Ámbito nacional

Cancer of the breast is the leading cancer among women in Western countries. It appears that this cancer is caused by one of several viruses and is increased in certain population groups. As mentioned before women who breast-feed their babies seem to be protected. Those with fibrocystic disease, a condition where the mammary glands enlarge and become engorged with sacs of fluid have an increased risk of breast malignancy.

Recent evidence points to the intake of caffeinated beverages, such as coffee, tea, and colas as factors in the production of this fibrocystic change. Beverage alcohol is believed to be one major risk factor in breast cancer. Men may also have breast cancer, but it is about 1/125th as common. Periodic self- examination is an excellent aid to early detection of breast cancer, especially if it remains the same throughout the menstrual cycle.

A great deal of controversy is raging in the medical world concerning the best treatment for breast cancer. Some types seem to be adequately treated by locally excising the tumor. The removal of a portion of the breast obviously preserves normal anatomy and is far less mutilating than the more traditional radical mastectomy.

Many types of breast cancer are quite adequately treated and often cured by a modified approach removing the breast only, while preserving the muscles in the chest and dissecting the lymph glands in the arm pit only when the risk of metastasis is high. This to me seems like a much more “middle-of- the-road” approach, avoiding the extensive mutilation and more serious complications of the radical surgery commonly performed.

CANCER of the GASTROINTESTINAL TRACT

For the last three decades, cancer of the stomach has been decreasing in frequency in the United States. It remains high in Japan and certain other Oriental nations, and is probably related to the intake of certain foods, some highly seasoned, and others extremely hot. The second most common type of cancer in our country is cancer of the colon and rectum. This often produces a change in bowel habits, the stools becoming more constipated or of small caliber. Bleeding from the rectum is occasionally seen. This is usually red when the tumor growth is low in the colon and darker, brown to black (called

melena) when the lesion is high in the colon or coming from the small

intestine or stomach. This color change is due to the partial digestion of blood products by bacteria and enzymes in the bowel.

The rectal examination is helpful in detection of many cancers in their early stages. A ten-inch tube with attached light, called a sigmoidoscope can be used to look into the lower bowel, where nearly three-fourths of the cancers are seen. This should be done in conjunction with a complete annual exam for individuals over the age of 40. A new technology in fiber optic viewing, called endoscopy, has developed instruments that can examine the stomach and duodenum (gastroscopy), and the entire colon (colonoscopy). These procedures are often done on an outpatient basis, and provide even more adequate confirmation than the traditional barium x-rays.

The cause of these colon cancers is still somewhat uncertain. It is felt that a high fiber diet, which increases the rapidity of transit through the bowel, will

chemical malonaldehyde, which seems to be increased when the meat is cooked!

Certain vegetables are not exempt from association with cancer. Moldy corn, peanuts, soybeans, and other seeds contain a factor called aflatoxin, which has been associated with liver cancer in several countries. It is

interesting to note that the incidence of cancer is increasing in many fish that inhabit polluted streams and rivers. Problems with meat inspection also contribute to risk of cancer, in that certain portions of an animal carcass may be preserved for food, while another part of the animal may have actual malignancy.

All of these danger signals are turning more food buyers to a vegetarian diet. In fact the numbers are growing rapidly in the United Kingdom, where a disease called bovine spongiform encephalopathy was discovered in 1985. It will undoubtedly spread to other nations. Often called the “mad cow

disease,” this condition results from using animal products such as a bone meal in cattle feed. The cows after a few years go crazy, and become violent. A virus-like particle called a PRION is found in the animal’s brain. Currently it is resistant to most germ killing procedures, including boiling, radiation, and disinfectants. Modern cancer virus research points out the “ounce of

prevention” at your supermarket being worth much more than “pounds of cure” in the hospital.

Another bit of good news in the treatment of cancer of the colon is that some types can be removed without radical resection of the organ. Many snares, cauteries, and forceps have been devised to remove these cancers from the rectum through the sigmoidoscope. Sometimes when the malignancy is present only as a growth on a stalk, the area involved can be followed with periodic examinations. Other times the removal of a portion of the colon is necessary to effect the cure. The possibility of metastasis to the lymph nodes or liver makes it important to achieve early diagnosis and therapy, if life is to be maximally prolonged.

CANCER of the UTERUS and CERVIX

Routine screening has decreases the incidence of cervical cancer in recent years. Called the “Pap smear”, this screening tool developed by Dr.

Papanicoleau has allowed for the early detection of change in the cells of the cervix. Being less common in nuns, in Jewish women, and in those with less sexual activity, this type of cancer merits great interest from a preventive standpoint. A virus similar to the Herpes virus that causes cold sores has been implicated in the development of some of these cancers.

More and more nurses, as well as many midwives are learning how to take these smears, thus increasing the acceptance of the pap smear to many women as well as making the procedure more available. It certainly should be part of an annual examination from the time of marriage on through life. Early diagnosis with surgical removal of the uterus and cervix can well be curative.

Cancer of the lining of the womb (endometrium) is less common, but is still taking many lives. This has definitely been related to the use of estrogens, the female hormone used traditionally to lighten symptoms of the menopause. Avoidance of these hormone preparations, as well as prompt medical

treatment in the event of unusual menstrual flow can provide the early diagnosis needed.

An outpatient procedure, using techniques similar to the pap smear (e.g.

Vabra aspiration, or the Pipelle) can with less expense and discomfort

provide the reassurance needed to evaluate this bleeding. LEUKEMIA

Cancer involving the blood and bone marrow is most often seen in children. Several types of leukemia are described, based upon the type of blood cells involved and their appearance under the microscope. Samples from the blood and bone marrow are usually compared.

Ionizing radiation, whether from nuclear sources or x-ray therapy, is clearly associated with an increased incidence of these leukemias. Chemical agents, such as the anticancer drugs and occupational exposure to benzal have been associated with increased leukemia. Some hereditary factors have also been linked with this disease.

Most interesting is the firmly established viral theory in relation to acute leukemia. In rodents, fowls, cats, and monkeys certain viruses are known to cause leukemia when experimentally inoculated. These animals can pass viruses to their offspring through the ovum or shed it in their milk or other secretions, thereby transmitting it to unaffected animals. Again it makes one wonder how much leukemia may actually be transmitted to human beings through the use of animal foods, such as meat, eggs or milk. Milk is

increasingly suspect for cancer viruses, especially the bovine leukemia virus (BLV) and the bovine immunodeficiency virus (BIV, a relative of HIV).

A disease in chickens (fowl leukosis) is estimated to affect up to 15% of the birds used for food, and many cases escape the casual inspection at the

demonstrated as superior. Combining a proper diet with the judicious use of fever therapy should induce the appropriate antibodies to aid in virus

destruction and the maintenance of health, as well as a decrease in

complications. This type of therapy has been used with increasing success in the treatment of related tumors, such as Hodgkin’s disease, chronic

lymphocytic leukemia, and some other lymphomas. These closely related malignancies all seem to have a common viral origin. Thus, they should respond to the intermittent induction of high fever, However, it must be given in a controlled setting for safety.