The average person has a 40 percent lifetime risk of developing cancer. your lifestyle has something to do with your risk, but many cancers just happen.

Some of the worst — colon cancer, esophageal cancer, pancreatic cancer and many others — have no symptoms and strike otherwise healthy people who have a generally healthy lifestyle. we can screen for colon, breast, and perhaps prostate cancer, but many other cancers seem to strike as randomly.

Decreased rates of smoking have reduced the rate of lung cancer, but other cancers are increasing in frequency.

Given all that, imagine if a drug company could develop a medication that reduces the risk of getting cancer by as much as 50 percent with almost no side effects. and just for good measure, this new drug also reduces the risk of heart attacks and strokes.

The drug would be a blockbuster. it would make gazillions of dollars for the lucky drug company.

As you have guessed, the medicine already exists, it is virtually free, and available over the counter at any drugstore or supermarket. as has been reported widely, our old friend aspirin is showing real promise against cancer: from prevention to death rate reduction to containment.

Three new studies in England published two weeks ago in the journal Lancet suggest that taking low-dose aspirin daily reduces the rates of cancer — in some cases by as much as 50 percent.

The studies were performed by a group of researchers from Oxford led by Dr. Peter Rothwell. they performed what is known as meta-analyses, a research process in which multiple studies of similar design are pooled to look for results that may have more statistical significance because of larger numbers of patients.

One of the studies combined 51 randomized trials that looked at patients who took low-dose aspirin for up to nine years compared to those who took a placebo. even though cancer incidence was not the outcome the studies were looking for, in retrospect the overall cancer mortality was 40 percent lower in patients that took regular aspirin for more than five years compared to patients in the control group who did not take aspirin. the benefit waned a bit with longer duration of treatment, but there was still a 22 percent lower risk of cancer in patients taking aspirin for more than 20 years.

The biggest benefit in cancer incidence was a decrease in colon cancer and other intestinal cancers where a 38 percent reduction was seen. there was also a reduction in certain types of lung cancers called adenocarcinoma, a type of cancer that is more common among nonsmokers. Aspirin use also was associated with a lower rate of esophageal cancer (the reduction was more than 50 percent), pancreatic cancer, breast cancer and prostate cancer.

In patients who already had cancer, aspirin was associated with a lower rate of spread (metastasis), especially in patients with colon cancer.

The effect was seen with low-dose aspirin, such as the dosages commonly used for heart attack prevention. Aspirin dosages as low as 75 mg were as effective as higher doses (1500 mg or above) in preventing cancer. In other words, more was not better when it came to cancer prevention. Baby aspirin, the most common dose used for heart attack prevention is 81 mg, an effective dose for preventing cancer, according to the studies.

Speaking of heart attack prevention, according to these studies, the benefit from aspirin on cancer prevention was greater than the benefit in preventing heart attacks and strokes.

The biologic mechanism that explains how aspirin prevents cancer has not been worked out, but most experts speculate that it may have to do with aspirin’s effect of reducing inflammation. but there may be other effects that have not yet been discovered.

Aspirin does have its downsides, however. the drug is an effective anticoagulant, and it promotes bleeding. it also is a direct irritant to the stomach lining, and all of the studies showed an increased risk of stomach bleeding associated with the use of aspirin. People with bleeding risks and a history of peptic ulcer disease may not be candidates for aspirin.

Curiously, two large American studies also looked at aspirin usage and did not show a reduction in cancer rates. the Women’s Health Initiative Study and the Physician’s Health Study, which looked at more than 60,000 men and women, were primarily looking at the effect of very low-dose aspirin on heart disease and stroke, but neither study showed a reduced risk of cancer. However both studies used low-dose aspirin every other day rather than daily, perhaps explaining the difference in benefit.

As promising as this research sounds, it is important to talk to your doctor before starting aspirin therapy. even though aspirin is available over the counter and is inexpensive, it obviously has enormous biological effects and is not for everyone.

But if these findings turn out to be confirmed, the implications are stunning. much more research needs to be done before we put aspirin in the water, but it is safe to say that these studies offer a ray of hope in the battle against cancer.

Dr. Bill Elliott is assistant physician in chief for Kaiser Permanente’s Novato office and Petaluma. his column appears every third Monday.

For Jirameth Chanasakul, cigarettes weren’t just a habit; they were an invaluable social tool.

“I started smoking out of necessity,” recalled the long-time Bangkok resident. “I was 21 years old and working as a salesman so I had to figure out a good way of getting close to potential clients. I noticed that lots of people loved smoking so I learned how to do it, too, thinking it would improve my chances of closing sales deals.”

Thirteen years later and by then a heavy smoker, Jirameth tried to kick the habit, but quickly discovered he’d bitten off more than he could chew. Tired of being constantly stressed out and irritable, he welcomed back his old friend and turned a deaf ear to the growing number of news reports about the link between tobacco consumption and lung cancer.

He puffed away happily for another decade before deciding to try and stop again. And this time he managed to stay off the ciggies for good.

“About 10 years after I’d permanently quit smoking, I started to feel really fatigued while out walking. I’d take a few steps and then I’d have to stop and rest. It didn’t occur to me that this breathlessness could be due to the cigarettes since I’d been off them for a long while.”

