Genetics, lifestyle key to cancer prevention

Cancer. It’s a word that rings in the ears of too many Americans each year. New or recurring, a cancer prognosis can be downright scary…overwhelming to patients and their loved ones alike. Even with all of the advancements in cancer avoidance and treatment, it still remains the number-two killer for Americans, right after heart disease. It’s no wonder the same month is used to observe and reinforce efforts to improve both cancer and heart health.

Fortunately, there are a growing body of organizations, lifestyle recommendations, vaccinations and information available to help. (See a listing of many of the events on the American Cancer Society website, the American Institute for Cancer Research and other sites.)

While the causes of cancer aren’t completely understood, a number of factors are known to increase the disease’s occurrence, including many that are modifiable, such as tobacco use and excess body weight. Others are not, such as inherited genetic mutations.

Without question, providers and payers continue to encourage healthy behaviors, important because as noted in the American Cancer Society’s Cancer Facts & Figures 2020 (sharable PDF), at least 45% of U.S. cancer deaths and 42% of our 1.8 million newly diagnosed cancers estimated during 2020 are potentially avoidable. This includes the 19% of all cancers caused by smoking and the 18% caused by a combination of excess body weight, alcohol consumption, poor nutrition, and physical inactivity. The statistic for lung cancer for men and women who smoke is scary — 25 times more likely to develop lung cancer.

Do any of these lifestyle behaviors sound familiar…either to you as an individual yourself — a provider living a precarious work-life fraught with stress — or for one (or most) of your patients? They do. And no one says it’s easy. But a lot of it is obviously avoidable.

Though the incidence of cancers varies based to some extent on not just lifestyle but location — such as exposure to a given risk factor (a factory that pollutes nearby waterways, for example) — fortunately or unfortunately, cancer as a whole doesn’t particularly discriminate based on sex though it’s somewhat higher in males. In the U.S., an estimated 42 out of 100 men and nearly 38 out of 100 women will develop one or more types of cancer during their lifetime.

Cancer trends going in right direction…down

Taken in total — in the U.S. and across the world — the prevalence of cancer is termed “one of the most significant public health challenges of the 21st century.” Fortunately, we’re trending in the right direction, and the growing availability of innovations such as genetic testing are beginning to have an impact.

But from the stats and quote above, more work remains. The overall age-adjusted cancer death rate rose during most of the 20th century, peaking in 1991 at 215 cancer deaths per 100,000 people, mainly because of the smoking epidemic. As of 2017, the rate had dropped to 152 per 100,000 (a decline of 29%) because of reductions in smoking, as well as improvements in early detection and treatment. This decline translates into more than 2.9 million fewer cancer deaths from 1991 to 2017, progress that has been driven by steady declines in death rates for the four most common cancer types — lung, colorectal, breast and prostate.

The role of medication management counseling and PGx

As a clinical pharmacist, I am the last person to say that medication is the first line of defense for cancer prevention. It’s actually one of the last…for treatment, not prevention, using chemotherapy often coupled with radiation. And note that while vitamins and other supplements can be just that — a supplement — to a person’s good health, they are not the best way to improve the chances of avoiding cancer; a healthy lifestyle is.

However, it is true there is more evidence as to how to maximize our chances to avoid cancer, including pre-teen vaccinations to help avoid such things as the human papillomavirus (HPV) that can lead to cervical, anal, or head and neck cancers.

Also, a periodic comprehensive medication management consult can go a long way to have a fresh set of eyes to examine all of a patient’s medications across all of their providers, with a clinical pharmacist recommending possible changes while factoring in supplements and lifestyle choices.

Having the most in-depth information on each unique patient is invaluable. It’s why RxLive delivers pharmacogenomic testing (PGx for short), to get the best sense of what medications are likely to be the most effective, ineffective or downright dangerous for each person.

Through collaboration, patients, their doctors and clinical pharmacists can closely track and positively impact health factors from lifestyle to vaccinations, diet, exercise and more. In that way, we can help each person minimize the risk of cancer and make it fall farther and farther down the list of leading killers. We’re proud to play a small but potentially life-saving part of that effort.

Valuable resources

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.