Getting Cancer

Some people worry about getting cancer continuously. Their fear of cancer rises to the level of an overt phobia known as cancerophobia. It is an active behavior related to the dread of cancer that may lead to repeated medical examinations that fail to reveal a malignancy. Despite this, people with this condition are unable to be reassured about their clean bill of health for any length of time.

Luckily, most of us are not overtly phobic about cancer even though it may be lurking deep in our subconscious. Why is it not an active fear for the bulk of the population? It is likely because in people without any signs of cancer, it is not perceived as an imminent threat. 

We are hard-wired to fear clear and present dangers. Risks and threats far into the future don’t get as much priority in our constellation of daily fears.

Examples of this from our daily life abound. For example, one study found that most people are not willing to take urgent action on climate change if it is presented as a distant threat. But if portrayed as proximal in time and place, more people are willing to act with urgency.

This may seem unrelated to worrying about cancer but the underlying neurobiological mechanism is the same.

So, should we worry more about getting cancer?

George Klein, Professor Emeritus at the Microbiology and Tumor Biology Center at the Karolinska Institute in Stockholm, Sweden, has been a teacher and a researcher since the mid-1940s. He published a fascinating article in The Scientist that makes the point that approximately 1 in 3 people will be struck by neoplastic disease in his or her lifetime. But, the other side of that coin is that two out of three people remain unaffected. Even the majority of heavy smokers who bombard their lungs with carcinogens and tumor promoters over many years remain cancer-free.

Pathologists have shown that virtually all men aged 60 or older have microscopic prostate cancer when examined at autopsy. However, most of these micro-tumors never develop into overt cancer.

It is also known that circulating tumor cells (CTCs) are present in many cancer patients. However, only a portion of these cells will enter and persist in distant parts of the body. These are known as disseminated tumor cells or DTCs. An only a fraction of them develop into secondary tumors (metastases).

They are kept in check by a mix of the following elements:

In other words, when it comes to getting or not getting cancer, the glass is more than half-full. So, should we just relax and not worry?

That’s not a productive question to ask. A more interesting one, that may actually produce interesting answers is: What makes most people resistant to cancer?

What causes cancer?

Cancer is caused by damage to genes that accumulate over time. There are a number of ways this damage can occur including, but not limited to this list:

  • Exposure to carcinogens, including those in tobacco smoke or in the environment (asbestos)
  • Infections with certain viruses or bacteria (hepatitis B or Epstein-Barr)
  • Radiation exposure
  • Some drugs, such as medications that weaken the immune system
  • Genetic predisposition (for example Lynch Syndrome)
  • Factors not yet identified

We know that colon cancer, breast cancer, and prostate cancer, develop through progressive stages of mutations that ultimately cause cell division to spin out of control and proliferate wildly.

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So is cancer resistance simply the other side of the coin, namely the lack of harmful mutations? Put in those terms, is not getting cancer simply a matter of luck? But to paraphrase Albert Einstein’s quip about quantum mechanics, evolution doesn’t play dice; it increases its odds with natural selection.

It turns out that mutations, harmful or otherwise, occur all the time in all of us. But, we all (with few exceptions of genetic or pathological conditions) possess several well-known mechanisms for active resistance to cancer.

The body’s anti-cancer mechanisms

In an important paper published in PNAS, George Klein identified five kinds of anti-cancer mechanisms:

1. Immunologic

The first type is immunological. For example, researchers have compared the antibody responses of the squirrel monkey and the marmoset when infected with Herpesvirus saimiri. Marmosets, but not the squirrel monkeys, develop rapidly growing lymphomas after exposure to the virus. Of note, the virus is endogenous to squirrel monkeys, but marmosets never encounter it. 

The researchers found a striking difference in the timing of each animal’s antibody response. In the tumor-resistant squirrel monkeys, the antibodies rose to a high level just three days after the infection. In the marmosets, however, the response took three weeks, too late to stop the virus-driven lymphoma.

The dynamics of the antibody response suggest that squirrel monkeys had pre-existing memory T cells against the virus. Whereas the marmosets had to develop them first before a full-blown antibody response could be mounted, a process that takes about three weeks.

2. Genetic

The second mechanism Klein describes is genetic. Our cells are constantly subjected to DNA damage. And, there are individual variations in the efficiency of the repair mechanisms.

Although, in the vast majority, these mechanisms are capable of repairing the damage quickly, some are not. An example is a DNA repair deficiency disorder called xeroderma pigmentosum. Individuals with this deficiency are highly sensitive to ultraviolet light. Even with careful protection, they develop multiple skin cancers due to their genetic deficiency.

3. Epigenetic

The third mechanism is epigenetic. This involves changes in gene expression, rather than changes in the DNA itself.

DNA methylation is one of the key epigenetic factors involved in regulation of gene expression and genomic stability. It is biologically necessary for the maintenance of many cellular functions.

