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有多少癌,可以不来

本文作者:游识猷

1“世事无常,生命有限。原来,在癌症面前,人人平等。”这是李开复先生2013年9月5日的喟叹。一时举微博皆惊。近年来,名人罹癌早已不罕见,青壮年就为癌症所累者亦不在少数。就连一些生活方式似乎相当健康的人,也逃不过癌魔的侵袭。

寻找因果关系是人类的本能,《此生未完成》中,于娟忆起了十年前住处甲醛超标十倍的家具。而李开复则反思,“曾天真的和人比赛‘谁的睡眠更少’、‘谁能在凌晨里及时回复邮件’……这种以健康为代价的坚持,不一定是对的”。

然而,癌症之复杂,不仅在于亚型繁多治疗困难,而且在于机制迄今没有完全搞清。感染性和营养性疾病可以很容易地找到病因。而癌症从基因与环境算起,可以追溯太多可能性。比北京地铁图复杂百倍的癌症相关基因调控网络每天都在“添砖加瓦”,而学界还在争议染色体结构数量紊乱会不会才是真正的癌症肇因……

对普通人来说,想搞明这一团乱麻更近乎不可能——新闻里每天贴心提示各种“长期大量可致癌”的化学名,市售与“癌症”相关的书籍绝大部分属于“非科学体系”。 而剩下的很小部分的科普书籍,却又由于出版周期漫长,部分知识已经过时,不再是医界最新的推荐——从前推荐胃溃疡患者休息喝牛奶,现在推荐先确定需不需要抗生素。从前推荐乳房自检,现在更推荐高危人群定期乳腺钼靶X光筛查……看到这里你是否已经头晕目眩,到底有没有方法评估自己的罹癌风险,远离癌症阴霾?

不如先从自问几道题目开始。

首先,你抽烟吗?抽烟的话不必往下再看,直接掐了烟吧。连续三十年每天一包烟的烟民,考虑做个肺部CT检查先。不管你抽的是“低焦油”还是“含草药”,吸入烟雾对全身器官的恶劣影响可是一点没减少,光增加几率的癌症就包括喉癌胃癌口腔癌、肺癌肾癌胰腺癌、宫颈癌胆囊癌结直肠癌……不胜枚举。尼古丁毒瘾戒除确实不易,但戒烟永远值得你再多努力一回。

不抽烟的诸位,值得赞许,请继续保持,并请深呼吸,准备感受来自科研界的恶意——

先从环境风险说起。你常吸到二手烟吗?家里烧柴烧煤吗?家具甲醛超标吗?住处附近发生过核泄漏如福岛三里岛切尔诺贝利一带吗?所在地空气污染严重吗?开窗通风进来的pm2.5多吗?不开窗通风的话家里放射性氡气超标吗?从事的职业需要天天接近致癌物如造船业者接触石棉吗?

个人风险里又分先天基因和后天习惯两大块。回忆一下,你有许多患了特定癌症的亲戚吗?你长得特高吗?体型肥胖吗?内脏脂肪堆出了一个大肚腩吗?每周锻炼少于2.5小时吗?你爱嚼槟榔吗?热爱红肉讨厌蔬菜和水果吗?爱吃腌制、烧烤和加工食品吗?每天喝酒超过两杯吗?常常大中午无遮无挡不涂防晒就在日头下呆上很长时间吗?感染过幽门螺杆菌吗?感染过乙肝病毒吗?倘若你是女性,初潮来得早吗?生小孩生得晚吗?从未母乳喂养吗?年过三十却从未做过宫颈抹片检查吗?年过四十却没有定期做乳腺X光吗?更年期用过激素替代疗法吗?看完这一串问题你感觉压力大吗?目前研究倒是认为精神压力不会增加罹患癌症的几率,但是可能增加已有癌症的转移风险喔……

倘若以上全部问题你的答案都是否定,恭喜你的癌症风险已经大幅下降,然而,这并不意味着你拥有癌症豁免权。李开复说,“病痛也是生活的一部分”。事实也确实如此。说到底,无疾而终是个美好梦想,目前大部分人都无法实现。生命本就有两种演化策略,一是以长生为目标,一是以早生早超生为目标——人类选择的是后一条路。我们身体里平均大概有百万亿个细胞,个头愈高,细胞愈多,而这些细胞不出错的“保质期”显然达不到目前的平均寿命。于是假如一个人没有因为意外凶杀心脏病而提前下台一鞠躬,那么他有大概率一辈子患上至少一次癌症。正如美国国家癌症研究所网页所述,癌症的头号风险因素,是长寿。远离风险因素的同时,别忘了定期体检和筛查。

TIPS

戒烟限酒吃蔬果,定期筛查多运动。有些检查确实谈不上舒适比如胃镜肠镜,这种最好跟亲友约定好,互相逼着去检查。同理适用于牙科。

空气污染没有“安全阈值”,即使是轻微污染也会增加肺癌风险。家庭内的污染物控制要从材料源头抓起,放活性炭远不如开窗通风管用。

别想着靠特定食物或者营养补剂防癌治癌,即使某种食物里能提取出抗癌的有效成分,也不代表你天天吃它就能吃到足够剂量,再说单种食物吃多了反而造成营养不平衡。

去医院吹口气就能检查自己有没有感染幽门螺杆菌,这类中的致病菌会增加胃癌和淋巴瘤几率。做个乙肝两对半可以检测自己有没有乙肝抗体,没抗体的话打几针疫苗。女性可咨询下自己是否需要HPV疫苗。

精神压力确实会引起许多身心疾病比如胃病,免疫系统和生殖系统疾病,不过目前研究认为不会直接导致癌症。对癌症患者来说,乐观或悲观也不会直接改变预后。但压力常关联着不健康的生活方式比如饮食不均衡和缺少运动。压力越大,越要为自己的健康作出努力。

如果你非常希望看到最新科学推荐,可以随时跟踪美国国家癌症研究所(National Cancer Institute,NCI)的相关网页http://www.cancer.gov 。如果你不喜欢看英文,可以关注科学松鼠会和果壳网。如果你希望根据个人情况得到推荐,去正规医院找个医生,听医生的。

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