Ka Wai Ola - Office of Hawaiian Affairs, 1 September 1982 — HE MAU NINAU OLA [ARTICLE]

HE MAU NINAU OLA

By Kekuni Blaisdell Mahalo a nui to you readers for your responses and ninau, questions, to our first eolumn. Y our reactions provide the basis for this second eolumn of ninau and pane, answers. 1 . Q: What is the mean of He Mau Ninau Ola? A: He Mau Ninau Ola means some health questions. 2. Q: What is OH A doing about the Hawaiian health problems you cited in your eolumn? A: Kamuela Apuna, OHA human services officer, reports that the OHA Heahh and Human Resources Committee, chaired by OHA Trustee Thomas Kaulukukui, Sr., has reviewed the Hawaiian health needs assessments to include that of Alu Like, and is focusing on three main heahh problems: (1) Prevention control of the high prevalence of cancer in us Hawaiians. (2) Combating aleoholism and its consequences in the Hawaiian aleoholie and his family. (3) Reducing unwanted teenage pregnancies in Hawaiian communities. Kamuela referred me to the Cancer Center of Hawai'i eoncerning the proposed cancer control project. The main features of this project are described below in the answer to Questions No. 4. Details of the OHA plans for alcoholism and unwanted teenage pregnancies will be covered in future columns. 3. Q. Did the ancient Hawaiians have cancer like so many Hawaiians today? A: Capt. James Cook's Journals of 1778-79, whieh describe our kupuna at the time of first contact with na po'e haole, contain no direct references to cancer as such or to disorders that could be readily inferred to be cancerous. The ailments alluded to in the writings of the earliest western explorers of the Pacific include skin sores, humpback, blindness, absence of hands and feet since birth, dwarfism, and a woman from Ni'ihau who was "wrong in her senses." Samuel Kamakau, one of the early native Hawaiian chroniclers, recorded in 1870 that before the coming of foreigners, there were "no ma'i 'a'ai, diseases that eat away the body." However, objective evidence of cancer in pre-contact Hawaiians is found in the bones of one human body among 1,171 excavated from the sand dunes of Mokapu, O'ahu, and now preserved in the Bishop Museum. The spinal vertebrae of this skeleton shows bone destruction characteristic of cancer, according to bone pathologists at the U.S. Armed Forces Institute of Pathology in Washington, D.C. The presumed cancer is thought to have spread to the bone from soft tissues, such as the lung or stomach. Thus, there is some evidence that cancer did exist in old Hawai'i, but we do not know precisely what varieties of cancer occurred and we do not know how commonly or uneommonly. A famous case of post-contact cancer was that of the breast tumor of the High Chiefess Kapi'olani who had defied Pele in 1824. Born in 1781, three years after the arrival of Capt. Cook, she died in 1841, after b: ast surgery by missionary Kauka Gerrit Judd. Today, because of fairly sophisticated statewide health-care, coordinated with meehanisms for data collection and analysis, we have invaluable information on the occurrence of specific types of cancer as related to race, sex, age and time. Figures from the Hawai'i Tumor Registry for the period 1973-1977 show that: (1) We Hawaiians have

more cancer of the lung, stomach, breast, uterus and pancreas than any other ethnic group in Hawai'i. (2) Since 1968-1972, increase in cancer of the lung is greatest among us po'e Hawai'i. The sad reality is that in our own homeland, we Hawaiians not only lead in cancer incidence for the specified issue sites, but for cancer of the lung, our rates are rising fastest with time. As one 'opio has said, "we are going from worst to worstest." 4. Q: Both of my parents died this year of cancer. Does this mean that I and my children will die of cancer too? A: The risk of yourdevelopingcancer is higherthan if your parents had not had cancer. The degree of risk and what you ean do about it depends on the type of cancer, what is known about causal and associated factors, and how you make use of this information. Most eommon cancers are sporadic, rather than familial, but occasionally cancers of the breast, eolon and uterus occur in more than one member of a family, and if so, they often occur at a younger age. A few rare tumors, such as polyps of the eolon and mukiple endocrine tumors, may be clearly hereditary, with at least one affected relative in eaeh generation. As for associated and controllable factors, we now know that most cases of lung cancer are related to cigarette-smoking; esophageal eancer is linked to both aleohol and cigarette consumption; stomach cancer risk is increased among eaters of pickled vegetables and dried, salted fish; breast cancer is more likely with obesity, high meat and fat-intake and late age of first pregnancy; eolon cancer with beef-eating; and skin cancer to sun exposure. It would seem advisable foryou to confer with your private physician and or phone 5241234, the Cancer Center of Hawai'i Information Line, about your particular situation. The Cancer Center's personalized, yet confidential, telephone education service is provided free to all. All readers should also be awarethat the National Cancer Institute, the American Cancer Society, and the Cancer Center of Hawai'i have provided the following guidelines for cancer prevention and eontrol: (1) Seek examination by your physician regularly: yearly for your children, at least every three years if you are age 20 to 40, and every year if age 40 or older. Ask your doctor about particular kinds of cancer to whieh you may be at high risk and about specific prevention measures. (2) Avoid exposure to factors that are known to in-Cigarette-smoking, whieh predisposes to cancer of the lung, mouth, larynx, urinary bladder, and pancreas. Aleohol, whieh is linked with cancer of the mouth, larynx,esophagus and liver. Industrial chemicals, such as asbestos associated with lung eaneei", and benzol with leukemia. Radiation, whieh enhances the development ofleukemia and cancer of the thyroid breast, lung, and skin. (3) Ask your physician about, and learn, self-examination for early signs of cancer, such as self-examination of the breast, testes and skin. (4) Be aware of early symptoms and signs of cancer, such as: A lump or swelling, Loeal soreness, Bleeding, Persistent cough, Change in bowel habits, Unexplained weight-loss. (5) Adopt a prudent diet to minimize causal factors in your food: Eat more vegetables, fruit and whole grains (starch and fiber) Eat more fish and ehieken, and less beef and pork

