissue, staining it, and placing it under the pathologist’s microscope. The appearance of the cells, their architecture and apparent degree of activity, will enable the pathologist to tell in practically all cases whether the cells are from normal tissue or from a malignant tumor.

Q. But suppose there is no suspicious area from which to take a biopsy. How can a cancer be detected if a patient lias no symptoms and the doctor is just looking for possibilities?

A. There are a number of things the doctor can do. For instance, in looking for a cancer of the uterus, a doctor can take a sample of cells from the vagina and place this fluid on a slide. This is called a vaginal smear. The smear is sent to a pathologist or cytologist, who studies the cells under a microscope. Again, in the case of possible lung cancer, indicated by a small shadow on X-ray plates, the doctor may send a sample of the patient’s sputum, smeared on a glass slide, to the laboratory for interpretation. This is cancer detection, not diagnosis. For actual diagnosis, a biopsy is needed.

Q. Can a doctor use smears to detect cancers other than the kinds you have mentioned?

A. Further applications of the smear technique are being studied in many laboratories, but they are not yet available countrywide. A malignant tumor sheds its cells as a tree sheds leaves. Such cells collect in the vagina from the uterus, or may be detected in the urine from the kidney, bladder, or prostate. New studies apply this technique to abnormalities of the stomach. A small deflated balloon surrounded by a black silk netting is swallowed by the patient. The balloon is then inflated, and the normal action of the stomach causes the net to pass over the stomach walls. The balloon is then deflated, removed from the stomach, and sent to a pathologist, who examines the stomach-lining cells caught by the silk netting.

Q. Most of us are pretty well aware that early cancer detection is partly the responsibility of the patient, partly the responsibility of the doctor. How well is the public doing? And how well are the doctors doing?

A. Detection of cancer is a twofold job. First, the patient: he must have a critical awareness of the symptoms that may mean cancer. Second, the doctor: he must continue to be cancer-conscious. He must be thinking of cancer. A doctor is confronted with between ten and fifty patients during his working day. They all present symptoms, and the doctor must determine what is causing them. We want him to be able to rule cancer out. We believe the public is doing very well. People are going to their doctor earlier than ever before, so the opportunities for complete cure are excellent. Doctors also are more cancer-conscious, in part because of such activities as the professional-education program of the American Cancer Society, which makes available to busy doctors such helps as refresher courses, publications, films, and professional meetings.

Q. Have people’s awareness of cancer and such measures as self-examination of the breasts actually done much good in sending patients to their doctor while cancer is still in the early, curable stage?

A. I’m certain they have. Two years ago, after widespread promulgation of a program of breast self-examination, the American Cancer Society received many letters from physicians saying their patients had detected some of the smallest tumors of the breast they had ever seen, and thus the prognosis was good. We urge women to periodically examine their own breasts after being instructed by their physician. A woman learns the normal feel of her breasts and then if at any time she discovers an abnormality that proves to be cancer, she can go to her doctor when it is in a very small, curable stage.

Q. That is heartening news, indeed, Doctor. Are there any similar protective measures for men?

A. We urge all males over the age of forty-five to have their chest X-rayed twice a year. The radiologist can then pick up a very small, almost imperceptible shadow in the chest X ray. If there proves to be lung cancer, and I say if, it is detected at a time when the opportunity for cure is excellent.

Q. What steps should be taken by a man or woman who has just discovered symptoms that suggest cancer?

A. See a doctor at once. A person should maintain a close relationship with his doctor and have regular checkups even if there are no signs or symptoms. See your doctor when you’re well!

Q. / take it, Doctor, you have in mind the period for many diseases when we aren’t in immediate critical danger but when the disease may be gathering force to break out disastrously. Is there such a period in cancer?

A. Yes. We know it takes a matter of months or years for a cancer, be it in the colon, breast, or uterus, to grow to a size that produces symptoms. This is particularly so in the uterus; we know it takes many, many years for a cancer in this site to become invasive. Yet that same cancer, before it spreads dangerously, can be detected by a vaginal smear. We urge all women to have a vaginal smear made when they see their doctor. Carcinoma in situ of the cervix is a cancer that has started to grow on the surface of the womb neck, before it has begun to invade muscle and deeper tissues. At this time, it can be completely removed. This is detecting cancer at a time when it is a hundred per cent curable.