Genomic hypomethylation is common in both solid tumors such as prostate cancer, hepatocellular cancer, cervical cancer, as well as in hematologic cancers such as B-cell chronic lymphocytic leukemia.

The next two mechanisms are, for some reason, my favorites.

4. Apoptosis or cell death

As part of an intracellular defense, a cell can trigger apoptosis, or cell death, if it detects extensive DNA damage. This prevents the cell from reproducing and spreading the damage. It is the ultimate altruism on the cellular level.

In some individuals, this mechanism fails. The cellular protein P53 is a tumor suppressor. When it is mutated, it increases the risk of inheriting Li-Fraumeni syndrome, a rare disease in which patients develop multiple tumors.

5. Factors in the tissue’s microenvironment

The last mechanism of defense against tumors resides in the microenvironment in which tissues are embedded. Here is a striking example. The naked mole-rat (NMR) and the blind mole rat (BMR), live up to 20 and 30 years, respectively, and never develop cancer. How do they pull off this trick?

The naked mole-rat (NMR) displays exceptional longevity, with a maximum lifespan exceeding 30 years. This is the longest reported lifespan for a rodent species. It is especially striking considering its small body mass. In comparison, a similarly sized house mouse has a maximum lifespan of 4 years. In addition to their longevity, naked mole-rats show an unusual resistance to cancer.

The NMR is a social species that lives in highly organized matriarchal societies. It has to force its way through narrow and often sinuous underground tunnels. The connective tissue in its skin contains a high-molecular-weight form of hyaluronic acid (HA) that makes the animal’s skin malleable. The corresponding HA in mice and humans has less than one-fifth of the molecular weight.

The heavy form of HA that occurs in the NMR is not only beneficial for the animal’s locomotion. It also prevents the transformation of normal cells in cell culture into cancer cells. Only after it has been removed can the NMR’s cells be transformed into cancer cells. The NMR cells also display an extreme sensitivity to contact inhibition: The cells stopped dividing when barely touching each other.

Several species of the blind mole rats (Spalax judaei and Spalax golani) are common in Israel and surrounding countries. BMRs are small subterranean rodents. They are distinguished by their adaptations to life underground, remarkable longevity (with a maximum documented lifespan of 21 years), and resistance to cancer.

In tissue culture, when overproliferation started taking place after several cell divisions, BMR cells began secreting interferon ß which triggered a massive cell suicide response (a.k.a. apoptosis). The Masada phenomenon is apparently alive and well in this Middle Eastern species.

In case you conclude that it is subterranean living or the small size that protects these animals from getting cancer, think again—the blue whale is cancer-free as well. So, we don’t have to live underground or go back to the ocean, where our very distant ancestors came from.

The bottom line is that most of us don’t need to worry about getting cancer

Rather, we can take a deep breath and relax because two-thirds of us will never develop cancer. As for the other third, don’t despair. Diagnostics and therapeutics for cancer are propagating at a rapid rate. That doesn’t mean all cancers are preventable or curable yet. But I, for one, am putting my faith in human ingenuity to one day make cancer less feared than it is today.

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Originally published 5/3/15, it was updated on 3/25/18. It was republished after a major revision on 11/9/19.

Dov Michaeli, MD, PhD

Dov Michaeli, M.D., Ph.D. loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us.

He was a professor and basic science researcher at the University of California San Francisco where he also taught biochemistry to medical students. During this time he was also the Editor of Lange Medical Publications, a company that developed and produced medical texts that were widely used by health professionals around the world.

He eventually left academia to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early-stage biotech company that developed products to improve post-surgical pain control.

He is now retired and enjoys working out, following the stock market, traveling the world, and, of course, writing for TDWI.

29 COMMENTS

  1. I have a fear of cancer and put off getting a mammogram. My last one was at age 38 and I finally scheduled one at 69. A spot was found on my right breast and an ultrasound was performed the next week. Thank God it was only a simple cyst so I will definitely get screening again next year.

  2. Im 16, and I am convinced I am going to get cancer at 18, survive it, then at 24 or 25, i get cancer again and battle it for 8 or 9 years and then die from it. That is what I think my life is going to be.

  3. The past couple months have been the worst. I have two bumps on the back of my neck, and I’m not sure if it’s my spine or what! I can’t get the thought out of my head that I have cancer and I’m going to die from it and there’s no way of knowing. My parents say I’m crazy. at this point I’m just losing my mind.

