The revolutionary, science-based plan to reclaim your health
“You have cancer.” These are perhaps the most feared three words that will ever come out of a doctor’s mouth, and more and more people are hearing them. Yet most patients (and some doctors) do not realize that lifestyle changes can dramatically reduce risk, assist treatment and improve chances of surviving and even thriving after a diagnosis.
Over the course of a major study Servan-Schreiber designed with Dr Lorenzo Cohen at the MD Anderson Cancer Center, six key areas have emerged: love and social support, stress management, rest, movement, nutrition and avoiding environmental toxins. Each plays a role–but it’s the synergies created by this potent “Mix of Six” that can bring about real shifts in health and well-being, significantly improving quality of life and positively supporting conventional cancer treatments.
Dr. David Servan-Schreiber’s Anticancer introduced a revolutionary way to understand and confront cancer, changing the lives of millions around the world. He laid out the principles of integrative care that had allowed him to live many years beyond expectations for his own cancer, but readers have long requested a specific plan to implement his approach. Anticancer Living is that book.
Dr Lorenzo Cohen is the Richard E. Haynes Distinguished Professor in Clinical Cancer Prevention and director of the Integrative Medicine Program at The University of Texas MD Anderson Cancer Center in Houston. He is on the board of the Academic Consortium for Integrative Medicine and Health and is a founding member and past president of the Society for Integrative Oncology. Dr Cohen has published more than 125 scientific articles in top medical journals and has edited two books on integrative medicine for cancer care.
Alison Jefferies, MEd, has worked extensively as an educator. She is a former president of the MD Anderson Cancer Center Faculty and Family Organization and works closely with Lorenzo Cohen to foster health and wellness in individuals and their communities.
To all cancer patients and survivors and to those who care for them. You inspire us to live in the moment and lead purposeful lives.
With love and gratitude to our parents—Paola, Jon, Susan, and Robert—who set us on our course; and to our children—Alessandro, Luca, and Chiara—who keep us focused on the priorities of life.
WHAT IF WE could make basic, sustainable lifestyle adjustments that might push back the onset of cancer or even prevent us from ever getting it? What if those with cancer could change the way they live to reduce their risk of recurrence and improve their chances of living long, vibrant lives? What if the missing link to cancer prevention and treatment is not the next pill or the latest scientific breakthrough but the choices we make every day that influence our body’s natural ability to maintain and restore balance and health? What if we could make changes in the way we live now, today, that would help us beat the odds, survive a diagnosis, or possibly remain cancer-free for life? I’ve devoted my career to trying to answer these questions.
We have reached a critical moment in terms of cancer research, treatment, and prevention. It is now clear from scientific research that how we live in our bodies, in our communities and the broader world—how we eat, sleep, work and play, manage stress and face life’s challenges, create our support networks and make choices about our environments—has a profound effect on our health and wellness; and on cancer in particular.1,2,3,4,5,6,7,8,9
The work that forms the basis for this book was inspired in part by David Servan-Schreiber, author of Anticancer: A New Way of Life and a true pioneer in the quest to demonstrate the links between lifestyle and cancer.10 Together, David and I designed and launched a pioneering study at MD Anderson Cancer Center in Houston, Texas, to better understand these deep connections and, most important, to develop research-based recommendations both for patients and for the ever-growing community of those concerned with prevention.11
My own work and David’s had been running on parallel tracks for decades, but there was a significant difference between us: David was living with a brain tumour, diagnosed at the age of thirty-one. David’s original cancer had been treated “successfully” with surgery, but it had returned five years later, and the prognosis was not good. The average survival time for this kind of recurrence is typically twelve to eighteen months, with five years considered to be the maximum. David had no choice but to undergo another risky surgery, followed by a year of chemotherapy and radiotherapy.
This marked the start of his journey to the work that emerged in book form as Anticancer: A New Way of Life. As the title suggests, for David this became a new way of living—with cancer. David made a deeply felt and very personal decision to listen to his body, to learn to tune in to its signals with a different kind of attention, and to trust its guidance. He amassed all the scientific evidence available at the time and used this to help guide his lifestyle choices. He became curious to the point of obsession about how our daily actions and choices affect what he called the cancer “terrain”—our genetic, cellular, and regulatory systems. He became interested in how he might influence his own biology in ways that would enhance his immunity, decrease inflammation, and suppress the tendency of cancer cells to proliferate, while simultaneously improving his quality of life. He quickly discovered that with each lifestyle improvement he made, he felt better, healthier, and more present—not just in body, but also in mind and spirit.
