Kenneth L Abbott, MD, FACP  |  1/18/2022

Games of Chance?

One of the most frequently asked questions that follow receiving a cancer diagnosis never appears on FAQ lists: Why me?

In a small space like this, I cannot begin to answer this question on its deepest, most profound level, nor is it appropriate for me to try to do so in this forum. But there are several less philosophical reasons why this question is missing from published lists.

We know enough about the risk factors associated with many cancers to warn people about them. Tobacco consumption in all its forms, especially cigarette smoking, has strong connections to many types of cancer. Drinking alcohol to excess carries dangers for cancers involving the liver and upper gastrointestinal system; drinking and smoking interact to make the risks worse. Various viruses promote cancer development. For example, the hepatitis B virus is perhaps the leading infectious cause of cancer worldwide, producing endemic rates of liver cancer in many parts of the globe. Almost everyone knows that too much sun exposure, particularly severe sunburns sustained in youth, causes increased rates of skin cancer, including the much-feared melanoma. Family history greatly affects one’s own risk for various cancers. We have learned to identify certain inheritable genetic mutations that have so much power to produce cancer that health care providers have to watch affected persons closely and even intervene before cancer appears.

Yet only a small percentage of people with cancer have one of the familial cancer syndromes. Furthermore, we all know individuals who successfully flouted the standard health and safety rules—a grandmother who smoked like an active volcano and lived to be 95 years old, for example. Having risk factors for cancer doesn’t guarantee a specific individual will develop the disease, while health-conscious others who took every precaution, even to the point of denying themselves certain pleasures, receive a cancer diagnosis. So, what’s going on? Sometimes it seems so random, like throwing dice against a wall and hoping to shoot a seven but getting snake-eyes instead.

That’s because it often is a chance event, or so it seems because we don’t have all the facts. The occurrence of most cancers appears random, due to the influence of conditions of which modern oncology remains ignorant and therefore cannot explain. Even after taking into account all the available clinical information, we often do not know why any specific individual develops cancer. This is one reason why bringing cancer incidence rates down is such a challenge—how do we manage factors of which we remain largely ignorant?

I don’t want to convey a sense of fatalism. Controlling known risk factors is still vital to adjusting the odds in your favor. Everyone should do what he or she can to avoid unnecessary risks. Any other action is foolhardy. But after taking all matters into consideration, a good answer to the “why me” question can, and often does, elude us.
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