As a radiation oncologist, Dr. Alexander Kirichenko has spent more than 30 years on the front lines of fighting cancer. But he also believes he has a responsibility to improve people’s understanding of cancer and cancer prevention.
Noting the lack of reliable information…and abundance of inaccurate information…about cancer online, Dr. Kirichenko created Cancer The Facts, a free website that has over 10,000 subscribers. The goal: educate around commonly-asked questions and misperceptions about cancer, particularly in the area of prevention.
“As a society, we tend to talk about cancer treatments and the tremendous progress we’ve made, but we need to be more active in spreading knowledge of how to prevent cancer,” he explains.
With that in mind, we invited Dr. Kirichenko to talk about his website and some of the preventative measures people can take.
Emily Laubham (EL): How did you conceptualize and decide to create the Cancer the Facts website?
Dr. Alexander Kirichenko (AK): In my work, I hear many questions about cancer from patients and their families. “What is cancer?” “Why do I have it?” “What can I do to make treatment more effective?” “Is my family at risk?” “How can I prevent cancer from coming back after treatment?”
Patients may not have much background on cancer, but they’ve heard some horror stories, and now they’re turning to me for support, and to get the truth. I realized that many people needed guidance, and my son, who has experience building websites, suggested that one way to provide guidance and raise awareness was through an educational website.
Now, I strongly believe a site like this must be led by oncologists. Sometimes patients will do online searches and end up on websites with misleading information, which may cause them to make the wrong decisions or delay treatment.
Unfortunately, people behind some websites use the fears around cancer as an opportunity to sell something — for example, making claims that a supplement alone will cure cancer. In fact, nearly 4 in 10 Americans “somewhat” or “strongly” agree that cancer can be cured through alternative treatments alone, according to an American Society of Clinical Oncology (ASCO) survey.
We made our website to help separate the truth from the fiction.
EL: Are there parallels between what motivates you as a radiation oncologist and what motivates you to run this website?
AK: I’ve witnessed incredible progress in treating cancer during my career. Patients are living longer, and there are millions of cancer survivors in our country. That is a success story. But I also see the other side of the story, and that is how treatment takes its toll.
Many cancer patients are in their 60s and 70s. They’ve come to a point in their life where they want to travel, enjoy free time, and be with family. Then, boom! They have a cancer diagnosis. They now have to spend time in the hospital, experience physical and emotional distress and quite often a financial burden, just when they were ready for a happy retirement.
So, here is what motivates me: The majority of cancer cases are preventable — two thirds by some estimates, and perhaps much higher. I look at these people suffering, and I think, “Most of you could have avoided this problem.”
EL: It’s amazing to think about two thirds of cancer cases being preventable when you consider the scope of the cancer problem in the U.S.
AK: The scope is tremendous. Over the years, surveys like the Mayo Clinic National Health Check-up have consistently found that Americans see cancer as the most important health problem facing the nation. Statistically, in 2018, there were approximately 1.7 million new cases of cancer in the U.S. and more than 600,000 people died from the disease. It’s the second leading cause of death in the country, very close behind cardiovascular disease. Cancer is also one of the most costly illnesses, both for the individual and in terms of cost to the U.S. health care system.
Knowing that cancer is often preventable, and acting on that knowledge, can save lives and money.
EL: Before talking more about prevention, let’s start with the basics. To echo one of the patient questions you mentioned: What is cancer?
AK: The common definition of cancer is this: A disease caused by uncontrolled cell growth happening in many parts of the body. However, cancer goes well beyond that definition.
Our bodies are a conglomerate of trillions of cells that work together and depend on each other in a complex network. Altogether cells grow and divide in a controlled fashion, with checks and balances to replace old or damaged cells by a process called apoptosis, or programmed “cellular suicide.”
Thanks to this well-organized function of cells, in harmony with good quality nutrition and an absence of smoking and alcohol, we stay healthy, well and happy. When cancer forms, it presents as a sort of failure to sustain that balanced maintenance of cells. It doesn’t happen overnight — there is a slow process of “smart” regression of normal cell population into independent, simple life, escaping from regulatory signals, that eventually allows cells to divide endlessly and resist cellular suicide. They gain a sort of immortality and hide from recognition and destruction by our immune system.
EL: Could someone, without screening, recognize this happening in their body?
AK: Depending on the cancer, people may not notice anything. That is why cancer screening is so important. Eventually, if undetected, cancer may begin to devastate the body, stealing nutrients and leading to cancer cachexia, which is a wasting syndrome that includes weight loss, anorexia, asthenia, and anemia. As the cancer grows and matures, it spreads throughout the body, causing pain, shutting down organ function and potentially causing death if it isn’t caught.
EL: How does cancer start?
AK: The trigger for normal cells to go crazy is gene mutation. Our DNA contains a template of genetic code that regulates the life of cells. Most mutations don’t have noticeable impact on cell life thanks to the body’s ability to repair DNA, which happens almost instantaneously. It should be noted that our body is constantly exposed to factors that damage DNA — inflammation, body fat, hormonal influence, chronic illness, smoking, alcohol, viral infections, and pollutants. But sometimes, this damage cannot be repaired. When the cell doesn’t commit cellular suicide, and there is persistent mutation, this increases the risk of cancer.
