Dr Shabab L Angurana
Cancer is a term used for diseases in which abnormal cells in the body multiply without control and become immortal, and are then able to invade other body tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems. Cancer is not just one disease, but many diseases. There are more than 200 different types of cancer.
World Cancer Day is marked on February 4th, every year to raise awareness of cancer and to encourage its universal objective of decreasing the global cancer epidemic by concentrating on three prime aims of prevention, early detection, and comprehensive cancer treatment. It is a single initiative under which the entire world can unite together in the fight against cancer the “global epidemic”. It is founded and led by the Union for International Cancer Control (UICC), a global consortium of more than 470 cancer-fighting organisations in over 120 countries. World Cancer Day targets the public through global communications, and encourages policy makers and UICC member organisations to make cancer a political priority. UICC also has responsibility for – The World Cancer Declaration – a tool to help bring the growing cancer crisis to the attention of Government leaders and health policymakers in order to significantly reduce the global cancer burden by 2020.
UICC in collaboration with World Health Organisation (WHO) and other United Nation Organisations (UNO), and other partners in the areas of international cancer prevention and control to increase political commitment for cancer prevention and control; generate new knowledge, and disseminate existing knowledge to facilitate the delivery of evidence-based approaches to cancer control; develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care; facilitate broad networks of cancer control partners at global, regional and national levels; strengthen health systems at national and local levels; provide technical assistance for rapid, effective transfer of best practice interventions to developing countries; and coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis (process of cancer formation), and develop scientific strategies for cancer prevention and control.
World Cancer Day is a reminder to us all to take action against the increasing burden of cancer as cancer cases are projected to almost double by 2030. Another horrifying fact, about cancer is that every year, 7.6 million lives are lost to cancer worldwide and that this is more than AIDS, tuberculosis, and malaria combined.
Cancer awareness has become exceedingly important in the 21st century because although there have been numerous advancements in the understanding, diagnosis, and treatment of cancer-factors that should contribute to the decline of the disease-the number of new cancer cases diagnosed each year has globally continued to increase on an alarming speed.
Can Cancer be Prevented
As a Medical Student, I was taught that, “prevention is better than cure”. If cancer did not occur, there will be no need to worry about curing cancer. Today, let us together, dream of a world free of cancer.
Cancer in an individual are caused by complex interactions of modifiable (Lifestyle, smoking, alcohol, environmental pollutants and chemicals, viral infections) and non modifiable factors (genetic changes). The holistic concept of prevention of cancers is about changing the modifiable factors. And researchers have stated the fact, that one third of cancers can be prevented by altering these modifiable factors. New independent evidence confirms that the increasing global trend of unhealthy and sedentary lifestyles is responsible for putting millions at an unnecessarily high risk of cancer. Also, new estimates released by the World Cancer Research Fund (WCRF) global network suggest that across a range of countries, making lifestyle changes including maintaining a healthy weight (as per your height and age), eating a healthy diet (400 to 500 gm of fruits per day, 400 gm of green vegetables per day, fish every day, chicken once a week and red meat once a month) and taking regular physical activity can reduce the risk of common cancers by up to a third. “In order to improve health and prevent several diseases, adults should do at least 150 minutes moderate physical activity throughout the week. This can be achieved by simply walking 30 minutes five times per week”. There is also consistent evidence that other healthy living initiatives are vital in reducing the risk of cancer including stopping tobacco use, avoiding exposure to passive smoke, avoiding excessive sun exposure and protecting against cancer-causing infections (Human Papilloma Virus (HPV) and Hepatitis B virus).
In India, 40 per cent of the cancers in the country are due to tobacco. Hence, Tobacco related cancers are very common among males, namely, cancers of the lungs and oral cavity. Prevention offers the most cost-effective long-term strategy for the control of cancer. Tobacco use is the single greatest avoidable risk factor for cancer mortality worldwide, causing an estimated 22% of cancer deaths per year. In 2004, 1.6 million of the 7.4 million cancer deaths were due to tobacco use.
Alcohol consumption accounts for approximately 22% cancers in men, whereas in women the attributable burden drops to 9%. It can further be reduced and prevented by appropriate interventions.
Among women, cancer of uterine cervix (Poor hygiene and Viral HPV Infection) and breast (fatty diet, minimal physical activity) are common.
Vaccines help reduce cancer risk. The human Papilloma virus (HPV) vaccine helps prevent most cervical cancers in females and is recommended between age group of 9 to 26 years, and the hepatitis B vaccine can help reduce liver cancer risk. These days both the vaccines are part of the Universal Vaccination Programme.
Environmental pollution of air, water and soil with carcinogenic chemicals accounts for 1-4% of all cancers worldwide, and these can be prevented by meticulous disposal and monitoring of these pollutants.
Can Cancer be Diagnosed Early and Screened?
Yes. Research shows that screening tests for commonest cancer such as, cervical (Pap test), Breast (Mammography), Prostate (Blood PSA levels and Digital Rectal Examination) and colorectal cancers (Colonoscopy and Faecal occult blood test) are recommended globally, which helps preventing and treating these diseases by finding them in precancerous stage or at a very early stage so that they can be treated and cured before they spread. Making cancer screening, information, and referral services available and accessible to the whole population can reduce cancer incidence and deaths.
Conclusion:
The Indian Government needs to make major policy decisions to ensure that access to health care is available to all people in the country, irrespective of their socioeconomic status. We need a strong mandate to strengthen the existing public health system with both improved infrastructure and additional manpower. Most district hospitals and even regional cancer centres do not have the facilities needed to provide quality cancer care to the people who rely on them. The Government needs to increase support to regional cancer centres with mandated authority to provide affordable (and free for poor patients) cancer care and prevention services. Enhancement of capacity and increased clinical and allied health-care manpower are essential. India needs to invest more of its gross domestic product (GDP) in health care, which will deliver both health and wealth to the country. Cancer needs to be seen and addressed as a public health priority. Improvements in outcomes will come through early detection and presentation, primary prevention (especially through tobacco control), and a greater emphasis on the social determinants of cancer. To truly serve public interests, Indian policy makers should be aware of this cancer epidemic reality, along with the importance of focusing rigorously on overcoming the fundamental barriers to provision of affordable, equitable, and universal cancer care for the entire population and “World Cancer Day” is the most appropriate day for individuals, health care workers, health organisations and Indian policy makers to pledge for “Cancer Free India”.
(The author is Consultant Cancer, Palliative and Pain care Specialist, GMC, Jammu.)
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