More than 1.6 million people in the United States are diagnosed with cancer every year, according to the American Cancer Society. And although cancer death rates in the U.S. continue to decline, according to the annual Report to the Nation on the status of cancer, amid so many new cases it’s easy to wonder why it seems everyone knows someone – or several people – with cancer.

Surge in survivors, seniors

“The question, ‘Why does everyone have cancer?’ doesn’t come up in my medical office as much as the question, ‘Why do I have cancer?’” said Dr. Judy Hopkins of Novant Health Oncology Specialists, a department of Novant Health Forsyth Medical Center.

“It is true that the incidence of cancer overall is rising, but that’s because we have more people in the world and the population is aging,” Hopkins explained. “If you look at most individual cancers, particularly breast cancer, the incidence is stable yet the death rate is falling. Some of that has to do with the fact that we’re detecting it earlier and the cure rate is better.”

Still, she added, “we have an aging population, and cancer is a disease of aging because our immune systems do not work as well as we get older.”

In fact, of survivors of the 10 most prevalent cancers, nearly half are age 70 or older, according to the American Cancer Society. The organization has reported that the majority (64 percent) of cancer survivors were diagnosed five or more years ago, and 15 percent were diagnosed 20 or more years ago.

Heart disease currently kills more people than all cancers combined, according to the American Heart Association. That said, the New York Times recently reported that not only is cancer poised to eventually overtake heart disease as the No. 1 killer of Americans, but that either heart disease or cancer will be the likely demise of those lucky enough to live a long time.

Hopkins underscored that while it’s true that the immune system becomes less effective as we age – making seniors prime targets for cancer, among other things – a healthy lifestyle bolsters the immune system even in the face of aging.

“If we all got eight hours of sleep every night, exercised 30 minutes to an hour every day and ate a well-balanced diet, would we be able to prevent cancer in most cases? The answer is probably yes,” she said.

Advances and great expectations

The advances that have occurred just within her 38-year medical tenure encourage Hopkins.

“You have to remember that when I graduated medical school in 1977, we were still doing clinical trials on the breast cancer drug tamoxifen,” she said. “It was just the dawn of the breast cancer era. Things have changed dramatically. I have patients today who would not have lived in 1977, who are living long, high-quality lives even if they have metastatic cancer.”

And yet, today’s diagnostic and treatment advances, decreased mortality and increased survival rates are sometimes paired with overly optimistic expectations on the part of patients, Hopkins said.

“In some ways, we’re at the opposite end of the spectrum from the fatalism patients used to have about cancer,” she said. “People think they should be cured, and if they’re not cured it’s because the doctor isn’t smart enough.”

Hopkins added, “Unfortunately, there are many cancers we can’t cure no matter how many doctors you see or centers you go to. All of that said, we’re definitely making huge strides.”

Improving the health of our collective tribe

So when it comes back to that question of what can be done when cancer is seemingly all around us, Hopkins is adamant that the most important work for a legacy of health care change starts with educating the next generation to make wiser lifestyle choices.

“Studies have shown that who you associate with and who your family members are – your tribe – are critically important,” she said. “If your tribe is overweight, chances are you’ll be overweight. If your tribe is sedentary, chances are you’ll be sedentary. If we can start with the youth and their parents and get everyone to be active and eating properly, it’d make a huge difference. We have to change our tribe so we can change who we are individually – and that goes for all health concerns.”

Hopkins stressed that “people need to understand that while cancer is a devastating diagnosis, we have so much we can do that we couldn’t do even 30 years ago when I started my career. And lifestyle makes a difference. People have a choice in how they live their lives and making appropriate choices can reduce the chance they have to face this dreaded illness.”

“Having said that, you can do everything right and still face cancer,” she added. “That’s something we still don’t understand, but hopefully at some point we will.”