Questions About Young Adult Cancer That ’50/50′ Doesn’t Answer

In the film 50/50, a 27-year-old man is diagnosed with a rare form of cancer, called Schwannoma neurofibrosarcoma. His odds of survival: 50 percent. Medical experts, family, friends—even WebMD—proceed to offer the patient a whirlwind of scientific data, raising more questions than answers about the nature of cancer.

We contacted Anna Franklin, medical director of the Adolescent and Young Adult program at M.D. Anderson Cancer Center in Houston, to learn more about cancers that afflict young adults.

What is the overall rate of cancer among young adults?

They aren’t really collected worldwide, but usually by country. In the U.S., there are about 70,000 young adults and adolescents [which the National Cancer Institute defines as ages 15-39] with cancer per year; and that is about seven percent of all cancer diagnoses in the U.S.

What is the survival rate of young adults with cancer compared to other demographic groups, such as older patients?

Much depends on the individual diagnosis. Obviously [each] different cancer is treated differently and will have different survival rates. For pediatric [age 10 and under] leukemia, survival rates are approaching 90 percent. As your age increases, your survival worsens. In older adults [ages 40-60], it’s about 50 percent. Older than that is even lower. For young adults, it’s probably about 70 percent.

It’s hard to [calculate] survival simply on age, because we know there are many other disease factors at play. We also look at [the patient’s] response to treatment. So after their first cycle of chemotherapy, if they still have a detectable disease, we know that their outcome is really quite dismal. So we may intensify their treatment even more.

The movie talks about cancer and libido. What’s the impact of treatment on sexuality?

Surgery and/or radiation therapy can interfere with the nerves that are involved in sexual arousal, such as erection. Some of the side effects of other forms of treatment, such as high blood pressure medications that treat side effects of chemotherapy, interfere with the nerves that help men have erections, have orgasms, and ejaculate.

But some of it is the experience of going through cancer treatments and the psychological ramifications of that.

The movie brings up a rumor that green tea reduces the risk of cancer by 15 percent. Is there any truth to this claim?

There have been studies—not a lot—on green tea. There have not been a lot of prospective trials, however, to see how much tea people drink and how many of those people develop cancer. There have been epidemiological studies, which show that people who drink green tea tend to have less chance of developing cancer.

It’s not just green tea, but other kinds of tea as well. Green tea is relatively new to the Western world—most of the Western world had been drinking black tea until about six or seven years ago. Both kinds of tea contain the same compound, polyphenols, which are believed to inhibit some cancers.

Do we know why people get cancer? Is it genes? Environment?

We still do not know many of the causes of cancer. For example, look at chronic myeloid leukemia, which involves a mutation of the Philadelphia chromosome [named in accordance with the Committee for the Standardization of Chromosomes, which in 1961 suggested that abnormal chromosomes be named for the city in which they were discovered]. If you put that mutation into normal cells, it can turn it into leukemia cells.

So we know the cause, but we don’t know why the cause happens.

The film focuses on a certain variety of cancer, which supposedly affects the spinal cord.
Spinal tumors are very rare. The Schwannoma cell is a specific type of cell in your central nervous system. Some of them are benign, and some of them are malignant. If [the cell] has elements of sarcoma, a term that refers to cancers of the connective tissue, then it is certainly malignant.

One of the problems with very rare tumors is that they’re difficult to research, because so few people have them. Whereas very common tumors—breast, prostate, lung—have many people to study and participate in trials. One of the reasons pediatric cancers have such high cure rates is we can have clinical trials, which allow testing of efficacy.

If you only have a few, or say, a couple hundred people who have [a specific] tumor, and you spread them out all over the world and the U.S., it’s hard to find a treatment that works for them.

-Joel Goldberg

Changing Planet