David set out to answer this question: does how we live—the quality of our relationships, what we eat, how we care for ourselves—determine cancer’s progress? He dedicated the rest of his life to understanding how our finely engineered bodies can sustain health, even in the presence of cancer. He wanted to find out if we could modify how we behave in our daily lives to prevent cancer, prolong remission, or simply improve and extend a cancer patient’s life. In fact, after making some of these adjustments himself, he led a rich and productive life for another nineteen years, outliving his statistical prognosis by a factor of four.
In 2009, following the publication of his book Anticancer, David and I hatched a plan to raise money for a clinical trial to examine the effects of comprehensive lifestyle change on survival and quality of life for cancer patients. David was instrumental in helping us design the early phase of our Comprehensive Lifestyle Study, a study of women with stages II and III breast cancer, which is now fully under way and ongoing here in Houston. Formal data will be available once the study is completed, but we are already seeing profound transformations in the lives of the study participants. They are truly the inspiration for this book. I also find inspiration in the broader community of patients, doctors, care providers, researchers, and scientists, all of whom are adding to the literature on how lifestyle heals.
The publication of Anticancer Living coincides with the tenth anniversary of Anticancer’s initial publication—and is in part a celebration of David’s achievement and clear evidence of how far we’ve come. A decade later, it’s undeniable that lifestyle should be as vital a component of comprehensive cancer treatment as traditional frontline medical treatments such as surgery, chemotherapy, radiotherapy, immunotherapy, and new targeted therapies. In fact, the pace at which new scientific evidence is connecting the dots between lifestyle factors and cancer progression and recovery is accelerating. It is, we are discovering, the synergy of both specialized medical treatment and lifestyle changes that offers cancer patients the best outcomes. But what the anticancer community has been wanting is a complete and simple plan for living the “anticancer life.” This book is intended as a road map toward the journey ahead, how we as individuals can work in tandem with the scientific community and doctors to support our own health even as new discoveries are being made. Mounting research suggests a clear link between lifestyle and wellness, and we will share the scientific evidence alongside the stories of cancer survivors to help bring that science to life. While each person’s journey is unique, we believe the cumulative impact points to a clear path forward.
Part 2 of this book outlines the cancer landscape and sets the stage for the role each of us can have in our own health, whether or not we have cancer. Each chapter in part 2 presents the latest research, inspiring stories and testimonials, and ends with evidence-based recommendations for adopting the six pillars of anticancer living. The key takeaway is this: our daily choices in life have a direct, measurable impact on cancer and other chronic diseases. If that seems daunting or discouraging at first, we hope you will come to embrace your role in this discovery and understand it as truly empowering. Each of us can reduce our cancer risk and increase our chances of surviving a diagnosis. This book is our effort to share and spread this message and to provide you and the ones you love with a step-by-step plan to maintain and foster your health.
Cancer does not grow in isolation. It develops within an environment we help create by the things we eat day after day, by our stress levels, our physical activity, our support network, the quality of our sleep, and our exposure to environmental toxins. We have chosen to focus on what we have identified as the six most crucial areas and how they work together synergistically. Taken together, these lifestyle factors, which we call the “Mix of Six,” have the capacity to impact our risk of disease and our chances of survival after a diagnosis.
With Alison Jefferies, my wife, coauthor, and full partner in devising a forward-looking plan for Anticancer Living, I aim to present a comprehensive plan based on scientific evidence, for lifestyle changes that improve health, reduce cancer risk, and help to control disease. Alison has the remarkable energy and drive to implement in the daily life of our family many of the changes I’ve been studying for years. After a long career as an educator, she is uniquely adept at trying new ways to foster anticancer living, both in our home, in our community, and as a co-presenter of this material at talks we give across the United States. If I can make a convincing case that lifestyle choices really do have a biological impact on cancer risk and our chances of surviving a diagnosis, Alison can show us how to make changes in our own lives that will improve our own health and the health and outlook of our loved ones.
Together, we have created a supportive system that will help you put into effect the message that David Servan-Schreiber gave us so compellingly in Anticancer. The purpose of this book is to educate all those currently dealing with a cancer diagnosis as well as those who have, so far, been fortunate enough to avoid cancer, to show how changing daily habits can bring enormous health benefits, and to demonstrate that increasing the odds of disease prevention is available to all of us if we begin to view our lifestyle choices as health choices.12,13 Anticancer living is a low-cost option that has the potential to dramatically impact health without any harmful side effects. Yet, its benefits may be priceless.
It is my wish that this book embolden and inspire, if for no other reason than we might spend our days feeling healthier and happier, stronger, more resilient, and better supported in an ever-more-challenging world. Anticancer living is built on a belief that self-care is healthcare and that greater wellness is available to us all. Those who have shared their stories in this book and countless others are real-life examples of this. Actively engaging in the protection and promotion of our own health is potent medicine that can and will bring immeasurable joy, as well as the empowering feeling that we are taking some measure of control over our health and well-being.
