Oncology. Cancer.

ETIOLOGY AND PREVENTION.

A broad array of agents can cause or directly contribute to a sequence of events or sensitize cells in such a way that cancer develops . The final common pathway in virtually every instance is a cellular genetic mutation that converts a well-behaved cellular citizen of the body into a destructive renegade that is unresponsive to the ordinary checks and balances of a normal community of cells. Promoters (oncogenes) and suppressors (like the retinoblastoma or p53 gene) play a central role in many cases . Chemicals such as benzene and nitrosamines, physical agents such as gamma and ultraviolet radiation, and biologic agents such as the Epstein-Barr and hepatitis viruses contribute to carcinogenesis under certain circumstances. Evidence exists to link dietary factors to carcinogenesis; although not as clear as one would like, the evidence is strong enough to recommend diets low in fat and high in fiber. A sensible diet is based on grains, vegetables, and fruits, with smaller than the current average proportions of fat. Inherited susceptibilities are becoming more evident and probably play a key role in a significant number of cancers of the breast and colon. Down syndrome and the Li-Fraumeni syndrome are well-known harbingers of a substantial risk for developing cancer.

The single most important carcinogen in the United States and Europe is tobacco, because it causes or contributes to the development of about one third of all cancers: primarily lung, esophageal, head and neck, and bladder. Less well appreciated is the contribution tobacco may make to causing breast, colon, and gastric cancer. Tobacco-related cancer is also important because it is preventable by the obvious, inexpensive, and 100% effective means of abstention. Although the total number of smokers in the United States has declined, women smoke more than ever, adolescents continue to view smoking as socially chic, and the number of smokers in Asia and developing countries is growing at an alarming rate.

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