So here’s what we can do about it. Read this section and make sure you are not ignorant about pain control. You will need to understand a fair bit about the use of painkillers yourself in order to get good pain relief. You may even have to teach your doctors and nurses something! I know it is frightening to think that your doctors and nurses may not know everything, but I believe you will be best able to deal with any pain you have if you accept this possibility. Those of you who don’t have this problem, whose doctors and nurses do understand how to use painkillers effectively, will probably still find this section helpful and interesting. For the rest of you, this section is absolutely essential.

If you are in a lot of pain right now, I suggest you ask a trusted friend or relative to read this section and help you to carry out some of my suggestions. You will have very little energy to spare until your pain is effectively treated, so ask for help.

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I am saying that many practitioners who specialise in treating cancer routinely advise unpleasant treatment that is unlikely to produce any substantial benefit and that they persist in recommending various anti-cancer treatments right to the bitter end. These practitioners seem unable to recognise any point when the possible benefit for the person with cancer is too small to justify the ‘cost’ for the person with cancer of starting or continuing further treatment. I emphasise the words ‘for the person with cancer’ because I believe this is the key to understanding this behaviour. And let’s face it—the sorts of behaviour I have described could seem crazy to any observer with a bit of commonsense who knows what the treatments involve and how unlikely they are to produce any real benefit.

I believe the basic problem is that these practitioners do not act according to what is best for their individual patients. They behave like a conceited general whose soldiers are people with cancer, whose weapons are anti-cancer treatments and whose enemies are cancer and death. The general can observe the battles from a safe vantage point on a nearby mountain top. His aim is to win the battle, not to do what is best for his individual soldiers. Even when the odds are overwhelming and defeat certain, he refuses to give the order to surrender. The soldiers are not kept informed of the stage the battle is at nor given the opportunity to decide for themselves to surrender. The general will not order a surrender because this would mean admitting to his soldiers and to himself that he is not all-powerful and that he cannot control the enemy. He would rather that his soldiers die in battle than that they realise that there are limits to his power.

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Listen to your mom. Mama put it this way: “You eat your vegetables now, young man.” The National Cancer Institute puts it this way: “Populations consuming diets high in fruits and vegetables tend to have a lower cancer risk.” They both mean the same thing, so do what Mama said. The National Cancer Institute suggests eating five or more servings of fruits and vegetables a day. More is better, according to Dr. Giovannucci, and variety is also important. He suggests that you eat, among other things, leafy green vegetables, deeply colored orange vegetables like carrots, tomatoes, garlic and onions, broccoli, and citrus fruits.

Listen to Neil Young. Excuse the apparent redundancy, but there’s another reason for pinching your overall calorie count besides losing weight. It has to do with the damages of oxidation. “It’s the ‘Rust Never Sleeps’ theory of cancer,” Dr. Wurzelmann says. “We’re under a lot of oxidative stress. The more we eat, the more the furnace burns and the more likely it is we’re going to create something that causes cancer. We can reduce that oxidative stress by reducing our total caloric intake.”

Hide the beef. Studies consistently show that colon cancer is low wherever meat consumption is low. There is some suggestion that increased meat consumption could also increase the risk for prostate cancer. Vegetarians, even in the United States, have a lower risk of cancer than their carnivorous compatriots. “Try to stay as close to a vegetarian diet as you can,” advises William J. Catalona, M.D., chief of urologic surgery at Washington University School of Medicine in St. Louis. “If you do want to eat meat, try to emphasize fish and chicken and limit the amount of red meat that you eat-ideally, not more than one serving per week.”

Iron out your risk. Dr. Wurzelmann led a study that showed a connection between high levels of iron and cancer. For the most part, he says, the link is a corollary of the red meat problem. “If you eat beef, you eat iron,” Dr. Wurzelmann says. But, he adds, there does seem to be a clear connection between iron overload itself and liver cancer. “People who are supplementing with iron might not be doing themselves a favor,” he says. “I think this medical practice deserves serious reappraisal.”

Get enough selenium. Research has pointed to a “very promising” role for the trace mineral selenium in reducing the risk of several cancers, including prostate and colorectal.

“There’s more work to do,” Dr. Giovannucci says. “But at this point it might be a reasonable thing to take selenium supplements given our current knowledge. More research is necessary to make firm recommendations, though.” The Daily Value for selenium is 70 micrograms.