I thought of David often as Alison and I worked on this book. He was a remarkable friend and colleague who lived the anticancer life eloquently and powerfully. His work and his example have inspired so many of us not just to survive but to thrive. And it’s been extremely gratifying to share the ever-increasing body of scientific evidence that validates and reinforces David’s central message—that it is within our power to reduce our risk of cancer or improve our chances of surviving a cancer diagnosis by changing the way we live. Now, more than ever, it is vital that we all take this message to heart.
AS DIRECTOR OF the Integrative Medicine Program at MD Anderson Cancer Center in Houston, I have spent much of my career working to incorporate evidence-based, unconventional treatment modalities and lifestyle changes into the medical community’s thinking and alongside conventional practices. As more research has emerged showing a clear link between our mental and physical states and lifestyle factors and our ability to avoid and survive cancer and other diseases, even the more sceptical within the medical community have begun to take notice. Over the years, more times than I can count, cancer doctors across all disciplines have confided in me that they have long suspected that their patients’ mental state and lifestyle plays an important role in their ability to survive a cancer diagnosis and restore themselves to wellness. What is becoming increasingly evident based on solid science and our improved ability to measure and document the biological effects of lifestyle changes is this: comprehensive lifestyle change, combined with conventional cancer care, is powerful medicine that can help control, and potentially prevent, cancer.1,2,3
Once, a cancer diagnosis was basically a death sentence. Although it could, with a lot of medical might, be beaten back, it would rarely be defeated. Over the past couple of decades, however, this has begun to change. Cancer is now, for many, considered a serious, chronic disease. What this means in practical terms is that more people are living longer with cancer.4 And this is very good news. But survival raises new questions: are these people who are living longer with cancer feeling better—healthy and well, even if they are not cured?
Some oncologists might wonder why, if the patient is surviving, this question is relevant at all. In my area of expertise, the world of integrative medicine, this question is everything. I spend my workdays helping cancer patients make choices so that they will feel healthy—even as they undergo difficult, sometimes debilitating, treatments—because it’s precisely these lifestyle changes that will also increase their odds of survival. And while I focus on their quality of life, my colleagues continue to better understand how cancer cells work, guiding the move from a one-size-fits-all approach to more nuanced, personal treatment. Much of this shift from a “hit it hard and fast” mindset to more of what is being called “precision medicine” is due to the relatively recent breakthroughs we’ve made in understanding how our genes and cells work.5 We’re also developing and harnessing technologies that allow us to detect many cancers earlier—and the earlier a cancer is found, the better the prognosis and treatment outcome.4
These innovations are incredibly important, and alongside these advancements are exciting discoveries being made not by scientists in labs or surgeons in operating theatres but by regular people in their kitchens and homes; on jogging trails; and in supermarkets, yoga studios, gyms, and wellness centres. Everyday lifestyle choices give us a surprising amount of control and influence over the trajectory of a cancer diagnosis and of our cancer risk. By making simple changes to the way we live, we can diminish the side effects of conventional cancer treatments, extend (and sometimes shatter) expected survival rates, decrease the chance for recurrence of disease, and potentially prevent the onset of cancer diseases in the first place.1,6,7,8,9 It’s an exciting time to be in the realm of integrative care, but it took us a very long time to reach this point, and it’s taking even longer to get the word out that lifestyle change is legitimate, effective medicine to help prevent and control cancer.
During the last fifty years, tremendous advances have been made in frontline treatments such as surgery, chemotherapy, and radiotherapy. These treatments, along with the innovative developments in targeted therapies (aimed at the abnormal proteins controlling cancer growth) and immunotherapy, have saved or prolonged the lives of millions of people.4 In fact, our success rate at keeping people alive after a cancer diagnosis is better than ever.4
Yet despite these medical advances, nearly 1.7 million Americans are projected to receive a cancer diagnosis in 2017.4 During that same twelve-month period, cancer will claim the lives of more than six hundred thousand people in the United States.4 Around the world, cancer remains a leading cause of death, and new cases are expected to increase by 70 per cent in the next two decades.10 In 2015, the disease took the lives of 8.8 million people globally.10
Based on current models, one-third of all American women and half of all American men will receive a cancer diagnosis in their lifetimes.4 Worldwide, nearly one out of every six deaths is due to cancer.10 This means that the odds are extremely high that both you and I will one day join the more than 15.5 million Americans who are currently living with cancer and the tens of millions of cancer survivors around the world.11
Given these staggering numbers, it’s unlikely that we’ll eliminate cancer anytime soon, though this will not stop us from trying. Also unlikely is the discovery of one drug or treatment—a magic bullet—that will eradicate this increasingly complex range of diseases. What is more likely—as we are beginning to see now—is that we’ll continue to understand how cancer cells respond to various stimuli and learn to slow or “turn off” their progression. Similarly, we hope to better understand the processes that trigger cancer’s growth and target them with effective treatment. We’re already seeing compelling evidence that lifestyle factors may be the missing ingredient of the existing cancer treatment model.