There are also critical genes called tumor suppressor genes or oncogenes. They control cell growth. When a significant amount of mutation occurs within a group of these genes, there’s almost no escape.
EL: I often hear people dismissively say that “everything” causes cancer these days. What really causes cancer?
AK: Part of what we do in the “Prevent” section of our website is focus on causes that people have control over. Cancer formation can take years, and the “fertile soil” that allows it to grow comes from years and years of aggressive impact. Poor nutrition, lack of physical activity, and obesity all have a hand in this, especially obesity since childhood.
There’s also the consumption of processed food, specifically processed meat, as well as environmental pollutants, overexposure to the sun, UV light, and sunburn. Now, imagine all these factors in combination. It makes sense that our body may not be able to fight all the mutations that eventually cause cancer.
That’s why age is the highest risk factor for developing cancer — there is a longer exposure to these impacts and carcinogenic environments. The good cells collect more and more mutated DNA, and then eventually lose the battle.
EL: Can you explain more about the correlation between obesity and cancer?
AK: The American Cancer Society estimates that obesity is responsible for about 8 percent of cancers in the U.S., and many other sources suggest it could be even higher. Excessive fat causes hormonal imbalances, which then causes cell proliferation (cell growth). If you look at the etiology or cause of multiple cancers, obesity is a contributing factor in breast cancer, colon cancer, rectal cancer, endometrial cancer, esophageal cancer, kidney cancer, pancreatic cancer, gallbladder cancer, and liver cancer.
Unfortunately, two-thirds of Americans are overweight or obese. This is an epidemic situation.
EL: And that’s partly what we’re talking about when we say many cancers could be prevented?
AK: Some studies have found that only 5 to 10 percent of cancer cases can be attributed to genetic defects. That means the majority involve environmental or lifestyle factors, many of which we can control. And the younger you are when you start taking anti-cancer measures, the more likely you can escape trouble.
The most significant method of prevention involves lifestyle changes. Researchers found that 18 percent of cancer cases and 16 percent of cancer deaths could be tied to excess body weight, alcohol, poor diet and physical inactivity. Smoking is responsible for another 19 percent of cancer cases and 29 percent of cancer deaths.
EL: What are some specific diet choices you can make to reduce your risk of cancer?
AK: A mostly vegetarian diet with moderate inclusion of fish, and maybe chicken, but with no additives, is good for cancer prevention. The fiber, antioxidants and phytochemicals in fruits and vegetables can all help prevent cancer — and more important to remember, processed meat may actually trigger it. We have a whole article on why processed meat is a problem and what falls under that category.
You also want to avoid chronic alcohol consumption — alcohol use is associated with higher risks of multiple cancers.
EL: Does physical activity fight cancer formation?
AK: Physical activity engages our immune defense, and that’s what helps to fight cancer. Physical activity can also reduce certain hormone levels, obesity, and inflammation, which are linked to cancer formation. There’s also a direct link between lack of physical activity and some cancers.
EL: What about the percentage of cancer formation that is hereditary — can anything be done about that?
AK: The first thing to clarify is that cancer is not inherited; genetic factors that increase susceptibility to cancer are what we inherit. Even when there is cancer in a family, quite often if someone down the line gets cancer, it’s due to similar lifestyle choices or environmental exposures rather than genetics.
If you have a family history that suggests an increased risk of developing cancer, hopefully that makes you more likely to take preventative measures where you can — healthy lifestyle, screenings, proactive testing, and genetic counseling.
Having a higher genetic risk of developing cancer does not mean you will definitely develop it. In many cases, you can still offset the increased genetic risk with a healthy lifestyle.
EL: What are you most excited about in the future of cancer care?
AK: I’ve lived through a cancer care revolution — it went from being usually incurable to something that, especially if it’s confined to the site of origin and hasn’t spread, most of the time we can now cure it.
But the goal is no longer just to cure cancer. Now we’re trying to figure out how to cure cancer with minimum trouble for patients — for example, to cure the disease without damaging organs. We’re looking at things like organ preservation, hormonal preservation, preservation of sexual drive — that is the art of treatment, to treat successfully while preserving normal life.
The decoding of cancer, or genetic profiling, is also exciting. At Allegheny General Hospital, our genetic lab will allow us to profile every single cancer, find the genes responsible for the signature, then target and eradicate them. That is the future.
EL: What are your goals for the future of CancerTheFacts.com?
AK: I recently saw an interesting statement that it is unreasonable to expect people to change behavior when faced with so many external forces, including culture and environment, that conspire against change. That is why I want to reiterate how important the physician’s job is to step up with individual initiatives, social networking, and conversations with patients and family members, with respect to something like changing a poor diet or habits of inactivity.
That is why we started Cancer The Facts. We wanted to be more active in spreading knowledge about prevention. So I want the site to continue to educate people — and help patients to feel more a part of the team when it comes to maintaining or recovering their health.
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