Ka Wai Ola - Office of Hawaiian Affairs, Volume 1, Number 2, 1 March 1984 — Your Reception is Most Appreciated [ARTICLE+ILLUSTRATION]

Your Reception is Most Appreciated

Mahalo ia 'oukou a pau loa for the many kind words expressed in conjunc-

tion with the February issue. Your reception to our new format and layout has been most encouraging.

This eighth eolumn answers ninau (questions) from several readers about ma'i 'a'ai (cancer) since 1 last discussed this topic in the Fall of 1982. Mahalo ia 'oukou apau readers for your continuing eoneem. Q: I am huikau (confused). In 1982, you reported that a cancer prevention program for us po'e Hawai'i (Hawaiians) would start in 1983. What happened to this project? In the recent Winter 1984 issue of Ka Wai Ola, I read that OHA is working with the Cancer Institute in research on the high incidence of cancer among us po'e Hawai'i. Why more research on what we already know?'Oiai (meanwhile), my husband has died of ma'i 'a'ai and now the kauka (doctor) says my son has cancer. How ean I prevent ma'i 'a'ai from occurring in my mo'opuna (grandchildren)? A: These three ninau will be answered one at a time. 1 . What happened to the cancer prevention proposal for Hawaiians? This chemo-prevention program for eligible kanaka makua (adults) is not just for po'e Hawai'i. Prepared by Dr. Thomas Hall of the Cancer Center of Hawai'i, it is still in the planning stage, and is now being revised for resubmission to the National Cancer Institute in July 1984. If approved and funded, it will begin in 1985 with a pilot study on Kaua'i and then on O'ahu. Several features in this proposal are helpful in answering your other questions whieh follow. 2. Is it possible to prevent ma'i 'a'ai occurring in your mo'opuna? Yes, it is now possible to prevent some forms of ma'i 'a'ai to some extent, and the optimal time to start prevention is in early childhood, as we shall see. Although precise details of mechanisms and means are not yet known, research advances in recent years have provided some guidelines. Four main factors seem to play key roles in the development of ma'i 'a'ai: a. The first is genes, whieh we inherit from our kupuna (ancestors). In 1980, Dr. Miehael Bishop in San Franciscodiscovered special "cancer genes" in the cells of man and other animals that are capable of causing cancer when "initiated." b. The second factor is "initiators." These are agents, such as cancer viruses, chemicals, or ionizing radiation, whieh activate a cancer gene to transform a normal eell into an altered, precancer eell. H owever, this step alone is unsufficient to result in cancer. e. The third factor is "promoters." These substances are necessary to transform a precancer eell into multiplying daughter cancer cells that invade normal tissue and spread to other sites in the kino (body). Such a process takes time, often years, with repeated exposures, and to some extent this process is reversible. That is, if promoters are interrupted early enough, ma'i 'a'ai does not develop. Some identified promoting agents are dietary fat, puhi paka (cigarette smoking), aleohol, asbestos and hormones. d. The fourth factor is kino resistance, whieh includes a variety of special anticancer cells and body substances. Thus, the development of cancer is a multi-factor-multistep process. In the chemoprevention proposal described above, volunteers ages 40 to 65, will take a pill containing betacarotene (vitamin A), whieh ean prevent promotion of lung cancer; or a pill containing selenium, a mineral, whieh ean prevent initiation of gut cancer. After five years, the occurrence rates of various ma'i 'a'ai

in these volunteers will be analyzed to see if betacarotene or selenium will have altered the cancer rates. While this ehemieal prevention trial may prove helpful, it will take at least five years to find out, and there are more effective cancer prevention measures we po'e Hawai'i, as well as nonHawaiians, ean start now, without waiting for someone else's plan, whieh may or may not be funded by the federal government. Professor Richard Doll ofOxfordand other cancer experts have estimated that over 30 percent of all cancers ean be prevented by puhi paka 'ole (not smoking); 35 percent of all ma'i 'a'ai ean be prevented by reducing fat, red meat, salted. pickled and smoked foods in our diet and by increasing high-fibre foods, such as whole fruit, vegetables and grains; and four percent of all cancers ean be prevented by eliminating aleohol. Thus, about 70 percent of all cancers are now preventable! Not by taking a magic pill, but by personal lifestyle measures. Since these lifestyle habits begin at an early age, we kanaka makua (adults) need to take the lead and serve as models for our kamali'i (children) and mo'opuna. The main cause of cancer turns out to be not a single ehemieal, but a variety of agents and behaviors associated with modern civilization, and whieh we ourselves ean control, if we choose to. 3. Why more research on the high ineidence of cancer in Hawaiians? The Cancer Center of Hawai'i has recently submitted a second proposal to the National Cancer Institute, not on the high incidence of cancer in Hawaiians, but to explore why we po'e Hawai'i have the highest cancer rates in the world, and to provide cancer education to school youngsters, to women on breast-screen-ing in Hawaiian communities, and eomplianee education for Hawaiian patients undergoing cancer therapy. Kamuela Apuna of OHA, Haunani Apoliona of Alu Like and Dr. George Mills of the Association of Hawaiian Civic Clubs, were scheduled to meet with the Institute site visitors Mar. 20 to discuss participation of po'e Hawai'i in this program. Here is an example of non-Hawaiian, quasi-governmental agencies reaching out to the Hawaiian community. But we po'e Hawai'i must begintotaketheinitiative ourselves for our own welfare and not wait for the handouts of others. In Hawai'i kahiko, promotion of one's health mana and prevention of illness were the main emphasis. Eaeh child was taught to know his kino and to care for his mana by being in harmony with himself, others, and nature about him. This involved not only proper food, but vigorous physical activity, adequate rest, avoidance of harmful substances, respect for nature, especially ka 'aina (the land), ke kai (the sea), and all forms of life, eommunion with one's 'aumakua, thinking wholesome thoughts and self-discipline. These are pono Hawaiian heahh values. Today, many harmful practices among us po'e Hawai'i are not Hawaiian. We have too easily_ embraced unfavorable anti-Hawaiian ways, such as puhi paka (smoking), 'inu loa (alcoholism), drugabuse, excessive dietary intake of fat and sugar, laek of physical fitness, and ha'ule (despair). Our way to survival as ka lahui (a people) is to selectively relearn useful virtues of our kupuna kahiko as we adapt to the rapidly changing, non-Hawaiian world about us in our pursuit of meaningful lives.

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D. ^lminii— ■ himmi m i i i