Cancer, first and foremost, is a disease of ageing: Our odds of getting most cancers rises significantly each decade we live past the age of fifty.12 This puts us in a bit of quandary, since we are—thanks in no small part to modern medicine—living longer and longer lives. The onset of diseases such as cancer adds a terrible burden to the already great challenges of ageing, as our cells become more vulnerable to damage and corruption.
Although most cancers strike when we’re older, there are some types (including colorectal and breast cancers) that are striking people at increasingly younger ages, and these cancers are often quite aggressive and fiercely resistant to treatment. In fact, recent data suggest that younger people are not only being diagnosed with colon cancer more than ever before but also dying of the disease in higher and higher numbers.13 Some childhood cancers are also on the rise.11
So far, the medical establishment’s response to the uptick appearing in the young has been to call for earlier screening, which is, of course, a prudent place to start. But early detection, we’ve found, isn’t always the best or only answer. There are instances of early detection with some cancers, such as early-stage, low-grade prostate cancer and very-early-stage breast cancer, that lead to overtreatment with no demonstrable survival benefits.14,15 In fact, the current recommendations have changed from “all men over fifty need to be screened to prostate cancer” to “all men over fifty should have a conversation with their GP about prostate screening.” Could there, then, be a better way to prevent or delay the onset of cancers, including the aggressive types that seem to strike people so young? I believe the answer is yes.
Current cancer statistics can be sobering, even frightening, but the larger picture offers good news. There has been a positive, almost radical shift in cancer survival rates. Fifty years ago, only one in four Americans survived cancer for more than a decade; today that ratio is one in two—a doubling in overall survival rates. Is this because treatments and technologies have improved? In part, yes. Absolutely. But now we’re beginning to understand that medical advances are not the only reason for improved outcomes.
Still, it is the unpredictable nature of cancer that often makes us feel powerless. Despite all we know of the disease and all the money that has gone into research and treatment, cancer has a way of defying our expectations and striking those who seem least likely candidates for a diagnosis. There is the singer who never smoked a day in her life who is diagnosed with lung cancer. Or the vegan runner who has been lean and fit his whole life and prides himself on his “clean” diet, only to be diagnosed young with stage IV colon cancer. And, most cruelly, there is the very young child who must battle an aggressive form of leukaemia before she even has the words to describe what it all feels like. Why is it, we can’t help but wonder, that my body, anybody’s body, would let this happen? What could trigger such an awful disease within us?
It is perfectly normal to run the gauntlet of these thoughts and feelings and ask ourselves all these questions, but it is even more important that we don’t beat ourselves up or blame or shame ourselves into resignation or passivity. Meg Hirshberg is a friend, breast cancer survivor, and the founder of the Anticancer Lifestyle Program, a not-for-profit, evidence-based lifestyle programme for people diagnosed with cancer. She recently spoke to me about why it’s so important to resist blaming yourself if you get cancer: “Our message is always, ‘Begin now. Don’t look back. We have no idea what caused your cancer and we never will. But we do know that there are things you can do differently that will make a radical difference in how you feel. There is also scientific evidence that shows how these lifestyle changes will positively influence the results of your treatment.’” For Meg and the people who go through her programme, this forward focus is accompanied by active education about the healing power of making lifestyle changes and the healing benefits of a loving community. As she continues, “Knowledge is power and, where cancer is concerned, knowledge has the power to enable survivors to lower the odds of cancer recurrence. There is data to back this up and we want to share that science with our community in ways that make people feel more hopeful, more powerful, more inspired, and more alive.”
