The Prevention Ladder

Doctors think in terms of primary, secondary, and tertiary prevention of disease. To illustrate the difference, think about your lawn. Primary prevention of lawn disease involves having a lush, thick grass carpet that chokes out any undesirable seeds that land on it. Secondary prevention would be applying sprays and chemicals to kill weeds mixed into the grass. Tertiary prevention comes after the back-breaking work of pulling out all your weeds and entails strengthening your grass to keep weeds from coming back.

In much the same way, doctors would rather never have to treat diseases in the first place for our patients. For this article, we’ll think about cancer care – but these same principles apply to heart disease management, to mental health, lung issues, and a whole host of ailments.

Primary cancer prevention, (not getting it in the first place), involves living in a way that keeps it away. There are positive steps one can take – the DO’s – and negatives to avoid – the DON’T’s. DO exercise. The National Cancer Institute says this prevents lung, colon, endometrial, breast and prostate cancers and promotes survival after cancer1. DO eat plenty of fruits and vegetables and white meats (fish, chicken) and watch your weight2. DON’T overdo it with red meat and especially with preserved meats treated with nitrates like bacon and sausage. DON’T be a sun worshipper. DO test your home for radon. Test kits are available online and at hardware stores. Sexually transmitted viruses like hepatitis and HPV increase your risk of cancer. DON’T catch them. (There are now vaccines for some hepatitis and for HPV.) DON’T overindulge in alcohol. And of course, there’s the big one, DON’T SMOKE or use other tobacco products. There are only a few cancers that aren’t related to tobacco in some way. This is the most effective and easy way to treat cancer – never having it in the first place.

Secondary cancer prevention means finding cancer when it’s small and dealing with it quickly. It’s much easier to remove a pea-sized tumor than a football-sized one. Treatment is much more effective and comfortable when dealing with one mass than with cancer that had spread all over the body. The National Institutes of Health states that “Secondary prevention is that set of interventions leading to the discovery and control of cancerous or precancerous processes while localized, i.e., screening, early detection, and effective treatment.3” This means another DO: Get all the tests recommended for your age. These include colonoscopies, mammograms, prostate exams, stool testing, skin screening, Pap testing, and dental visits among others. More information is available on the website for the National Cancer Institute4. Not all tests are recommended for all ages. Some are only for people predisposed by genetics, smoking history, or other factors. It is important to get the ones that are right for you. Ladies, DO check your breasts for new or changing lumps every month or two. Men, especially young adults, should check for testicle lumps every month too.

Tertiary prevention is behaviors that keep cancer from coming back once you’ve had it. Some of these are common sense, for example, if your oncologist puts you on tamoxifen to prevent breast cancer recurrence, take it until you and your doctor decide you’re out of danger. A lot of tertiary tactics circle back to the same things as primary prevention: exercise, building up your immune system, not eating a lot of fats, etc. These lifestyle changes are so effective it can be frustrating for doctors when patients, after all the torture we’ve put them through to get rid of cancer, go back to smoking or other lifestyles that brought it on it the first place.

This stepladder way of thinking can help stop cancers from coming and help eliminate others while they’re still small. Of course, cancer will still happen to some people in spite of everything they do. Cancer is currently the second leading cause of death in America. We should do all we can to reduce that.

1 https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/physical-activity-fact-sheet

2 https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/how-healthy-eating-prevents-cancer

3 https://www.ncbi.nlm.nih.gov/pubmed/7311550

4 https://www.cancer.gov/about-cancer/screening/screening-tests