Kate Middleton and other celebrity diagnoses could fuel public cancer fears

When it comes to cancer, we have many fears: of treatment and its side effects, of pain and suffering, of radiation and relapse, of impotence and infertility, and of course, the greatest fear, of dying. Some of these fears are now exaggerated or outdated thanks to medical advances. Yet there is a reason why oncologist and writer Siddhartha Mukherjee called cancer the “emperor of all diseases,” and why it tops the list of diseases we fear most, even if it is not the biggest killer (that “honor” goes to cardiovascular disease). It is widely viewed as a “malignant, unpredictable and indestructible enemy,” as one systematic review of attitudes put it.

Cancer used to be considered a death sentence, which was not an unfounded fear before the development of modern treatments. For example, testicular cancer, which I was diagnosed with in 1984, now has a five-year survival rate of 95 percent, according to the National Cancer Institute (NCI), up from about 80 percent in 1975. The five-year survival rate for breast cancer is now 91 percent, according to the NCI, up from 76 percent in 1975.

According to the NCI, the five-year survival rate for all types of cancer is now over 69 percent; in 1975 it was about 50 percent.

At the same time, some immunotherapies and other medications aren’t nearly as effective as older therapies, which have common side effects like nausea, vomiting and hair loss. That’s why both experts and cancer survivors keep telling me, “Educate yourself about your type of cancer,” which can go a long way toward curbing fear.

David Ropeik, a retired journalist and author of the new book “Curing Cancerphobia: How Risk, Fear and Worry Are Leading Us Astray,” debunks other outdated fears. “Our fear of cancer has not kept pace with the advances that medicine has made in recent decades,” he says. “Up to two-thirds of the nearly 200 types of cancer can (now) be treated as chronic diseases or completely cured, but we don’t think so.”

As a result, there are what Ropeik calls too many “fearctomies” — medically unnecessary surgeries such as prostatectomies and radiation for asymptomatic, slow-growing prostate cancer and full mastectomies for ductal breast cancer that hasn’t spread yet and often won’t. In both cases, experts say active surveillance with regular follow-up is a good approach.

Ropeik says our perceived loss of control or powerlessness over the disease makes things worse. “If we can’t do anything about it, we’re even more afraid,” he told me. Psychologist Levin agrees: “We want to be able to say, ‘I can do this and avoid that.’ Cancer sticks in your mind as one of those things you ‘can’t control.'”

But science has discovered over the last two decades that each individual can do much more to reduce their risk of cancer. The most important thing is:

Do not smoke. Researchers recently reported that those who quit had a 17 percent lower overall risk, any cancer than those who continued smoking. In particular, they found a 42 percent lower risk of lung cancer, a 27 percent lower risk of liver cancer, a 14 percent lower risk of stomach cancer, and a 20 percent lower risk of colon cancer.

Eat properly. Studies have shown that a healthy diet (less meat and processed foods, more vegetables, whole grains and fish), regular exercise, sun protection and preventive medical examinations also reduce our risk of cancer, says Levin, but not to zero, “which is really hard for people to accept.”

Cancer phobia can lead to overscreening, overdiagnosis, and overtreatment by encouraging the discovery of some cancers that are thought to be unlikely to spread or cause symptoms. Overtreatment refers to opting for more aggressive, even riskier, treatments than are medically necessary, such as the prostatectomies and mastectomies mentioned above.

So what can you do to curb the fear of cancer? In addition to doing research to understand your condition, experts suggest the following strategies:

Mind-body interventions: These include cognitive behavioral therapy, mindfulness meditation, relaxation techniques, and the use of creative arts (as a means of self-expression). A meta-analysis published in Psycho-Oncology concluded that “these interventions produced significant, small to moderate effects” that were sustained at follow-up for up to two years. Some research suggests that the psychotropic drug psilocybin may be helpful, although much research is still being done on this topic.

Continue talking about the causes of your fear. The fears we know are actually less scary than the fears that are hidden. Levin added that avoidance doesn’t reduce risk, but it can limit your options. Find a therapist who has dealt with these issues. Many cancer clinics can provide referrals.

It’s okay to ask for help. In fact, it’s not only OK, but a sign of strength, to say, “I can’t do this alone.” Don’t be afraid to say you’re overwhelmed. Most people feel this way; you don’t have to be the proverbial cancer fighter.

Help can take many forms. These include psychotherapists, social workers and religious leaders, nutrition experts, organized support groups, and of course friends and family. If you’re worried about the treatment process, seek out people who have already been through it. Worried about finances? Look for financial experts who can assess your situation.

Beth Rosenberg, a retired cardiologist from North Carolina, put it succinctly: Fear of cancer can harm us as much, if not more, than a cancer diagnosis. “Unfortunately, I have treated too many patients who were afraid of what might be found and waited until the pain or bleeding was unbearable.”

She recalled a patient who delayed seeing a dermatologist because she feared a patch of skin was cancer – which turned out to be true. Or the woman who didn’t come until her breast tumors were too big to ignore. Both died within a year. “The scars and pain they suffered were so much worse than if they had overcome their fear and come sooner,” Rosenberg said.