Dr. Geetha Nagasree N
February fourth is observed throughout the world as the World Cancer Day. This special day is marked throughout the world to spread awareness about early detection, prompt treatment and preventing disinformation, discrimination, stigma and to prevent injustice to people suffering from cancer. The Union for International Cancer Control is one of the leading bodies which support the World Cancer Day to draw attention to the world cancer declaration. This declaration calls upon the Governments, health care stakeholders and policy makers to ensure steps to reduce the burden of cancer in the world and to promote the cause of cancer control, early detection, cancer care access, preventing discrimination and stigma of cancer patients throughout the world, along with ensuring proper rehabilitation. Various events, public meetings, shows, runs, charity events, fund raisers, research meetings and patient interaction meetings mark this day.
The theme of this year is “I am and I will. “ This means that every individual should resolve to take a personal battle against cancer by leading a healthy lifestyle, screening and early diagnosis and treatment, and promote these healthy attitudes and support for cancer victors around oneself. Then only will there be an impact for oneself, within the family, community and thus the entire world.
The need for this kind of focus is immense, just because of two main reasons. The sheer magnitude of this problem in India, and second, the demographics affecting the most productive age group in India causing considerable morbidity and mortality, compared to the rest of the world.
Life span increased
The life expectancy of an average individual has increased tremendously since independence. It used to be around 47 years then and has progressed to almost 80 years now. This improvement in life span has come about despite deterioration in the available quality of air we breathe, contamination of the water we drink, and the adulteration of the food we eat. What are the Indians ding of now? If we look at the statistics, the majority of Indians no longer succumb to infectious diseases, such as the respiratory tract infections, or diarrheal diseases. We bridged that gap almost by the turn of the century. We have made progress and the crossover happened almost two decades ago. The cause nowadays are chronic diseases such as diabetes, hypertension, cardiac diseases, brain strokes and, of course, cancer.
Cancer remains major concern
How much exactly is the cancer burden now? The number is starting to look alarming. Non communicable diseases account for almost 63% deaths now of which the majority is cancers. The projected incidence of patients with cancer amongst males was 679421 ( 94.1 per one lakh population) and amongst females was 712758 ( 103.6 per one lakh population). This is for the year 2020 as per the National Cancer Registry. Cancers common in men are lung, mouth, prostrate, tongue, and they account for 36% of all cancers, and for females, breast, cervix, uterine, ovarian and lung cancer constitute 53% of all cancers. One in 68 males ( male cancers) and one in 29 females ( Breast Cancers) and 1 in 9 Indians will develop cancer throughout their lifetimes.
Breast, cervical cancer deadly
Female cancers deserve a special mention in the Indian context. The incidence of breast cancer is high in the urban Indian females, while the incidence of cervical cancer is high in the rural Indian females. Breast cancer in India is particularly important due to the lower age of onset of the disease by almost 10 years compared to the Western countries. The disease is more aggressive and is detected at a later stage, thus causing almost one out of two females in India diagnosed with breast cancer to succumb within one year of diagnosis. Similarly, India has one of the highest burdens of cervical cancers throughout the world. This is particularly distressing because cervical cancer is perfectly screen able and a preventable disease as well. And when detected early, considerably morbidity and mortality can be prevented. Ovarian cancer is difficult to diagnose at an early stage due to vague symptoms, requirement of a high index of suspicion, and nonspecific presentations.
A loaded gun
A lot of discussion happens on whether cancer is a genetic disease? Does cancer run in the family? Cancer can be compared to a loaded gun. While genetics loads the gun, environmental factors pull the trigger. That means, there are modifiable and non-modifiable risk factors. Genetic factors are certainly one of the non-modifiable risk factors. Certain cancers like breast cancer, ovarian cancer, colonic cancers, and blood malignancies have a genetic predisposition. The genetic predisposed cancers tend to occur in lower age group and within first degree relatives. Age is another non-modifiable risk factor. As the age becomes more, the genetic defects become less and less amenable to correction and repair by the body and thus cause cancers.
Smoking, alcohol kill
Smoking and alcohol are the commonest causes of cancer. Smoking accounts for almost one fifths of premature deaths due to various diseases including cancer. Commonest cancers caused by tobacco and alcohol are oral cancers, lung cancer, throat, and stomach. Lack of physical exercise, sedentary activity and obesity can cause hormonal changes which cause increased propensity towards certain malignancies. Breast cancers and Gynecological cancers are common with obesity. A diet rich in smoked meat also cause colonic cancer. Similarly, exposure to radiation and other harmful chemicals may lead to certain cancers.
Lifestyle changes effective
A lot of cancers are a product of the harmful choices we make for ourselves. Changes in lifestyles are thus highly effective. Avoiding smoking, alcohol and exposure to harmful substances, leading a physically active lifestyle, and having a diet rich in fresh fruits and vegetables are a key to fighting cancer. Not only is such a lifestyle protective against cancer, but also protective against a lot of non-communicable diseases like heart disease, stroke and renal dysfunction.
Screening is the key
Early detection and screening will result in detection of cancers at an early stage and limit the morbidity and mortality. Just as we are aware of the surroundings of our body, we should also be body aware, that is sensitive to any small changes within the body. It is therefore important that we note changes in the body which may point to cancers. Lumps in breast, neck or any other part, especially if painless must be evaluated. Not all lumps are malignant, but malignant lumps are usually painless to start with. Similarly, non-healing ulcers, wounds which bleed easily on touch must be evaluated. Post-menopausal bleeding, blood in motion, vomits or cough must be evaluated as well. Nonspecific vague complaints like unexplained weight loss, early satiety, fullness and abdominal distension are usually missed leading to late detection.
Classification helps planning
The diagnosis of cancer is typically a tissue diagnosis and is done by examining bits of tissue under the microscope. The extent of the disease is also studied using imaging studies like ultrasonography, CT scans, MRI or PET scans. The cancers can be divided into stages depending on localized disease, loco regional spread or distal spread. Classifications like these help in planning of the treatment or estimating the prognosis.
Sea change in treatment
Treatment of cancers has gone a sea change from the earlier times. Improvement in anesthesia techniques and technology in surgery has meant that surgery is no longer as mutilating as earlier; recovery is faster and with less pain and possibility of organ salvage. Similarly, it is possible to push beyond the limits to improve complete removal of the tumors. Better chemotherapy regimens with fewer complications are now available. Personalized precision medicine means only those drugs with maximum effect and minimum side effects suited to a person’s genetic makeup can be given depending upon the tumor biology. The side effects can be minimized and the quality of life enhanced. Radiotherapy is also more precise with less injury to surrounding organs and with minimal doses.
New challenges due to Covid
The covid times have posed new challenges to cancer victors and those fighting cancer. The NCCN guidelines have formulated strategies for vaccination agains t Covid, in which they have recommended that Vaccine can be given when available to patient undergoing active treatment including chemotherapy , surgery and radiation. These patients must be prioritized. The reasons for delay are the same as general population like having just recovered from Covid. Those who have undergone transplantation for blood conditions should delay the vaccine for three months. Those patients receiving ntensive chemotherapy with low blood counts should wait out till the counts return to normal.
The world cancer day thus provides us with an opportunity to dispel widespread misconceptions, and lead us to a healthy lifestyle. The advances in knowledge means that not only can we add years to the life of a patient, but also life to the years of the patient.
(The writer is a senior consultant surgical oncologist. Mobile No. 9908216809)
(Feb 4 is World Cancer Day)