Q. A hundred per cent curable—that’s unbelievable for a disease as serious as cancer!

A. It should be a hundred per cent curable in cancer in situ of the cervix. But most women come to us after they start to have symptoms, such as abnormal bleeding or spotting between periods or a spotting after the menopause.

Then examination shows the tumor, which may have been present for five or ten years, has invaded blood vessels and deeper tissues. At that time, instead of a hundred per cent cure, we are nearer fifty or sixty per cent cure.

Q. Doctor, can you tell us how to spot a cancer quack? Some pitiful people fall into the hands of vicious charlatans who promise cures with magic salves, liquids, electronic boxes, etc.

A. Cancer quacks are individuals, usually not physicians, who claim good results, even cures, from using unorthodox methods. Usually they charge large fees. Most important, by going to a quack, a person with cancer delays receiving, or never does receive, proper medical treatment which may save his life. My plea, Mr. Cooley, for any of your readers confronted with such a situation is to discuss it frankly with the family doctor or with the local county medical society to get on the right track for the best medical advice.

Q. What are the recognized methods of curing cancer?

A. At present, there are only three recognized methods: radical surgery, X ray, and radium.

Q. We are told cancer is a curable disease, and I think a large part of the public accepts that. But I wonder if you have any statistics to show just how curable it is, so worried people won’t think of cancer as a death sentence. Has the cure rate actually improved?

A. Oh, it has improved a very great deal. But let’s separate early and late cancers. In breast cancer, we can cure between seven and eight of every ten patients who come in with an early malignancy. Yet only thirty to thirty-five per cent of women who have late breast cancers can expect five-year survival. Larynx cancer is curable in about eighty-five per cent of early cases; in late cases, the cure rate drops to about fifteen per cent. Cancer of the cervix, or neck of the uterus, is seventy to seventy-five per cent curable in early stages, but in late stages doctors can cure only twenty-five per cent. Roughly speaking, we should be permanently curing twice as many people with cancer as we are now—and we can accomplish this if people will only come in when their symptoms first start, or better yet, for periodic checkups before symptoms start.

Q. Is there any possibility we will have blood tests, urine tests, or other simple tests to discover cancer in people who have no symptoms?

A. If and when that day comes, it will be one of the most important events in man’s fight to control cancer. The prospects are fairly good. We now have many such tests under study, but besides detecting cancer they also detect tuberculosis, rheumatoid arthritis, and a number of other diseases, thus giving false cancer positives. Five large universities supported by the – National Cancer Institute are spending a great deal of money investigating various chemical tests for cancer on blood and urine, seeking to find tests that will be positive for cancer and negative for other diseases.

Q. Aren’t the sex hormones intimately involved in some types of cancer?

A. We know there is marked similarity in the chemical structure of sex hormones of the body and of chemicals we know to be cancer-producing. Whether or not, through some metabolic change in the body, these hormones become converted into cancer-producing chemicals we don’t know, but the matter is being carefully studied. In prostate cancer that has spread from the gland to bone or other parts of the body, we know that removing the source of male hormones —that is, the testes—and giving female hormones enable the patient to live many months and years of comparatively normal life. We don’t say it cures the cancer, for it does not. But it puts the brakes on the cancer’s rate of growth. In advanced breast cancer that we know will not be cured by surgery or X ray, the patient may be treated by castration—removal of the source of female hormones—and given male hormones, and this treatment will slow down the rate of tumor growth. Here is evidence that sex hormones have a great deal to do with these varieties of cancer.

Q. What about germs and viruses? I think some people still have a sneaking feeling that cancer is catching.

A. We know cancer is not contagious, for doctors and nurses who work day and night with cancer patients do not have any more cancer than the general population. We know nothing about germs causing cancer. But it appears from studies on mice with breast cancer that viruses are related in some way to cancer. There seems to be a substance passed from mother to offspring, probably a virus, that has to do with the offspring’s developing cancer in later life. On the other hand, work is being done with viruses in experimental treatments of certain types of cancer in laboratory animals. There have been cures in cancerous mice by using viruses. However, viruses have been used in only two or three human cases, too few to have significance at the present time.

Q. I have seen figures that indicate overweight is slightly associated with increased incidence of cancer. Can you tell us anything about the relationship of diet to cancer?

A. Insurance companies tell us that cancer and heart disease, the two biggest killers today, are especially associated with obesity. A good deal of work is going on with nutrition in laboratory animals. We know that animals whose genetic background indicates they should get cancer do not get as much cancer as expected if they are not fed as well as their brothers and sisters.