At least 50 per cent of cancer deaths could be prevented by making healthy lifestyle changes, and the percentage could be even higher.1,2,3,4,5,6,7,8,9 Dr. David Katz, one of the leading authorities on lifestyle change and founder of True Health Initiative, believes that as much as 80 per cent of chronic disease and premature death could be prevented by healthy living.16,17,18 A 2016 study by Harvard researchers who reviewed data from more than 135,000 people they have been following for more than forty years found that not smoking, drinking in moderation, maintaining a healthy weight, and exercising regularly could prevent 41 per cent of cancer cases and 59 per cent of cancer deaths in women and two-thirds of cases and deaths in men.19 The exact percentages may vary from study to study, but the consistent message is that we can prevent at least half of cancers and cancer deaths. Graham Colditz, a professor of epidemiology and the co-author of an editorial that accompanied the Harvard study, summed up the findings like this: “As a society, we need to avoid procrastination induced by thoughts that chance drives all cancer risk or that new medical discoveries are needed to make major gains against cancer, and instead we must embrace the opportunity to reduce our collective cancer toll by implementing effective prevention strategies and changing the way we live.”20
While we continue to work toward increasing public awareness about the health dangers from behaviours and practices that have become so ingrained in Western culture, it is important to note that anticancer living is in no way at odds with standard medical care. David Servan-Schreiber understood that aggressive medical treatment was the “bull’s-eye” of effective cancer treatment: he never considered forgoing surgery, chemotherapy, or radiotherapy. In fact, with his first diagnosis, he dismissed any suggestions that he try “alternative” treatments at all. What mattered most to him was that the medical professionals he chose to work with related to him first and foremost as a human being, not simply as a host for cancer. He needed to trust that his doctors truly had his best interests at heart. As it turned out, this instinct was right on target. A commitment to living wholly as a human being rather than allowing himself to be limited by his diagnosis was foundational to his approach.
Anyone who doubts the impact of lifestyle choices on our collective risk need only look back to what we learned in our not so distant past about the connections between lung cancer and smoking. In the early 1960s, a coalition of agencies, including the American Lung Association, the American Heart Association, the American Tuberculosis Association, and the American Public Health Association, pressed President John F. Kennedy to address the public health crisis being brought on by cigarette smoking. In 1962, Kennedy followed through and pulled together a broad alliance of experts who then spent two years combing through more than seven thousand scientific studies and articles.21 In 1964, Surgeon General Luther L. Terry released the group’s findings. The conclusion: cigarette smoking was responsible for a 70 per cent increase in mortality rates for smokers relative to nonsmokers. Since then, the tireless work by subsequent surgeons general, public health advocacy groups, and the activists behind successful, highly publicized lawsuits against tobacco companies has kept up public awareness of the causal link between tobacco (whether chewed or smoked) and cancer.22 Yet it remains alarming that 15 per cent of the US population and 15.8 per cent of the UK population still smokes and that rates remain exceedingly high in many Asian, African, European, and Middle Eastern countries.23 Australia, which has smoking rates comparable to the United States, in an effort to reduce rates to zero will continually increase taxes on cigarettes through 2025, when they will cost up to forty dollars a pack.24,25 The rule of thumb in the United States is that a 10 per cent price increase on a pack of cigarettes results in anywhere from a 2.5 per cent to a 5.0 per cent overall decline in smoking, with most studies showing an average 4.0 per cent drop.25 In Russia, where cigarettes are much cheaper, 60 per cent of men and almost 40 per cent of the general population smoke.26
What’s more, we have allowed the tobacco industry to reinvent itself with the advent of vaporized nicotine (vaping), bringing with it a slew of other chemicals that have not been adequately tested, including chemical compounds that have been linked with cancer.27 So, although the rates of young people starting to smoke cigarettes have declined, teenagers are now turning to vaping (purportedly invented to help people quit smoking) as a new method of nicotine consumption.28
It also is worth noting that although the rates of lung cancer among American men have declined, the rates of lung cancer among American women—who began smoking publicly and freely much later than men—continued to rise through 2000 and have just recently started to decline slightly. Again, this is likely because lung, throat, oesophageal, and other tobacco-related cancers are most common among the elderly, and so women who began smoking, say, during the 1960s and 1970s, may just now be facing the cancer-related consequences. Unfortunately, tobacco is not the cause of just lung cancer but is now linked with fourteen different cancers.29
This recognition, that tobacco consumption—an avoidable (though addictive) behaviour—is a direct cause of cancer, revolutionized the public’s understanding of the links between behaviour and disease. There was no longer any denying that our actions do matter, where cancer is concerned. This awareness launched the new field of cancer prevention, the search for other lifestyle or environmental factors connected to the onset of cancer.
Additionally, funding for cancer research began to increase, and it continues to pour in today. Yet—somewhat puzzlingly, if you think about it—the majority of these resources are invested in seeking cures. Funding for prevention research is dwarfed ten to one by the sums invested in developing treatments and testing new drugs to thwart cancer.30 I battle this discrepancy on a near-daily basis, despite how black-and-white the causal links between lifestyle factors and cancers may be. But the example of tobacco and lung cancer shows what can be accomplished when we put our minds and dollars toward the cause. What if we had the same level of public outcry against processed red meat (such as bacon and hot dogs), which has been labelled as a carcinogen by the International Agency for Research on Cancer?31 What if we had higher taxes on junk food and sugar-sweetened beverages? What if we had public service announcements warning against the excess consumption of sugar and processed foods, which have been tied to the obesity epidemic and a host of chronic diseases, including cancer?32,33,34 We’d be living in a very different world.
