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André Picard: As I mentioned earlier, we do not do a good enough job of prevention or screening in either men or women. It is true, though, that, to date, screening programs have been aimed exclusively at women screening mammography for breast cancer and Pap tests for cervical cancer.
The number one cancer killer of men is lung cancer, followed by colorectal cancer. The evidence for the benefits of colorectal cancer screening, using a fecal occult blood test, is strong. However, in speaking of the lack of cancer prevention in men, I believe you are making reference to the PSA test. Many men are currently tested for PSA (prostate specific antigen) but there is no universal screening program. The reason is that many experts believe that PSA is not a good screening tool that it has the potential to cause more harm than good. But the test and the research is evolving so that may change. And that does not mean that individual men should not get a PSA test, which can provide some valuable clues about disease progression.
Nadejda Aletkina, Kingston: Do you have any thoughts on why the idea of detoxification for cancer prevention and treatment doesn't attract much attention?
André Picard: Generally speaking, a lot of cancer patients use alternative therapies. Many may very well work but they need to be subjected to the same rigorous testing as mainstream pharmaceutical products, and they need to be used with the same cautions, i.e. there are not miracle cures. It is also important for cancer patients to tell their physicians they are using alternative products as there may be interactions with prescribed drugs.
Pam Wilkinson, Canada: I'm a 56-year-old woman with estrogen positive breast cancer. Having read about cancerous stem cells being resistant to chemo, am reluctant to go through that again should it return. Are there any upcoming trials for women like me with aggressive cancers?
André Picard: I am not a physician and cannot offer any medical advice. What I can do is urge patients to discuss these issues with their treating physicians and nurses. A caution too about the new research that indicates that some stem cells may be resistant to chemotherapy: While this will influence researchers and may change approaches to treatment down the road, no one should make a decision to receive treatment (or not) based on a single study.
Brenda McGuire, Ottawa: Are there any effective (and practical) preventive strategies, other than the obvious, like not smoking and exercising?
André Picard: Roy Romanow was fond of saying that the top 10 things a person can do to ensure good health were:
1. Don't be poor.
2. Pick your parents well.
3. Graduate from high school or, better yet, university.
4. Don't work at a stressful, low-paid job. Find a job where you have decision-making power and control.
5. Learn to control stress levels.
6. Be able to afford a foreign holiday and sunbathe (with SPF 30).
7. Don't be unemployed.
8. Live in a community where you have a sense of belonging.
9. Don't live in a ghetto, near a major road or polluting factory.
10. Learn to make friends and keep them.
In other words, a lot of our health risks cancer included depend on genetics and the broader socio-economic environment we live in.
Beyond that, there are lifestyle factors that have some impact: Don't smoke, be active, eat well. And with cancer, getting screened and being treated quickly are important.
Rasha Mourtada, globeandmail.com: Thank you, André, for joining us today to take questions from globeandmail.com readers. Any last thoughts you'd like to leave us with?
André Picard: Thank you to everyone for your challenging questions. In closing, I would just say that while our on-going series has focused on cancer, the issues raised about prevention, treatment and research apply generally to a broad range of chronic conditions. What we have learned about improving cancer care using nurse-navigators, broadening screening efforts, providing specialized care in specific facilities, setting wait-time benchmarks, knowing the benefits and limitations of drug treatments and so on has applications throughout the health system. While cancer touches many Canadians, the lessons of cancer should be applied broadly to improve and modernize our health system across the board. The last thing we want or need is disparities of care based on a person's affliction.