Q. Can you tell us something helpful about factors outside our own bodies, things we come in contact with, that might induce cancer? There have been scare stories about smoking—an impressive large-scale statistical study by the American Cancer Society had a lot to do with that, as you know, Doctor—and we hear about dangers of air pollution, auto-exhaust fumes, occupational exposures to chemicals, etc.

A. The widely publicized report—and it was only a preliminary report, at that—of the society’s smoking study seems to indicate an association between smoking and heart disease and cancer. But surely much work needs to be done to determine the nature of this association as well as the role of exhausts, air pollution, asphalt highways, and so forth, before anyone can make an accurate statement on the cause of cancer. Environmental factors are a fascinating story. People who work with with some types of oils are very prone to skin cancer. We know that farmers and sailors, who spend their lives out of doors in the sun, have a high incidence of skin and lip cancers.

Q. Then the practice of sun-bathing until one’s skin is tanned a coffee-berry brown isn’t necessarily a healthful thing?

A. Sunbathing in moderation is certainly healthful, but it is known that certain types of skin are more prone to cancer than others. Light, fair, actinic skin seems more vulnerable, so people whose skin freckles and burns easily would be wise to avoid overexposure to intense sunlight.

Q. Does having children affect the likelihood of a woman’s developing certain cancers?

A. There is some evidence to show that women who have children have a higher incidence of cancer of the uterine cervix than women who have not had children. On the other hand, childless women seem a little more susceptible to breast cancer. It is interesting that racial factors seem to be involved. Uterine cancer is rare in orthodox Hebrew and Moslem women, common in Gentiles. It is also common in Mexican women, while breast cancer is much rarer. North of the border, the ratio is almost reversed. A great deal of study must be done to find out what habits, customs, and racial factors have to do with cancer.

Q. On behalf of Cosmopolitan readers, Dr. Miller, I’m going to ask you to suggest some steps, routines, habits, the individual can take to prevent cancer or to recognise symptoms that precede cancer, as a sort of “cancer insurance.”

A. We have mentioned being alert to cancer’s danger signals, self-examination of the breast, routine chest X rays, and vaginal smears. These plus periodic visits to the doctor will save many thousands of lives. Any long-continued, chronic irritation of tissues could be a predisposing factor to cancer. Such a condition—for example, a mole or wart that is constantly irritated by pressure or friction, as of tight clothing—should be taken care of promptly. Women who have chronic infections of the cervix should have this condition cared for and watched carefully. There is a close relationship between rectal polyps, which are easily detected by the doctor’s examining finger, and cancer of the rectum, so doctors routinely examine that area. These polyps are easily removed, and their removal will prevent later trouble. Most of these polyps are benign, yet they are what we call precancerous lesions. People who have white plaques in the mouth (leukoplakia) should have this treated, for here again is evidence of a precancerous lesion that can be controlled before it gets serious. People should occasionally take a look in the mirror at their mouths, beneath the tongue and the sides of the cheek. If they see something odd and it stays there a week or so, they should certainly call it to their doctor’s attention.

Q. Is there any possibility ice will someday have a chemical cure for cancer—that is, drugs as effective in bringing about cures as surgery, X rays, and radium now are?

A. Things look moderately encouraging, particularly in the research that has been done since the last World War.

Q. Do cancers ever cure themselves, disappear spontaneously through mysterious readjustments of the body that nobody understands?

A. There have been a very few cases in which a cancer disappeared completely and spontaneously. I recall an interesting case of a woman who was operated on and found to have a very large ovary cancer. Her case was considered hopeless. Doctors gave her what help they could and urged her to go to a terminal-care institution. But she preferred to stay in her own home. Seven years later, when it was taken for granted she was dead, a patient with the same name and hospital number came walking into the hospital with a case of gallstones. Doctors thought there must be some mistake. But sure enough, she was the same patient they had given up for lost. Without any treatment whatever during seven years, her ovary cancer had completely disappeared. So there are extremely rare cases that apparently regress spontaneously. Why, we do not know. There may be a close relationship between immunology and cancer. People develop antibodies in their blood and become immune to smallpox by vaccination and to diphtheria by injections. There is also some evidence that patients develop an immunity to certain types of tumors. Considerable research is being pursued along these lines.

