A Book for Readers Concerned About Tumors: Genetic Consultation in Clinical Cancer Care

In the United States there is a dedicated profession called the genetic counselor. A genetic counselor is not a clinician, but possesses rich oncology knowledge and can help clients analyze their own and their family's cancer risk, identify high-risk causes of carcinogenesis, design pre-cancer intervention strategies, and offer a series of recommendations to prevent malignant transformation.

In this age of high tumor incidence, the genetic counselor is a very important profession—the value of preventive medicine exceeds that of clinical medicine. I myself would very much like to become a genetic counselor. Sun Simiao, the famous ancient Chinese physician honored as the "King of Medicine," explicitly stated: "The highest physician treats disease before it arises, the middle physician treats disease about to arise, and the lower physician treats disease that has already arisen." It is best to intercept a major disease such as cancer while it is in the pre-disease state. Once cancer develops, not only is the patient's life threatened, but the whole family is greatly burdened, both economically and emotionally.

Genetic Consultation in Clinical Cancer Care is the work of the veteran American genetic counselor Katherine A. Schneider, with a foreword by Judy E. Garber, director of the American Center for Cancer Genetic and Prevention. Its Chinese translation was completed jointly by three Chinese academicians of oncology: Zhang Xue, Ji Jiafu, and Xu Binghe. Academician Zhang Xue is a medical geneticist; Academician Ji Jiafu is a world-renowned authority on gastric cancer; Academician Xu Binghe is an authority in breast cancer. Three academicians collaborating on the translation shows the book's high caliber.

Cancer is already a common, frequent disease; about one third of Chinese people will eventually develop cancer, among which lung, gastric, liver, and breast cancer are most common. About two thirds of cancers are preventable, but because the public generally lacks understanding of carcinogenic factors, many people live unhealthy lifestyles and eat unhealthy diets, and ultimately fall ill with cancer—inflicting major loss on their lives, health, and family property. It is a great pity.

China is currently a developing country with per-capita income not yet high, and few people are willing to spend much on cancer counseling. Introducing popular-science works such as Genetic Consultation in Clinical Cancer Care and popularizing them among the public has some effect in preventing cancer.

DNA in human cells is highly prone to damage and change; this is key to biological evolution and environmental adaptation, but DNA variation can have adverse—even lethal—effects on a particular individual. Cancer is a complex disease caused by structural and functional changes in DNA, the price paid by multicellular organisms including humans for long-term adaptation to the environment.

Cancer has hereditary susceptibility: the children of cancer patients are more likely to develop cancer than the children of non-cancer patients. At the same time, environment and lifestyle are important triggers; inherited genes are only a gun loaded with bullets, and it is the acquired survival environment and the individual's lifestyle and diet that pull the trigger. If ordinary people understood the principles of carcinogenesis, stayed away from carcinogens, and consciously abandoned bad habits, cancer incidence would drop sharply.

The services provided by genetic counselors are precisely aimed at reducing cancer incidence. Many people spare no expense treating cancer after developing it, yet are unwilling to spend far less on a genetic counselor before developing it—a backward life philosophy.

Oncology knowledge is advancing rapidly, so a work like Genetic Consultation in Clinical Cancer Care will inevitably fall out of date. Schneider's book is now in its third edition, and the omission of the newest oncology knowledge is a shortcoming. Even so, it remains an excellent work on cancer genetics; for ordinary readers, this book is enough to help prevent many cancers.