  4. Hello. Sorry for bothering and for my English. I’m from Romania. I dont really know if I am ‘cancerophobic’. For the last 3 months I had some swollen lymph nodes on the left submandibulary part of the neck. One of them had shrinked, but it didn’t dissapear. I’ve made some analyzes (not so many because of the coronavirus), and it says that I do have Toxoplasmosis and I had an infection with Epstein-barr some months ago. The doctor is … I think…. busy these days and he does not answer to my calls because I want to know if the lymph nodes are swollen because of toxoplasmosis or EBV (with IgG, IgA etc). I have read some articles about how EBV infections may lead to lymphomas such as Hodgkin’s or Burkitt and these months of quarantine and even now I am feeling very anxious and I am afraid that I will develop Cancer from this EBV infection. Some doctors said that i should do a biopsy to be sure that they are not cancerous but i cannot do a biopsy now because of the coronavirus. I want an opinion, how probably is to develop Cancer because of the EBV infection? Thank you for reading this. (I am a Male, 18 years old)

  5. I constantly worry about getting cancer, or my partner or my children.. I worry everyday constantly checking for lumps and bumps and then freaking myself out thinking it could be. No one in my family has died from cancer that I know off but I know of a few people who have it or had it and are now in remission.

    I find my biggest help with overcoming this fear that seems to plague my life some days is excerise. But even then I still find myself worry about it. This article I read almost once a month and helps calm my anxiety about it all so thank you

    The statistics scare me as well 1 in 7 women will get breast cancer? Does that mean that when I walk down the street that one in 7 that I see will have it?

    • Ayla, This must be really distressing. What you are describing is a classical case of cancerophobia. I am glad this article gives a measure of relief, however temporary. To increase your level of comfort, you don’t have to worry about 1 in 7 women on the street having breast cancer. This figure is over a lifetime, so on any particular day, the number is orders of magnitude smaller. In your situation statistics can help only that much. Any phobia, including cancerophobia, requires psychological help. You should not let it control your life.

  6. A family member of mine was taking the ranitidine that was pulled off the market for high levels of carcinogen. She is paralyzed with fear. Is there any way I can help her?

  7. Thank you for the rather optimistic outlook of how you mentioned that you have faith that human ingenuity will prevail over the fear of cancer someday. My grandfather recently was diagnosed with skin cancer and I was surprised at how many treatment options were presented to us. It’s great that it was detected in its early stages.

  8. Interesting take on cancer. Sure, as per 2019 reports cancer deaths have diminished by nearly 25%. Yet, cancer still remains the #2 killer globally. This is largely due to decreased rates of cigarette smoking and advances in early detection and treatment. While a 1 in 3 chance of developing cancer in your lifetime does seems low, consider in the US, drivers have a 1 in 100 lifetime risk of dying in a car related accident. Significantly lower risk! Should I not wear my seat belt? I think not. While I appreciate that patients should not spend useless energy worrying about what may happen I would not encourage people to shun preventative cancer screenings that exist for cervical, breast and colon cancer. Prostate cancer screening? That’s another story.

    • Dear Dr.Cloud,
      I agree with your comment that people should not expend useless energy on worrying about cancer. The low mortality rate in car crashes is because we wear seat belts, so not wearing them would bring the death rate to what it used to be before it was mandated by law. Likewise, we could bring down mortality rate due to lung, head and neck, and bladder cancers by the simple measure of stopping smoking. At no point did I advocate not doing preventive tests. But what you probably know, there are cancer-phobic people whose lives are consumed with fear. These are the people the article is aimed at.

  9. Hi! I’m a teenage girl (14, almost 15) and I suffer from anxiety. I constantly think about this, and any time a lump or bump appears anywhere on my body, I become terrified and can’t stop thinking about it. The lumps usually go away on their own, but it’s still terrifying to think about what will happen if they don’t. For this reason, I’m also terrified of the doctor. Thank you for writing this!

  10. Hi! Great article. Is it okay if I use the photo of the worried woman for a post on my blog? Who should I give credit to?
    Thanks,
    Angela

  11. My sister got a rare sarcoma in her 30’s (leiomyosarcoma) and died from it and I know quite a few people who died from breast cancer, lung cancer, etc. So I am worried about it. I can’t help it.

  12. […] getting cancer because the body has multiple robust mechanisms to protect us against that disease.Why You Probably Don’t Need to Worry About Getting Cancer published first on […]

  13. I know I am late to the party but I just wanted to say; that was a very positive and insightful outlook into quite a feared topic. Thank you Dr Michaeli.

  14. Whew! Human life is complex, beautiful and mysterious. Thanks to scientists and doctors laboring in their studies, trying to understand and provide solutions to our problems.

  15. Great and thoughtful post. Many of us will do ourselves more harm than good by “worrying” about cancer and getting overscreened. In the Nebraska state wellness program, the sponsors bragged about screening employees for cancer much more than the ACA “minimums,” without understanding that the “minimums” are optimums, balancing the potential harms and benefits of screens. Increasingly, the US Preventive Services Task Force is recommending fewer screens, not more.

    • Thank you for the kind comment. It will take sustained voices, like yours, to change the American midset that ‘more is better’. We should indeed promote the concept of ‘optimum’.

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