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Health PsychologyChapter 10: Cancer

Spring 2000

Mansfield University

Dr. Craig, Instructor

Cancer Facts and Terms

In 1997 was the 2nd leading cause of death 201/100,000 population 40-60% of premature deaths due to life and

environmental factorsCancer- new cells that grow out of control and

can affect other healthy organismic functioning. tumors Can affects all cell-based creatures

Mutation- change in cell function can be generated by external agents (x-ray,

benzene, asbestos)

Cancer Terms continued

Mutated Cells: “neoplastic cells” cause autonomous“neoplastic growth” that robs

organism of nutrients (provides no benefit).

Benign cells- localized growth

Malignant cells- “metastasize”, that is spread and setup new

colonies. Typically through blood or lymphatic system.

Types of Cancer

Carcinomas- cancer of cells that provide outer and inner lining to the body

stomach, skin, lung 85% of cancers risk increase with age Carcinogens- substances increase rate of carcinomas

Sarcomas- cancers of connective tissue bone, muscle 2% of cancers

Leukemia- blood or blood forming cells stem cells in the bone marrow (make immune cells)

Lymphoma- cancer of lymphatic system relatively rare

Changes in Cancer Mortality Statistics

Cancer death 3x greater now than in 1900 Why?

1. More accurate techniques for diagnosis2. Some decline in CV mortality (live longer)3. Rapid rise of AIDS-related cancer deaths4. Sharp increase in lung cancer tied to cigarette

smoking

Variations in Cancer Mortality

All-Cancer mortality dropping since 1950 for men and women across all ages (Fig. 10.2 & 3)

Lung CancersLung Cancers- curve rising for women (10.5), high, but recent decrease for men (10.4).

Major sites for Men: lunglung, prostate, colo-rectal, pancreas

Major site for Women: lung, breast, colo-rectallung, breast, colo-rectal, pancreas breast cancer 5 year survival improved, but little change in

total mortality statistics colo-rectal rates declining for women, but not men.

Behavioral Risk Factors for CancerSmoking

• account for 400,000 deaths annually (including other than deaths)

• the leading cause of cancer deaths• 9x increase risk of cancer death (strongest single factor

in behavioral science)

Dose-response relationship between cancer risk and cigarettes smoked

15-25 year lag in mortality statistics• faster declines in smoking among men 25-years ago,

equates to more drastic decrease in LC mortality now.

Breast Cancer- Dose-response relationship but increased risk not as great as LC (75% for those 40 or more cigs/day)

Smoking Continued

Synergistic effects with environmental factors pollution, SES, occupation, ethnicity, building

materialsETC...

Optimistic Bias- “recognize problem exist for everyone else... but not me”• clear in HS students

• heavy smokers Pipe and Cigars- 2.5 and 2.9x increase in cancer

rates respectively. Combine with cigarettes 8.1 and 6.9 increase risk!!!

Potential BRF: Diet

Estimated that 1/3 of cancers may be related to dietary choices

(Fats- bad, F & Vegs- Good)

Bad Foods?• spoiled foods

• weight gain after 18 years old

• proteins and non-vegetable fats 50% of cals from fat = 3x risk of breast cancer high cholesterol level- 2x risk of LC in men

Good Food• Vit. A & beta-carotene (carrots, sweet potatoes) (weak)

• Pizza (lycopene)- cooked tomatoes

• Vit. C- (ascorbic acid)- inhibits carcinogen nitrosamine

BRF: Alcohol, Physical Activity

Alcohol- potential secondary RF• little evidence in the way of direct causal relationship• set stage for weakened response (cirrhotic liver)• synergistic effects with smoking

Physical Activity (or inactivity)• Breast Cancer-

50% less in women who began exercising regularly in early life (by early adulthood ?)

less in women who exercise at least 4 hrs weekly (particularly in pre-menopausal women)

• Prostate Cancer low activity jobs/sendentary behavior raises risk in later life regular exercise markedly reduces risk

• Colon Cancer- “jury is still out”

BRF: Exposure to UV Light, Sexual Behavior Skin Cancer-

• particularly a problem with fair-skinned people, light hair, blue eyes

• risk of exposure greatest among young Why is it not taken more seriously?

Low threat of mortality

Sexual Behavior• cancers resulting form AIDS

Kaposi’s Sarcoma- purple nodules with skin lesions (internal and external) more likely in gay men than other AIDS patients

• Cervical Cancer- early partnering, multiple partnering, hygiene, not using barrier

forms of contraception protection appears offered by childbirth early in life

RF over which we have little control

Environment radiation, asbestos, pesticides, chemicals

Nuclear Power plants- long term exposure to work environment appear to increase many chronic forms of mortality, including cancer.

living in the vicinity of a power plant does not!! Study of 40 million people over 35 years

High Power Lines• NO EVIDENCE after many good studies-- a myth

Inherent Risk Factors most cancers are not heritable FH of CancerFH of Cancer

• breast cancer risk is 2-3x greater

Inherent Risk Factors

Ethnic BackgroundEthnic Background 40-50% greater incidence in AA than Eur. A EA greater than Asian, Native Americans

• believed to be related to social/behavior factors not genetic structure

SES, knowledge about cancer and its treatment, attitudes toward disease (optimistic bias), access to good health care.

AgeAge see figure 10.6 steep increase after 45 years especially for men.

Psychological Factors and Cancer

The “Type C” Personality no global personality trait linked to cancer.. However…

Suppression of Emotion suppression of emotion, denial of anger significantly

increased changes of breast cancer 5-years follow-up after biopsy (Greer & Morris)

MMPI measured suppression predicted male-cancer diagnosis 10 years later

Physicians who suppressed and were “loners” were 16x more likely to have cancer in a 30 year follow-up!

Depression a RF for dying of cancer, but not contracting it.

Psychosocial Factors and Survival

Key Variables: “Fighting spirit”, Marriage/social support, Therapy

Be a fighter better adjusted, less hostile, less angry... More likely to die why do you think?

Married people seems to survive longer why? (they’re diagnosed earlier.. explains a little) social support appears to enhance personal control and

healthy behaviors, reduce optimistic bias?) Speigel- breast cancer and supportive group psychotherapy

(video clip)