Cancer prevention as a way of life

Leading the efforts of cancer prevention at the world’s top cancer center is no small task. Yet Ernest Hawk, M.D., vice president and head of MD Anderson’s Division of Cancer Prevention and Population Sciences, embraces this mission.

He stands at the helm of one of the largest international efforts in prevention and control. And his impressive faculty of cancer prevention clinicians and researchers has spent many years dissecting and investigating methods to reduce the number of people who develop cancer.

“We know how to prevent at least 50% of all cancers,” Hawk says. “We also know that early detection and screening are critical keys to reducing cancer incidence and mortality.”

Everyday choices matter

“Cancer is not caused by a single event, but is the result of a process that takes years to develop,” Hawk says. “It’s the result of a combination of inherited susceptibilities and a variety of lifestyle choices people make daily.”

Research has shown that people can do a lot to reduce their risk of developing cancer over time, including being physically active, maintaining a healthy diet, and limiting harmful occupational and environmental exposures.

Because there are limited effective therapies for treating advanced cancers, information about strategies to detect and prevent cancer are extremely important.

With greater frequency, people are becoming more comfortable talking about cancer and cancer risks, such as a sedentary lifestyle, obesity, UV exposure and smoking. But there are conflicting messages not only for the general public, but also for those in the medical industry, Hawk says.

The public often depends on popular reality programs such as “The Biggest Loser” or the latest news reports for health information, but there can be confusion about the importance and credibility of the findings. People tend to follow advice they are most comfortable with. To make the best decisions, they need trusted sources for this information.

Collaboration leads to promising discoveries

Over the past few years, several discoveries under Hawk’s leadership have advanced the goal to prevent and control cancer. For example, MD Anderson epidemiologists recently reported in The Lancet results of a large study that showed 15 minutes of exercise a day, or 92 minutes per week, extended a person’s expected lifespan by three years — a 14% reduction in mortality.

Another study, led by health disparities researchers, involved an intervention in health care settings to help reduce tobacco-related mortality and morbidity. The study, Ask Advise Connect, was published in the Journal of the American Medical Association Internal Medicine and showed that smokers directly connected to the Texas Quitline were 13 times more likely to enroll in a treatment program, compared to smokers who were advised to contact the quitline.

Cancer prevention is a multi-prong approach and requires collaborations across a broad spectrum of disciplines.

• Behavioral scientists are making strides in dissecting the brain’s response to emotional cues to understand smoking behavior, cessation and relapse.
• Physicians and scientists in clinical cancer prevention are investigating the earliest changes in cells that could signal transformation toward cancer.
• Epidemiologists are working to identify risk markers in the human genome.
• Health disparities researchers are studying and implementing ways to reduce the cancer burden in the poor and medically underserved.
• Health services research investigates the delivery, quality and cost of health care.

Making meaningful changes

Hawk maintains that consistent, meaningful changes can have a significant impact in reducing the incidence of, and deaths due to cancer.

“Screening and early detection are critical strategies,” he says. “Over the years research has shown that screenings are responsible for a 20% reduction in mortality for breast and lung cancers, 30% reduction in colorectal cancer and a steady and impressive decline in cervical cancer. There’s no doubt that we’re making significant progress. Yet, there’s still much to be done.”

Since the announcement by Ronald DePinho, M.D., MD Anderson president, of the Moon Shots Program, Hawk and his team are developing and supporting the prevention aspects of the moon shots.

Much more can be done through a combination of broad public education programs and legislative action. One example concerns ultraviolet (UV) light exposure — particularly during youth.

“We still have high rates of minors using tanning beds in the state of Texas,” Hawk says. “UV exposure represents a substantial risk for developing skin cancers, especially melanoma, which can be life-threatening. Through legislation Texas has been able to restrict minors’ access to tanning beds, thus reducing the incidence of skin cancers.”

Another ongoing project involves tobacco cessation. Long-term exposure to tobacco continues to account for more than 80% of lung cancers. In the United States, mortality from this disease is higher than from breast, ovarian, prostate, colorectal and pancreas cancers combined. In addition to programs for adults, MD Anderson has interactive, educational programs designed for youth and adolescents to inform them about the dangers of tobacco products with the goal of dissuading their use.

“The earlier you invest in education and screening, the better the chance you have of preventing cancer,” he says.

With his dedicated team of researchers, scientists and clinicians, Hawk hopes the next five years will generate more resources dedicated to bringing about meaningful changes in which healthy lifestyles and broader use of evidence-based screening exams become the prevailing way of life.