Avoid too mueh fat, such as meats, whole-milk dairy products and cooking oils. Avoid sugar and salt Maintain your ideal weight. This prudent diet should apply to most of your meals. It should replace "junk, fast foods," like cheeseburgers, french fries, milk shakes, soft drinks, pastry and candy, whieh now dominate our lifestyles. If you and your kamali'i, children, abide by this healthful diet fairly regularly, then you ean afford to "treat" yourselves on infrequent, special occasions, such as a wedding pa'ina, with modest portions ofpua'a kalua, roast beef, haupia eake and iee cream. The recommend diet covers most of the items that characteristize the nutrition of so-called "primitive" peoples, including our kupuna maka'ainana. The major exception is the excessive pa'akai, sodium, consumed by the Hawaiians of old and at present. lf we avoid pa'akai, while we return to the main foods of our forefathers, such as kalo, uala (sweet potato), uhi (yam), ulu (breadfruit), mai'a (banana), and the many varieties of i'a (fish), the experts say we would have less cancer and other "diseases of civilization," like high blood pressure, diabetes and heartattack. In Hawai'i kahiko, prevention of illness was the main emphasis, rather than treatment. Eaeh person was taught as a child to take care of himself. This involved not only proper food, but wholesome physical activity, adequate rest, avoidance of harmful substances, respect for nature, especially ka'aina, ke kai and all forms of life, eommunion with one's 'aumakua, thinking wholesome thoughts, and self-discipline. These are pono Hawaiian heahh values. Today, many prevailing practices among us Hawaiians are noi Hawaiian. Self-abuse in the form of puhi paka, inu loa, drug misuse, excessive intake of fat and sugar, laek of physical fitness, and despairing thoughts are not only «n-Hawaiian, they are an/i-Hawaiian. We shall return to this dominant theme in future columns. Meanwhile, readers should be interested in a five-year ehemoprevention cancer control proposal whieh has been endorsed by the OHA Heahh and Human Resources Committee and other groups in our state. The project is still in planning stages by the Cancer Center of Hawai'i whieh is seeking National Center Institute funds. If approved, beginning in 1983, all residents on O'ahu, ages 45 to 74, will be asked to participate for five years. The sample of at least 20,000 volunteers out of a potential 200,000, will be divided into four main groups. Eaeh group will take a different pill, one a day, containing a ehemieal whieh is believed to protect against lung, gut and breast cancers. These chemicals are: vitamin A, vitamin C, vitamin E and the trace mineral selenium. After five years, the occurrence rates of various cancers in these residents will be analyzed to see if any of the four chemicals have had any effect on cancer outcome. Since the highest rates of most eommon cancers occur among us Hawaiians, our ethnic group is of major interest. Dr. Thomas Hall and his team at the Cancer Center of Hawai'i, who are responsible for this chemoprevention project, are eager to engage us Hawaiians in improving the effectiveness of this proposal by participating in information and planning sessions, and in pilot trials. Will we Hawaiians, ages 45 to 74, be willing to take a designated pill daily for five years? Will we be willing to be interviewed about our diets? Will we kokua in periodic blood tests? These and many other ninau are expected in kukakuka, discussions, as this proposal is aired throughout the community. Please feel free to express your views by writing to me care of this eolumn. Ke 'olu'olu. Future topics in this eolumn will be high blood pressure, heart disease, diabetes, alcoholism, unwanted teenage pregnancies, Hawaiian health conceptsand practices, and of course, your ninau.