Q. Is cancer a single, uniform disease?

A. The word cancer applies to many malignant diseases, depending upon the organ or cells affected. Acute leukemia in a child has no relationship to stomach cancer in an adult, bone cancers have 110 connection with breast cancers, soft-tissue sarcomas are different from lung cancers.

Q. Is there a “cancer age” for important types of cancer?

A. Cancer in general is a relatively rare disease before the age of forty. More children die of cancer between the ages of one and five in this country than die of measles, polio, and diphtheria put together. From the age of five to fourteen, cancer causes more deaths than any other disease and is exceeded only by accidents as a cause of death. However, the number of new cancer cases rises sharply after forty years of age. Most cancer is in oldsters, fifty to seventy. We urge younger as well as older people to have a routine yearly health checkup. Remember, they are starting a health-habit routine that may pay off after they reach the age of forty.

Q. As we all know, the will to get well plays an important part in recovery from many diseases. Does it play a significant part in recovery from cancer?

A. It plays a very important part in any patient convalescing from an illness, particularly cancer. Whether or not the patient ultimately survives depends, I think, on other factors than the will to live. Yet patients with a firm will to live survive their expected time of death by a much longer span. The reason? Doctors shake their heads and say, “I don’t know why he’s around today. He should have been dead a month ago.”

Q. What kind of family program can be followed to safeguard against cancer as far as is humanly possible?

A. If I could urge your readers to do nothing else, I would say to them they have a great responsibility to themselves and to members of their families. Just as many men die of cancer as women, yet women are more health conscious than men. It’s the women of our country who become responsible for the health of their children. Wives have a duty, it seems to me, to get their husbands to participate in a family health program. I urge your readers to take on a program of annual health examinations for themselves and their families. Call it “family insurance.” We periodically check our automobiles, paint our houses, fix up the cellar, but most people disregard their bodies until symptoms of trouble appear. And if these symptoms are due to cancer, it may be too late. Why not have trouble detected before symptoms start? My plea is for a closer relationship to your doctor when you feel well.

Q. How expensive would such a program be? Is it a big sock to the family budget?

A. It shouldn’t be, but it depends on the type of examination. Most cancer detections, once a year, run between fifteen and twenty dollars, including a chest X ray. This type of examination picks up most cancers. It does not include gastrointestinal X rays, but does include vaginal smear, careful examination of mouth, skin, chest, abdomen, body cavities.

Dr. Miller, / want to thank you personally and on behalf of Cosmopolitan readers, to whom you have been talking across your desk this afternoon, for the warm and heartening way you have given us authoritative information about cancer, leaving us confidently alert instead of frightened and disheartened.

The End

  1. Charlene says: July 19, 201212:19 pm

    I was recently talking to a medical researcher who pointed out that reducing one’s risk of cancer isn’t as clear-cut as science writers often imply. One can reduce the risk by keeping fit, not smoking, etc., but there’s no way to cut the risk to zero, and some methods of risk reduction are worse than the disease. For instance, the earlier a woman has her first child, the lower her breast cancer risk in later life – but the benefit is the greatest if she gives birth before age 13, and dwindles if she waits until the grand old age of 18. I don’t think anyone would suggest mass teen pregnancy as a public health move!

    He also said that the one cancer with the strongest correlation to tobacco use is bladder cancer, not lung cancer. Lung cancer is strongly correlated with tobacco exposure, but there are other risk factors – including being female and perimenopausal. In some populations, 10% of lung adenocarcinomas are in non-smoking women over 35.

  2. Toronto says: July 19, 201212:43 pm

    Charlie: Despite the “Recent Comments” showing 2 comments here (Fluffy and Charlene) there’s only one showing. I noticed this a few days ago as well. It might indicate a deleted message, but then it shouldn’t show on the “Recent” list.

    Also, asphalt as a cancer cause? Really? I thought it was the big metal gas burning things on top of the asphalt.

  3. Charlie says: July 19, 201212:53 pm

    Toronto: Fluffy’s comment was on another post. http://blog.modernmecha…

  4. Hirudinea says: July 19, 20122:52 pm

    Hey Sunshine causes cancer, your best bet is just to try to stay as healthy as you can, avoid obvious risks, like smoking, and hope you don’t get cancer until your 150!

  5. Toronto says: July 20, 20127:23 am

    Thanks, Charlie. Sorry for the false alarm.

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