Go for the grape. The revered grape has long been a folk cure, but a 1997 study by University of Illinois at Chicago researchers has put some scientific muscle behind the idea. The preliminary evidence in test tubes and animals is that resveratrol, a compound found in grapes and other plants, may slow down tumor growth, block the action of cancer-causing agents, and even clean up precancerous cells.

Yes, there’s resveratrol in wine, but Varro E. Tyler, Ph.D., dean emeritus of Purdue University School of Pharmacy and Pharmacal Sciences in West Lafayette, Indiana, and distinguished professor emeritus of pharmacognosy (natural pharmaceuticals), suggests taking advantage of the potential benefits by adding some real grapes or a glass of grape juice to your diet.

Smother it with onions. If you’re in the habit of saying “hold the onions,” you might reconsider. Dutch researchers found that volunteers who ate half an onion a day had half the risk of stomach cancer that their sweeter-breath co-subjects did. The heroes in onions are allylic sulfides, which help enzymes neutralize cancer-causing substances.

Get enough vitamin C. It’s always a controversial topic, but when researchers look into the health role of vitamin C, they usually find that it protects against certain cancers, according to the National Cancer Institute. The best evidence is that it fights cancers of the esophagus, mouth, and stomach. But it also helps fend off pancreas and rectum cancers.

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There are various investigations which can be carried out at a hospital or special clinic if any disease of the breast is suspected. The more common ones will be described here, before the actual process of diagnosis is explained. All doctors and all hospitals and clinics have their own way of doing things, although there are plans to standardize this care.

Mammography

Mammography involves taking X-rays of the soft tissues of the breast and armpit. It is used for routine breast screening and as a tool in the diagnosis of breast diseases.

The natural contrast due to the breast’s fat content is exploited in mammography. Most breast cancers occur in women over the age of 45, and it is around this age that glandular tissue within the breast begins to be replaced by fat. The appearances of different types of growth vary, allowing quite accurate distinction between some benign and malignant lumps.

Young women, who are concerned about breast cancer, perhaps because they have a family history of this disease, may find that their request for a mammogram is refused; some then arrange for mammography at a private clinic. However, mammograms are not normally helpful in women under the age of 35 as their breast tissue is too dense for most abnormalities to be visible.

Seen on an X-ray, benign breast tumours and cysts tend to have a smooth outline, sometimes surrounded by a ‘halo’ of fat. Malignant tumours, on the other hand, are usually poorly defined, more diffuse masses with diagnostically important tendrils extending randomly into the surrounding tissue. Both types of tumour can contain calcium deposits, but these are more numerous, irregular and less coarse in a malignant growth. If mammography reveals a lump in the breast, it may be followed by further investigations such as a biopsy.

When is mammography necessary?

Apart from its use as a screening tool for women over the age of 50 in the UK, and for those who are particularly at risk of developing breast cancer, mammography is important in the diagnosis of various breast diseases. The following are some signs and symptoms which may need to be investigated by X-ray mammography.

* A lump of unknown origin.

* Several small lumps which can be felt within the breast.

* Unexplained discharge from the nipple.

* Unexplained inversion of the nipple.

When malignant disease is suspected, mammography is also used to:

* confirm the clinical diagnosis,

* determine the extent of the disease – there may be more than one cancer in the breast,

* look for disease which cannot be felt but which may be apparent on a mammogram as areas

of calcification,

* look for cancer in the other breast.

Mammography can also help in the planning of surgical treatment as a lumpectomy will not be suitable for all women. It may also be used to look for signs of recurrent disease or further breast lumps following cancer treatment.

Some small benign lumps, and occasionally cancers, within the central ducts of the breast near the nipple are difficult to detect by mammography, and X-ray following the injection into the duct of a radio-opaque substance may be required if these are suspected.

The process of mammography

You will be asked to remove your clothing down to your waist, and a radiographer will then help to position you for the X-ray. Each breast in turn will be placed on a shelf-like plate on the mammography machine, and another plate will then be lowered onto the breast to compress it. You will be asked to keep very still while the X-ray is taken.

The pressure on the breast as it is compressed between the two plates can be quite uncomfortable, but lasts only a few seconds. Many women are anxious about having a mammogram and so are more than usually sensitive to any discomfort it causes. Some do find the process painful – particularly just before a period – and, rarely, it can cause bruising of the breast and in some cases pain that can last for several days or weeks. However, the pressure of the plates is unlikely to cause any harm, and the radiation level from the X-ray is very low, although higher radiation doses are required to take X-rays of the breasts of young women, who therefore should not have more mammograms than necessary. The benefits of mammography as a diagnostic tool and for breast screening do outweigh any discomfort it may cause.

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