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Next tool is the observation of the development of cancers in people. Work on the location of cancers and where they spread was mainly carried out in the nineteenth and early twentieth centuries and this process of careful description of what happens to patients, allied to very detailed descriptions of the behaviour of tumours, can still contribute useful knowledge. There remains a role for the doctor or group of doctors who keep meticulous records of the findings with large numbers of patients and the outcome for each and every one of them. This kind of clinical science is important but probably has now contributed most of what it can to our knowledge of cancer.
The third kind of method which helps us understand cancer is the study of the development of cancers in communities and of the links between the cancers seen in communities and other features of life in those communities, This is the science of epidemiology and it has, in many ways, been the most revealing of all of the sciences in the study of cancer in chit century (although many scientists practising in the laboratory might not share this view). In fact, epidemiology and experimental science and clinical observation are all complementary and, together, can tell us much about the different causes of cancer.
The study of the development of cancers in populations is best illustrated by the link between lung cancer and smoking. This topic merits a chapter in its own right, which will follow later, but the essence of the observations allows us to illustrate how epidemiology can work. As smoking increased in communities in Western Europe and North America so did lung cancer. Within those communities, it seemed to be mainly people who smoked who got lung cancer. Different groups within the society who had different exposure to cigarette smoking had different rates of lung cancer and when particular groups, for instance doctors, reduced their smoking, lo and behold, they got less lung cancer. This is a simple statement of a very complicated story and the net result has been to reveal the single most important known cause of human cancer, cigarette smoke. All of these observations were made by studying the patterns of cancer within communities, although they went extended by experiments in which the important elements of cigarette smoke, particularly ear, were mixed with cells and were shown to be capable of causing cancerous changes. The link between cigarette smoking and lung cancer remains the strongest clearest and most important link in our entire knowledge of cancer, and the one that presents the greatest potential for winning the war against cancer, at least on that front. In other areas, the links between cancer and lifestyle are much less clear, but they may turn out to be even more important; they certainly require very careful study.
In this chapter we are going to explain how a researcher can work on these problems, how certain of the observations he makes may be very compelling and also what the pitfalls and uncertainties may be. This will provide the basis for discussing each of the important potential causes of cancer, one by one, in ensuing chapters. The values and the limitations of epidemiology are an extremely complex topic and are frequently only well understood by people who are deeply immersed in the subject professionally. Misunderstandings about the strengths and weaknesses of this science have generated considerable confusion among the general public and also among healthcare professionals, and it is worth spending some time looking at how the suggestions of epidemiology are studied and evaluated, how they become more certain and how they may well remain unproven despite many years of careful work.
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Each organ consists of a number of different types of cells arranged in a characteristic pattern. For example, the stomach has an inner lining, a muscle layer and an outer protective coat. The lining contains acid-producing and mucus-producing cells. The middle layer contains muscle cells, blood vessels with the different types of blood cells within them, lymph vessels, lymph cells, and supporting cells which hold all the others together. The outer layer contains supporting cells and nerve cells.

Some cells, such as the acid-producing cells, occur only in the stomach. Some, such as the muscle cells, are also found in the intestines, bladder and other organs. Others, such as blood and lymph vessels, are found throughout the body. Each type of cell has a unique job and a unique appearance. A muscle cell cannot do the job of a nerve cell. An acid-producing cell cannot do the job of a blood cell, and so on.

The process of developing special functions is called differentiation or maturation. A cell with few or no special functions is called undifferentiated, immature or primitive. The only function of undifferentiated cells is to multiply when necessary to produce cells which are capable of developing into specialised cells. Once cells specialise they often lose the ability to multiply. For example, mature red blood cells are so specialised for carrying oxygen around the body that they cannot reproduce themselves. As old cells wear out or are lost by bleeding, new red blood cells come from undifferentiated cells in the bone marrow, not from the mature red cells in the blood.

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Exotic Fried Wild Rice

1 small onion

1/2 carrot

1/2 lemon (squeeze out juice)

1 stick celery

1/2 green capsicum

75 ml vegetable stock

1 clove garlic, crushed

1 tablespoon tamari or shoyu

150 grams wild rice

Sea salt to taste

1 spring onion, chopped

2 eggs

Finely dice the onion, carrot, celery and capsicum. In a wok or frying pan, add 2 tablespoons of the vegetable stock and heat through until the stock boils (alternatively olive oil can be used). Add the garlic and onion and stir fry. Add the other vegetables progressively, adding a little tamari and lemon juice when necessary. Add the cooked wild rice and mix well. While in the wok, push the rice mix towards the edge of the wok and make a small circle in the centre. Break open the two eggs into this space, let this cook. When cooked, dice with a spatula. Blend in with the rice mix. Season to taste with sea salt. Fold the spring onion through the mixture and serve.

Ginger Snapper Fillets

25 grams asparagus

1 carrot

1/2 teaspoon ginger root, finely grated

1/2 teaspoon sherry

1/2 teaspoon soy sauce

1/2 teaspoon corn flour

150 grams snapper fillets

50 grams mushrooms

1 teaspoon parsley

Trim the asparagus and cut the carrot into strips. Combine ginger with sherry, soy sauce and corn flour. Set aside. Place fish in a baking dish with the mushrooms and steam or bake in the oven for 5 to 7 minutes, or until done. Meanwhile, steam the prepared vegetables. Drain the juices from the cooked fish and add to the ginger mixture. Bring to the boil (add a little vegetable stock or water if too thick) and spoon a little over the fish – this keeps the heat in the fish when you serve. Arrange the steamed vegetables on the plate with the fish. Spoon the remaining sauce over the fish and serve.

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