Cancer risks during each decade of life – Men

Scott E. Woods, M.D., M.P.H., M. Ed.

The American Cancer Society estimates that approximately 1.3 million new cancer cases will be diagnosed in the United States this year (excluding skin cancers). More than 1,500 people die every day because of cancer. It is our second-leading cause of death, surpassed only by heart disease.

For nearly all cancers, rates are higher among men than women. Cancer incidence also exhibits considerable racial variation, with African-American males having 22 percent higher total incidence of cancer compared to Caucasian males. Native Americans have the lowest cancer rates, exhibiting about one third of the rate experienced by African-Americans.

The most commonly occurring cancers among men (other than skin cancer) are those of the prostate, lung, and then colon. The order changes when you consider cancer deaths. In males, lung cancer is the leading cause of cancer death, followed by prostate and then colon cancer. Although most people fear cancer, few people realize that an individual’s risk of certain types of cancer changes with each decade of life. For example, the most common cancer in a 20-year-old male is totally different from the most common cancer for a man in his 40s.

Most men during their 20s are thinking primarily about their career and relationships. Cancer is usually not a primary concern. How-ever, the occurrence of testicular cancer in several sports notables, including ice skater Scott Hamilton, cyclist Lance Armstrong, and baseball player John Kruk, has brought considerable attention to the disease for younger men.

The highest incidence for testicular cancer is from age 25 to 30, with the risk decreasing after age 30 and reaching nearly zero by age 40. There are 5,500 new cases diagnosed in the U.S. each year. The reason for the high occurrence in young men is unknown. It is known, however, that there is a higher-than-normal risk in men whose testicles have not completely descended into the scrotum.

Testicles are normally very smooth and oval in shape. There is only a small, soft tube that connects to each testicle. Frequently one testicle will be larger than the other. Testicular cancer presents as a painless hard growth on the otherwise smooth surface of the testicle. The tumor will remain painless regardless of its size. Unfortunately, there is no blood test for early detection of this disease. Males are encouraged to perform regular monthly checks for any physical changes. A physician should examine any testicular irregularities.

Fortunately, this is a highly curable cancer. After removal of the diseased testicle, chemotherapy is the mainstay of treatment. The cure rates are greater than 99 percent if the cancer is localized to the testicle. Even if the disease has spread to other organs (most commonly the lymph nodes, lungs, bones, and brain), the cure rates are still greater than 80 percent.

The decade of thirtysomething carries two main cancer risks. First is testicular cancer, which decreases as the decade proceeds. The second cancer risk is lymphoma, a common malignancy from age 30 to 50. NHL hockey player Mario Lemieux is a survivor of lymphoma. Many who develop lymphoma have previously been infected by the Epstein-Barr virus (the virus that causes infectious mononucleosis).

Lymphoma typically presents as painless enlarged lymph nodes. Non-specific symptoms such as fatigue, weight loss, and low-grade fevers may also be present. Many factors can cause lymph nodes to swell, including trauma, infection, irritation, and inflammation. However, in all of these situations, the lymph nodes will likely be very tender to touch and, given a small amount of time, will return to normal size. In lymphoma they tend to remain enlarged and painless. Unfortunately, there is no blood test for detection of this disease. Individuals are encouraged to see a physician if any lymph nodes remain enlarged longer than two weeks.

There are two types of lymphoma: Hodgkin’s disease and non-Hodgkin’s lymphomas. The cure rates are generally very good for both types. As with most cancers, the earlier the disease is detected and treated, the better the chance of survival. Radiation and, if the cancer is more advanced, chemo-therapy are used for treatment. There are a limited number of very advanced, aggressive lymphomas that carry a poor prognosis.

Men typically start thinking about cancer risk during this decade. Lymphoma is still a significant possibility during this period; however, this is the decade when colon and prostate cancers begin to be considerable risks. The American Cancer Society recommends beginning screening during this time for both of these diseases if you are at high risk.

There are 150,000 new cases of colon cancer diagnosed in the U.S. each year. One in 20 persons develop this disease in their lifetime. A diet high in fat and red meat and low in vegetable fiber is associated with a greater risk. In addition, any family history of colon cancer increases lifetime risk of developing this malignancy threefold.

Colon cancer originates from colon polyps, which are mushroom-shaped growths that develop in the intestine. Although there are many types of colon polyps, colon cancer originates from just one type of polyp, called a villous adenoma. All other polyps do not become cancerous. Screening, starting during the 40s for high-risk individuals, involves the use of a flexible sigmoidoscope used by a physician to examine the colon. This should be done every five years to screen for polyp formation. A less invasive, but also less accurate, test for colon cancer is an annual screening for microscopic blood in the stool. However, this test assumes that all colon cancers bleed, which unfortunately is not realistic.