When diagnosed with a life-threatening illness, statistics and probabilities are a challenge not only to understand but also to know if and when they apply. David’s work led him to challenge the statistical models of survival that most oncologists rely on to predict outcomes for their patients. How could columns of numbers account for all the very human variables that make up the unique and complex details of an individual’s life? How could all the forces, the choices, of what we think of as “lifestyle,” the gestures of our lives, not come into play when dealing with a cancer diagnosis? Never mind the intangibles, such as grit, the will to live, or faith in a higher power. What about diet and exercise? What about psychological aspects of wellness, such as hopefulness and gratitude? What about exposure to known carcinogens such as coal dust, asbestos, tobacco, or even the rays of the sun? David wanted to better understand all these factors. He craved a full, three-dimensional understanding of how lifestyle might affect cancer’s ability to develop and grow.
This approach was, and still is, revolutionary. David embraced the fact that he had no choice but to learn to live well with cancer present in his body. What he modelled for us was a radical form of acceptance. He knew that cancer had become an integral part of him, and this acceptance empowered him to live with the illness powerfully and purposefully.
I don’t know whether David lived his life with the goal of defying the odds and outliving his cancer the way he did, but I do know that he was instrumental in helping us understand how fluid these numbers can become when we decide to actively change the way we live with cancer.
In a chapter in Anticancer called “Escaping Statistics,” David writes about the cancer experience of legendary scientist and writer Stephen Jay Gould, who was diagnosed at age forty with abdominal mesothelioma, a rare cancer that is linked to asbestos exposure. Gould immediately underwent surgery, but afterward, when he couldn’t get a straight answer from the oncologist about his prognosis, he did what great scientists have always done: research. He learned that his type of cancer was considered “incurable” and that the median survival time was eight months from diagnosis.35 He was stunned. He was also, fortunately, versed in how to read a bell curve. Gould noted that there wasn’t much time for half of those who were diagnosed with mesothelioma (zero to eight months of life), so he focused his attention on the other side of that statistical bump. He saw that those who lived beyond the median (the middle figure in a set of numbers), the people to the right side of the curve, enjoyed a significant amount of breathing room, in terms of projected mortality. At the far end of the survival “tail,” a person with mesothelioma could live three to four years. That was far better than eight months, and it would give him the time he needed to figure out how to improve those odds further. He was determined to become an outlier among outliers.36
Although naturally optimistic and curious, Gould acknowledged the dangers that statistics might pose for a cancer patient’s state of mind. Impersonal data sets had the potential to seriously dampen a patient’s attitude and outlook. In his essay, “The Median Isn’t the Message,” Gould wrote: “Attitude clearly matters in fighting cancer. We don’t know why… but most people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, a commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer.”36
Gould exemplified this by living twenty years beyond his diagnosis. Both he and David Servan-Schreiber significantly exceeded the expected survival times for their (very different) types of cancer, and I feel certain that this was not just a stroke of luck or some random “miraculous” occurrence. Both studied the science and came to the same conclusion that I have reached: healthy lifestyle change is the key to preventing cancer and to extending the survival curve for every type of cancer.
Every summer, Alison and I take our family on an annual pilgrimage to a rustic cabin on an island in Georgian Bay, north of Toronto. The location, near the town of Perry Sound, is one of those magical summer places where we can connect with nature, escape our hectic lives, and leave all our troubles and cares behind—including our mobile phones and our computers. The silent evenings are periodically interrupted by the call of loons on the glass-still water, and the whole area is perfumed by the scent of white pine and cedar. Over the years, we’ve become close friends with Molly M., a clear-eyed woman in her late fifties whose family has been spending their summers on the bay since the early 1900s. Molly is an avid outdoorswoman with an epic backstory. In her youth, after spending almost a year by herself on an island in the bay, she taught in the High Arctic and was the first woman to complete a 100-mile ski race. She knows the landscape like the back of her hand. For the past eighteen summers, we have shared meals, raced canoes, and watched sunsets on the reefs together.
Molly has survived for eighteen and a half years with glioblastoma multiforme, the most aggressive form of brain cancer—defined as terminal and incurable—the same kind of cancer that eventually took David Servan-Schreiber’s life. In May 1999, when she was a forty-year-old high school science teacher, she began suffering from exhaustion, debilitating migraine headaches, vision issues, and other symptoms that she later found out were due to the brain tumour. One afternoon, after driving an hour to get home, she had a major seizure. When she went to the local hospital, they diagnosed her with a stroke and epilepsy but refused to provide the MRI she told them she needed. A month and several more seizures later, she saw a specialist in a large city hospital, had an MRI, and was diagnosed with a brain tumour that doctors wanted to remove immediately. She assumed her debilitating migraines would end, and she spent the night writing exam answers for a course she knew she wouldn’t be there to mark. The resident sitting with her wept.
