beth israel deaconess medical center a harvard medical school teaching hospital

  • Contact BIDMC
  • Maps & Directions
  • Other Locations
  • Careers at BIDMC
  • Smaller Larger

Find a Doctor

Request an Appointment

Smaller Larger

Cancer is Usually Just Bad Luck

Posted 1/7/2015

Posted in

  If I had to identify the two most common themes that I have heard from patients over the decades, they would be: 1) I am afraid I am going to die of this cancer, and 2) What did I do to cause it?

  The first fear is almost universal and completely rational. Although we are told the statistics by our doctors, and we all understand that we are an "n" of one, we also know that nothing is certain, and no one gets a promise. If you have been diagnosed with a more advanced or aggressive cancer, this is comforting. If your cancer is a less virulent one, this can be another scary fact. In the second instance, the safe passage of time usually helps calm the anxiety.

  The questions about causality, however, don't go away. I have heard every possible theory, ranging from "the dog stepped on my breast, and then I found the lump in exactly that spot" (without apparently making the fairly obvious connection that the dog step made her sore, resulted in her feeling her breast and finding the lump) to "it is because I eat too much red meat" or "I know it is stress." Let us be clear right here: Stress does NOT cause cancer. Stress absolutely can wreck your quality of life, but it does not cause cell mutations that result in cancer.

  There are a few things that we do know can cause cancer. If you carry one of the so-called cancer genes, e.g. the BRCA genes, you are much more likely to develop a malignancy. Smoking can cause cancer as can asbestos or radiation exposure. Heavy alcohol use is highly associated (note that I am not using "cause"here) with head and neck cancers, but many of these same people are also smokers, so that confounds the stats.

  I cannot count the times that I have said to someone: "If you leave my office with only one thing today, I hope it can be letting go of the worry that you are responsible for this." You're not. Cancer is mostly random, as in "shit happens", and now there is research to prove it. An article just published in Science indicates that two thirds of cancers are caused by genetic mistakes or mutations--meaning that healthy cells somehow screw up. Please read this and let yourself off this particular hook.

Cancer’s Random Assault

It may sound flippant to say that many cases of cancer are caused by bad luck, but that is what two scientists suggested in an article published last week in the journal Science. The bad luck comes in the form of random genetic mistakes, or mutations, that happen when healthy cells divide.

Random mutations may account for two-thirds of the risk of getting many types of cancer, leaving the usual suspects — heredity and environmental factors — to account for only one-third, say the authors, Cristian Tomasetti and Dr. Bert Vogelstein, of Johns Hopkins University School of Medicine. “We do think this is a fundamental mechanism, and this is the first time there’s been a measure of it,” said Dr. Tomasetti, an applied mathematicia


Add your comment