Symptoms of colon cancer can range from none to intestinal bleeding, obstruction, and weight loss. This cancer commonly spreads to lymph nodes and the liver. Treatment involves surgery to remove the primary cancer and regional lymph nodes. Chemotherapy is also used to treat any disease that may have spread. Colon cancer diagnosed early carries a great prognosis (more than 95 percent cure), while late-stage cancer is difficult to overcome (less than 5 percent survival at five years).

Prostate cancer is more common than colon cancer in men of this age group. One in 11 men will develop this disease during their lifetime. It is the second-leading cause of cancer mortality, behind lung cancer. Annual screening, which includes both a rectal exam by your physician and a blood test (prostate-specific antigen), begins at age 45 for high-risk individuals. The cause of prostate cancer is unknown. Risk factors for prostate cancer include advancing age, African-American race, high-fat diet, and a family history of prostate cancer. There is currently a large nationally conducted study sponsored by the National Cancer Institute to investigate if daily doses of selenium or vitamin E can prevent prostate cancer.

Early symptoms can include a decreased urine stream, urine retention, prostate infections, and urine frequency. A more advanced disease will present with bone pain and weight loss. Diagnosis is made through a biopsy of the prostate. In general, this is a slow-growing cancer. The treatment involves surgery or radiation of the prostate, with the more advanced disease being treated with antitestosterone drugs and chemotherapy.

This decade carries a large risk for colon and prostate cancers; thus, all individuals are screened for these diseases during this decade. The additional cancer risk for this decade is lung cancer. Greater than 95 percent of all lung cancers occur in current or past smokers.

Unfortunately, lung cancer produces few to no symptoms until there is significant growth. This is because lung tissue itself is void of pain receptors. Only when the tumor has grown to the chest wall or the bronchus, both of which possess sensory nerve fibers, do individuals develop noticeable symptoms. Common symptoms are weight loss, fatigue, and a bloody cough. Lung cancer can rapidly spread to a person’s bones, lymph nodes, liver, and brain. Diagnosis can usually be made with just a chest X-ray. Bronchoscopy is usually done to procure a sample of the tumor, since there are different types of lung cancer. The type of cancer influences treatment. If there is limited disease, surgery to remove a lobe of the lung can be performed. Otherwise, radiation and chemotherapy are the mainstays of treatment. Prognosis is poor, because the disease is frequently not caught early. The five-year survival rate is only 15 percent.

Although there is no recommended screening test for lung cancer, there is currently research into using spiral CAT scans to find lung tumors early. However, nearly complete prevention can be obtained by not smoking.

The Social Security decade comes with significant risk of colon, prostate, and lung cancer. Screening measures for these continue during this decade. Although these three are the major cancer risks during this period, leukemia also becomes a risk during this decade.

Leukemia is a cancer of the white blood cells. These blood cells normally fight infections. There are two types of leukemia (acute and chronic). In both types of leukemia there is a proliferation of immature white blood cells. Although there are exceedingly increased amounts of white blood cells, these immature cells have limited infection-fighting ability. In the acute leukemias all of the white blood cells are immature and nonfunctional, thus making the risk of infection very high. Chronic leukemias are characterized by both mature and immature white blood cells. The mature white blood cells make infection risk much lower, thus individuals can frequently live multiple years with a chronic leukemia.

Screening for this disease can be obtained with a complete blood count, which is usually performed at an annual physical exam. Symptoms can include abdominal pain from an enlarged spleen, fatigue, lymph node enlargement, and weight loss. Diagnosis is made by a bone marrow biopsy. Treatment is chemotherapy followed by a bone marrow transplant.

As men reach their 70s and beyond, the risk of developing cancer reaches its peak. Cancers of the prostate, colon, and lung continue to be very significant risks. Screening for multiple diseases should be performed on an annual basis with a complete physical by a personal physician.

Although there is already enough cancer risk to be concerned about, there are several relatively rare cancers that become more common at this time. Included in this group are cancers of the urinary bladder, throat, esophagus, kidney, and pancreas. The majority of the risk from these entities can be substantially reduced by never smoking.

The last significant cancer risk is multiple myeloma. This is a cancerous proliferation of one type of white blood cell called a plasma cell. Symptoms and diagnosis are identical to those of leukemia. Treatment consists primarily of chemotherapy. Unfortunately, complete cures are rare. The prognosis varies depending on how early the disease is identified.

Your Risk
Although there will be significant improvements in the diagnosis and treatment of most of these feared illnesses, cancer will continue to be a major health issue for the twenty-first century. Regard-less of which decade of life, men should avoid cancer-causing substances and habits.

Cancer risk is different for each decade of life; it’s important to understand how the risk changes over time. Proper screening includes considering your family history, personal habits, and occupational exposures. The American Cancer Society recommends screening plans for individuals at normal risk levels. Discussing your risks, along with developing a screening plan with your personal physician should prove beneficial.

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