You Don't Beat a Disease Like Cancer All At Once

Humor for my dad and me was much more than making each other laugh. It was an active hobby, and a means of communication. Some beaten-to-death punchlines made for great shorthand between us, even when we were talking about serious things.

In that spirit, I want to share a joke, and then lay some pretty heavy stuff on you. My dad told me this joke when I was maybe ten years old, and it became an oldie-but-goodie for us:

A man happens by a farmer's field and notices a pig with only three legs. He decides to knock on the door of the farmhouse and ask about the pig. The farmer is happy to tell him.

The farmer says, "Let me tell you about this amazing pig. This pig saved my life on more than one occasion. Once we had a fire in the middle of the night, and this pig came out of his pen, ran to the farmhouse, woke us all up, and helped us escape to safety. And if that isn't enough, another time, I had an accident while plowing the fields. I was trapped under the machinery, and this heroic pig ran to find help."

The other man is impressed, but before he can ask about the pig's missing leg, the farmer presses on, "Just last year we had a snake loose in the farmhouse, and this fearless pig cornered it until I could trap it and get rid of it."

The man asks, "Is that how he lost his leg?" The farmer tells him no. The man asks, "Well, why does he have only three legs?"

The farmer says, "You don't eat a pig as special as this one all at once."

In my mind, shaped by this joke and a thousand others like it, cancer is the pig you don't eat all at once. Except, obviously, cancer is horrendous. Cancer is too complex, too multi-faceted to beat with a single devastating move.

I am not being pessimistic when I say that we won't cure cancer. At least, we won't cure it in the way the word cure conjures a magic remedy that makes cancer disappear. We won't cure it in part because cancer isn't an "it". It is a group of many diseases that behave differently and that occur for different reasons. Nonetheless, some cancers already are quite treatable, others are manageable, and some can be avoided. We have made great progress, and much more progress is possible if we do what we already know to be effective.

So, what do we know? There are four things every person can do that can reduce the risk of dying from cancer. Read that last sentence carefully. I didn't say "prevent cancer" or "cure cancer" - I said reduce the risk of dying from cancer. Prevention and treatment are part of the mix, to be sure, but they are a means to an end. The goal is to avoid dying from cancer.

It's also important to remember that many cancer risk factors are beyond anybody's control. For example, what can you do about heredity or age? Anyway, the four things everyone should do:

1. Don't use tobacco at all. Not in any form or in any amount.
2. Protect your skin from the sun. The surest way is to stay out of the sun during the hottest part of the day. Otherwise wear a hat and some kind of clothes. Sunscreen may protect you from sunburn, but it may not offer protection from skin cancer. More on this in a future post.
3. Maintain a healthy weight. Get there through a healthy diet and regular exercise. By some estimates, obesity is responsible for about 100,000 cancer deaths a year.
4. Get the recommended screenings for your age and gender. There are proven tests that screen for colorectal, breast, prostate, and a few other cancers. Here are the American Cancer Society's cancer screening guidelines. Finding some cancers as soon as possible can give you the best chance at longterm survival.

According to some estimates, if every single person was totally compliant with these four practices, we could cut the number of US cancer deaths nearly in half. This is astounding. Of course, it also means that about 275,000 people would still die from cancer every year, because, as Ben Folds sings, "shit just happens sometimes."

As a non-smoker who got lung cancer, my dad would have fallen within that unlucky second group. But I don't believe we should become fatalistic or resigned about cancer just because we can't always account for why it strikes. Nor should anyone ever be blamed for getting a cancer diagnosis - it's tempting, but quite unfair, to guess at why a particular person gets particular cancer. You can never know for sure, and except in cases of environmental exposure, what good is it to know the cause?

The point is that the remarkable progress we've seen in reducing rates of people getting and dying from cancer shows that more progress is possible. And since half of all men and a third of all women will have a cancer diagnosis at some point, it is more than worth the effort to try to eat that pig.