After undergoing a chest x-ray and a thorough physical examination, Jirameth, by then 54 years old, was diagnosed with third-stage lung cancer, meaning that the malignancy had spread to his lymphatic system. the cancerous lymph nodes were located very close to one of his bronchi, a sub-division of the windpipe, so surgery had to be ruled out. the only treatment options were chemotherapy and radiation therapy.

After extensive chemo- and radiotherapy – six courses in all – the malignant cells shrank and eventually vanished. Jirameth, now 60, goes back to the hospital once a year for an x-ray to check whether the cancer has recurred.

The survival rate among stage-3 cancer patients is quite low, so Jirameth realises that he is very lucky to be alive.

“Back when I was smoking, I was young and healthy so I didn’t think cigarettes could do me any harm. It was only when I got lung cancer that I realised how dangerous smoking can be.”

The organisers of this year’s World No Tobacco Day are hoping to get Jirameth’s message out to as many young people as possible.

According to Dr Chatchai Koowattanapaisan, an oncologist, the number of young smokers in Thailand is on the rise and therefore it is paramount that they are provided with all the facts about the health risk associated with tobacco use.

“Most teenagers are influenced by friends and driven by curiosity. This curiosity can lead them to smoking. Smoking can be the beginning of other more serious issues such as alcohol and drug use. in the end, this becomes a social problem,” said Dr Chatchai who sits on the central committee of the Thai Society of Clinical Oncology.

Statistics compiled by the World Health Organisation (WHO) show that tobacco use is second only to hypertension as the most common cause of death globally; it currently kills one in 10 adults worldwide.

Smoking is also responsible for 90% of lung-cancer cases, Dr Chatchai added. in Thailand, lung cancer is the second most common cancer in men after liver cancer. in women, lung cancer is ranked fourth (after breast, cervical and liver carcinomas, respectively), but it is the second most common cause of cancer-related fatalities in the population as a whole.

In 1988, to highlight the health risks posed by smoking, the WHO declared that May 31 would henceforth be World No Tobacco Day and urged people around the world to abstain from smoking for a 24-hour period. Dr Chatchai wants to raise awareness about the diseases caused by tobacco not only to encourage existing smokers to quit, but also to make Thai adolescents think twice before experimenting with cigarettes.

“You probably think you have very little chance of contracting lung cancer. but the truth is that smoking can give rise to other illnesses, too. one of the most commonly found diseases among heavy smokers is pulmonary emphysema in which the air sacs [lungs] are over-inflated and damaged. Smoking can also cause bad breath,” the physician warned.

A highly alarming feature of lung cancer is that it is usually asymptomatic in the early stages. Symptoms often become apparent only when the malignancy has reached a critical stage.

The younger a person starts smoking, the more toxins from tobacco accumulate in their bodies. According to Dr Chatchai, those who start smoking in the teens or 20s are likely to display signs of lung cancer when they reach the age of 40.

To make it more difficult for youngsters to try their hand at smoking, Jirameth, the cancer survivor, suggests more stringent enforcement of the law which prohibits under-18s from entering pubs, bars and other adult-entertainment venues.

“Children these days aren’t like those in the old days,” he observed. “When I was young, if I did something wrong I’d get smacked or punished. Parents don’t do those things any more. So if we want our children to listen to us, we have to talk to them nicely and give them reasons to back up our instructions. If we don’t want them to take up smoking or if we want them to quit, we have to tell them why, support them, encourage them and convince them how bad smoking is for their health.”

More importantly, Jirameth continued, parents should be role models and stick to the teaching-by-doing approach. in other words: there’s no point in adults telling their kids not to smoke if they themselves don’t practise what they preach.

After his close brush with death, Jirameth has learnt his lesson well. he hasn’t touched a cigarette in more than 16 years. making today World No Tobacco Day is only useful, he said, if it gets smokers and would-be smokers to give the issue some serious thought.

“Stopping for one day a year isn’t enough,” he declared. “Everyone should make every day a no-tobacco day.”

World No Tobacco Day activities in Thailand are increasingly focused on making young smokers aware of the potential dangers to their health two or three decades down the road Trying to give up cigarettes can be a daunting task at first, especially for heavy smokers. It sometimes helps to think of kicking this habit as an ongoing battle against oneself which is in one’s own best interests. Cancer specialist Dr Chatchai Koowattanapaisan has a few tips on how to quit smoking and then stay free of nicotine addiction.

- Throw away all the cigarettes you have as well as smoking paraphernalia like ashtrays, cigarette-holders, lighters and matches.

- Avoid environments or activities that usually trigger a desire to smoke like pubs, consuming alcohol or a particular group of friends that smoke.

- Whenever you have a craving for a cigarette, find something else to do, such as exercise.

- Drink lots of water, especially if you feel like smoking.

- Opt for a healthier diet and eat lots of fruit and vegetables. Bananas, oranges, grapefruits, apples and broccoli will help make cigarettes taste terrible.

- believe in yourself. Be strong and determined. If you fail once, don’t give up the struggle. Think of all the reasons you decided to quit smoking (the money you spend on cigarettes might be put to better uses; paying your kids’ tuition fees, for instance).

- You might consider trying nicotine-replacement products such as patches, nicotine gum or lozenges. but bear in mind that the most important anti-smoking weapon in your arsenal is your own will-power.

- Consult a specialist or counsellor if you feel the need.

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