She didn’t use the C-word for three months, but instead she set about finding the best facility to get radiotherapy. She hoped to return to teaching—a job she loved—but one after another doctor gently increased the recommended time off work from six months to a year to permanently. She was, after all, given a prognosis of six to eighteen months. Three brutal chemotherapy drugs followed the radiotherapy, along with steroids.
When told she had six months to live, Molly told the nurses in the chemo clinic that she didn’t know what she had been put on the earth to do. Their response: “You can be a miracle; miracles happen every day.” Molly took that to heart and decided not to be a statistic. But then, almost exactly six months later, the cancer came back. Molly underwent a second surgery. She virtually walked out of this second surgery, unlike the first, and began a newly approved chemotherapy. She insisted on receiving the drug until “either I die or the cancer dies.” At the same time, she started researching complementary treatments and worked with a herbalist who is an expert in cancer care. When I spoke to Molly recently, she reminded me that being forced out of teaching had not been easy. “I’d already had so much loss, having had several miscarriages. Never being able to have children, the kids at the school became my life. I hated leaving them, forced out by the seizures and cancer, especially when I felt like I was really hitting my stride as an educator.”
Molly realized that she would have to focus all her attention and time on getting well. As she put it, “You have to accept the reality of your situation, even if it sucks—and believe me, cancer sucks. I had to have four different kinds of chemotherapy and they really knocked the stuffing out of me. I was forced to slow down and really learn to listen to my body and I began to change the way I lived one day at a time.” Molly had heard the statistics that made her survival seem unlikely. Although she was told she had between six and eighteen months to live, she decided not to trust that prognosis. As she explains, “I’m not a number on some doctor’s chart—I’m a person. I decided that I would educate myself and do everything within my power to defy the odds and to live as well as I possibly could for as long as I possibly could.”
To make that happen, Molly has changed virtually every aspect of her life, from the way she eats to the way she thinks (reframing negative thoughts) to the company she keeps. The news can be toxic and addictive, so when alone she rarely turns on the radio. She starts every day with a mind–body practice that involves meditation and visual imagery, and she has learned to listen to her body in a way that is both gratifying and astounding. She is a living, breathing example of how anticancer living can not only extend our lives but also sustain and nurture our spirits so we can better enjoy the time we have.
Here’s how Molly explains her new mindset: “You have to decide you are going to live differently. This kind of acceptance is the opposite of resignation. It’s about deciding you really want to live.” Molly has survived more than eighteen years and counting with an aggressive brain cancer. I’m looking forward to seeing her up at the bay again this summer.
Molly’s example is especially poignant in our current age, when so many of us (and our loved ones) are facing life with cancer. In 2016, the number of Americans living with cancer was more than 15.5 million.37 That number is expected to exceed twenty million by 2026.37 The World Health Organization predicts that the number of new cancers diagnosed worldwide will rise to twenty-two million within the next twenty years, a 70 per cent surge.10 Most of these cancers (60 per cent) will be identified in Africa, Asia, and Central and South America, where 70 per cent of all cancer deaths now occur.10 In the United States the rate of breast cancer is expected to increase more than 50 per cent between 2015 and 2030.38 These projections make clear that we need to start educating people across the globe about the prevention and healing effects of adopting a healthy lifestyle. If we adopt and promote an anticancer living plan, I believe that we can see cancer rates decline in my lifetime. This, to me, would be the greatest indicator that we are moving toward a real cure for cancer and other deadly chronic diseases.
As more oncologists, surgeons, and other treatment providers begin to understand that lifestyle can enhance the efficacy of conventional cancer treatments and encourage their patients to make lifestyle changes, the right side of the prognostic graph, which charts mortality, keeps extending for many types of cancers, while the smaller tail on the left side, which identifies the date of initial diagnosis to the date of death for some patients, has remained static.
Let’s stop and imagine a new kind of bell curve: a different kind of statistical graph, one that will completely change our idea that a cancer diagnosis is an inevitability for almost half of us at some point in our lifetime. What if we found a way to track and quantify our ability to prevent the onset of cancer in the first place?
