Despite developments in cancer prevention, diagnosis and treatment, half of the world’s population do not get the full range of essential health services. Availability, accessibility, affordability are important factors that cause this gap in care, says Dr Sushmita Ghoshal, Professor and Head, Department of Radiotherapy, PGIMER
February 4 is World Cancer Day. But awareness is nothing if not acted upon. Most cancers are preventable if we watch our lifestyle. Some of them are slow-growing as tissue changes take time and regular screening can pick them up for earliest intervention, says Dr Sushmita Ghoshal, Professor and Head, Department of Radiotherapy, PGIMER.
Why is cancer such a dreaded word?
Cancer is the second leading cause of death worldwide. The word is correlated with the fear of suffering and death. The suffering is not merely physical but psycho-social, economic and spiritual. Much of the fear stems from ignorance and misconceptions and can be allayed through communication. After all, it’s just a word, not a sentence.
Can cancer be cured?
Yes, if detected early. Early detection and appropriate treatment can cure approximately one third of all cancers. Not only are lives saved but also the cured survivors can go back to their normal lives and contribute to society. Hence, we must stress upon the importance of early detection at every possible forum.
Cancer can be detected early by actively looking for the disease even before it has become obvious – the process is called screening. Cancers of the mouth or uterine cervix are known to develop over many years through a continuous process of changes in the tissue. These changes are pre-malignant in the beginning and following constant exposure to the risk factor(s) may convert into full-blown cancer. By observing the tissue, it may be possible to detect the changes quite early and appropriate action may be taken to prevent further progression of the disease process.
Similarly, small nodules in the breast can be diagnosed by methodical physical examination or seen with the aid of X-rays or ultrasound. When detected in the pre-malignant or early stage, cancer treatment is very effective with lesser side effects and disfigurement. There are several methods of screening cancers. However, the ones that are commonly practised are the ones that are cost-effective and help to save lives. In our country, screening for breast, cervical and oral cancers have proven to be cost-effective.
Is it possible to prevent cancer?
Approximately 40 per cent of cancers can be prevented by modifying lifestyle and exposure to risk factors. Many cancers are associated with the use of tobacco and alcohol. Cancer of the cervix is associated with viral infection that can be prevented by vaccination at an early age. When such known risk factors are avoided/controlled, it can prevent development of cancer. Therefore, it is important to know the risk factors that lead to cancer. When the risk factor cannot be modified (e.g. genetic defect), the individual needs to be monitored closely by appropriate screening.
Why is it that so many patients come to the hospital in the late stage of cancer?
The early symptoms and signs of cancer are not very specific and people often ignore them. Lack of awareness among primary care physicians means they often fail to notice the warning signs. Considerable time is lost before the diagnosis is established. The treatment is often not available near the patient’s home and arrangements must be made to go to higher centres for treatment. In our hospital, we see many patients who travel more than 100 km to seek treatment. Some look for alternative therapy for various reasons.
What are the socio-economic effects?
Cancer affects the individual, caregivers, family and friends and in many societies, it’s considered a taboo to mention it. It may lead to social isolation, depression, anxiety and many more distressing psychological symptoms. Despite the awe- inspiring developments in cancer prevention, diagnosis and treatment, half of the world’s population do not get the full range of essential health services. Availability, accessibility, affordability are important factors that cause this gap in care. This is why the Union for International Cancer Control has chosen the theme, “Close the Care Gap” for World Cancer Day 2022 – 2024. By raising the public and political literacy, we can reduce fear, increase understanding, dispel myths and change attitudes.
What message do people need to take away?
First, cancer is a spectrum of diseases, not a single disease entity. So, all cancer patients will not have the same treatment or outcome. Prevention is better than cure, so be aware of the risk factors and avoid them. Early signs of cancer may be non-specific, so look out for these signs and symptoms. An ostrich attitude will not evade cancer, so appropriate investigations and treatment are a must. Raise your awareness about appropriate treatment, the most expensive one is not necessarily the most appropriate choice. Treatment of cancer is possible and should be available for all. The common myths and misconceptions regarding cancer should be dispelled. We must ask for proper treatment closer home, affordable cancer care and access to palliative care. Most importantly, we need to overcome our fear, unite our efforts to demand for quality cancer care including dignity, respect, support and care. Let us all pledge to do our bit to close the care gap.
What are risk factors of cancer?
Intrinsic risk factors:
*Random errors in DNA replication (Unmodifiable)
Non-intrinsic risk factors:
Endogenous risk factors
*DNA repair machinery
Exogenous risk factors
*Tumour causing viruses
*Bad lifestyles such as smoking, lack of exercise, nutrient imbalance etc