In January 2015, research results published in Science suggested that the development of two thirds of cancers is highly correlated to normal cell division that continuously takes place as part of the body's homeostasis mechanisms and that the remaining one third of cancers may be attributed to "environmental factors or inherited predispositions."1 The authors referred to those random cell mutations leading to cancer that occur during normal cell division as "bad luck." That cancer could be a matter of "luck" prompted much discussion in both the popular and scientific literature including speculation on the manner in which Tomasetti and Vogelstein's findings were communicated by the media, which cancers they included in their analysis, and how they were interpreting or framing cancer risk.2 Twelve months later, with the debate still raging, scientists from Stoney Brook University declared lifestyle choices and environmental exposures to be highly correlated in the development of 70% to 80% of cancers, choice rather than luck.3
Where does the truth lie in this debate? First, it lies in evidence yet to be gathered on the development of this complex disease in individuals whose genetics and life circumstances are highly varied. It also lies in one's perspective on not only how to live life but how to adjust to the flow of life's circumstances whether lucky or not. In that regard, my father comes to mind. Born the oldest of 7 children of Italian immigrants who today would be considered living at the poverty line, my father took his first job at the age of 8, lighting and extinguishing gas lamps in the alleys of South Philadelphia. His pay was 50 cents per week, which he gave to his mother to purchase food for the family. My grandmother had a small garden in her backyard and she made everything "from scratch," soup on Monday, pasta on Tuesdays, Wednesdays and Thursdays, fish on Fridays, and some meat for the weekend meals, usually poultry. Red meats, much too pricey, were rarely consumed, with the exception of a little ground beef mixed with bread and other fresh ingredients to form "meatballs" to go with the spaghetti. My father's family lived near family. There was always someone around to help out, to celebrate, and to care in times of sickness and stress. My father's infant sister died in the flu epidemic of 1918, and the family was quarantined when my father's brother contracted diphtheria. Owning a car was financially impossible so everyone walked everywhere. My father's only vice was cigarette smoking, which he began in his teens and stopped, cold turkey, in his early forties. He never smoked more than 5 cigarettes a day because finances would not permit. My mother and father had a happy marriage that lasted 68 years until my mother's death at age 89. They both lived with me and my husband for the last 22 years of their lives. My dad had prostate cancer at age 82, with no recurrence and was diagnosed with bladder cancer at age 93, which healed completely after surgery. He died peacefully in our home at the age of 104. I think he knew that he was dying when I arranged his covers on that last night. He smiled wryly and was gone half an hour later.
Was my father lucky even in face of the fact that he had cancer twice? Giving up smoking was probably the only strategic lifestyle choice my father made that could have ameliorated his experiences with cancer. His luck, I believe, was intimately tied to how he lived; with a supportive family, with moderation in his Mediterranean diet, with walking instead of riding, and with a low arousal, humorous approach to life in general. It is also likely that he was not genetically disposed since cancer was an infrequent occurrence among his siblings and other relatives. Luck is the result of chance rather than deliberate choice, and life is ultimately the interaction of luck and choice. As we monitor the debate on cancer, let us keep making healthy lifestyle choices. Maybe we will get lucky!
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
REFERENCES