I’ve thought a lot about what this kind of graph might look like. In this new graph, the pinnacle of the “bump” is now the date of onset—or, more accurately, the date of initial diagnosis, since cancer usually grows quite slowly and can take years, even decades, to become large enough to be detected. Our new graph encompasses the ideas supporting the improvements in the survival graphs from the time of diagnosis, showing the lengthening tail of survival to the right, but in a prevention graph now we have a growing tail of prevention to the left. If we think about our health, our bodies, and our control over both, and we decide to focus on prevention (whether initial diagnosis, recurrence, or progression), the graph becomes dynamic in new and exciting ways.
There’s not just the possibility to live better and longer with cancer; now we open up the possibility that we might be able to “push off” a diagnosis further into the future, or perhaps if we dream big enough—and I am all about dreaming big where cancer prevention is concerned—we are able to push off getting a cancer diagnosis indefinitely.
This way of thinking is a dramatic shift—I would go so far as to call it a “revolutionary change”—from our current reactive posture with cancer detection and treatment. At the heart of an anticancer lifestyle is a new way of thinking about health with the purpose not only of preventing or overcoming disease but also improving the quality of life we have left, however long or short that might be. This is the anticancer revolution.
Backed by this new way of thinking, what if we all decided to modify our lifestyles now, much the way David and Stephen Jay Gould and Molly and so many other cancer patients I have met have done after their diagnoses? What if we decided we weren’t going to wait for illness to strike before we stepped into action? What if we had the scientific research that showed us that making healthful adjustments now would fortify our bodies and increase the odds of our ageing while free of cancer and other life-threatening diseases?
Imagine the possibilities.
CANCER. IT’S THE word none of us ever want to hear, and yet, most of us will at some point in our lives. It has certainly touched my own life in multiple family members. Ten years ago, my father was diagnosed with prostate cancer. Like most patients with early-stage prostate cancer, he was told by his doctor to pursue his normal routine and received no advice about lifestyle changes. “No need to do anything special,” he was told. “We’ll just re-biopsy you in a year.”
Even in 2008, Alison and I knew all too well that this was not in keeping with the latest research. A year earlier, Dean Ornish, the renowned doctor and nutritionist, had shown in a randomized controlled trial that patients with early-stage prostate cancer who changed their diet and lifestyle for a year could slow the progression of their disease and greatly reduce the need for surgery.1 Solid scientific research was thus increasingly pointing to the power of modification in lifestyle to alter the course of cancer’s progression, especially when it was caught early. I urged my father to embrace these changes, to start meditating, to increase his physical activity, to cut back on meat and dairy consumption, and to start drinking green tea. I recommended, in addition, two teaspoons of tomato paste and one Brazil nut a day. (Brazil nuts have high levels of selenium, a trace mineral that has been shown in several studies to reduce prostate cancer risk. The lycopene in tomato paste has been shown in laboratory and animal studies to slow cancer cell growth.) My father took some of my advice. Eventually, he elected to have surgery. He does, however, continue to eat a healthy diet, one high in vegetables and fibre, low in meat and dairy products, to exercise daily, and to practise qigong. These routines help keep his body fit and outlook positive.
My father took his cancer diagnosis in his stride, but his cancer was caught early and his prognosis was good. For others, the psychological impact of a diagnosis can be devastating, not only to the patient but also to the family and friends. As a psychologist, I worry that our deep fears about cancer make us feel powerless when confronted with the news that we have this disease. The truth is we are anything but powerless. As we continue to lift the veil on the mysteries of cancer, thanks in no small part to our new understanding about how genes work, we are learning that our bodies are, by their very nature, robust disease-fighting machines, and our task is to ensure our everyday lifestyle choices and habits help our bodies do what they are programmed to—heal themselves.
Before we can step into action, however, it’s important to stop and acknowledge the tough questions that will arise when we or those we love are diagnosed. Many cancer patients can’t help but wonder: why did my own body allow the creation of something so destructive? How do I reconcile myself to this kind of biological betrayal? Did I do something wrong? The paradoxes presented when cancer appears work cunningly to separate us in body, mind, and spirit at the precise moment when we need to be our most whole and integrated selves so we can make well-informed choices.
With this disease, we tend to lose trust in ourselves, in our bodies, and this can make it difficult to take daily actions that will support our natural defences and promote our ability to heal. It’s important for us to try to accept a diagnosis with a certain amount of curiosity, if for no reason other than that we are, inevitably, going to have to make some important treatment decisions. What if we decided that rather than convincing ourselves that we had no ability to participate in our care, we followed the examples of David Servan-Schreiber, Stephen Jay Gould, and our friend Molly M. and decided that we would listen to our bodies and make a commitment to give them what they need to heal? Taking it a step further, what if we took such a course of action while we are still healthy?
With all the innate potential of our bodies to help in the prevention or overcoming of cancer, why is it that some doctors—even if they try to educate themselves2,3,4,5,6,7,8