“Close the Care Gap” focuses to have impact beyond World Cancer Day
4th Feb 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 stake holders 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.
This year, instead of the World Cancer Day being just a day, the theme has been set for three years, and the action plan for each of the three years laid out. The theme of the year 2022 to 2024 is “Close the Care Gap”. The campaign focuses to have an impact beyond the day itself and hopes communities will take up the responsibility to address the theme beyond the day well into the three years on a continuous sustainable basis.
The campaign focuses on emphasizing the difference in cancer incidence and care available to various people based on their gender, socio economic status, ethnicity, sexual orientation, political outlooks, or any other discriminating factors.
The first year is about “Realizing the problem” that inequalities exist, and that these inequalities are not set in stone and efforts can be made to break down these inequalities and try to develop a cancer free society, and a society where every individual has equitable access to the right kind of cancer care he needs. The second year is about “uniting our voices and taking action”, where it is a known fact that we can make a strong impact only if we are united in our efforts. We can join Hands with our friends, neighbors, colleagues, and those around us. Once enough buzz and opinion is generated, the last year of the theme is focused on “Together, we challenge those in power” where the issues faced regarding the inequality in cancer care are scaled up to the leaders and those in power, so that policies and an environment for prioritizing and bridging the gap in cancer care can be created.
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.
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 dying of now? If we look at the statistics, most Indians no longer succumb to infectious diseases, like 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.
How much exactly is the cancer burden now? The number is starting to look alarming. According to the report from the National Cancer Registry Program, India, National Statistics report released in 2020, Non Communicable Diseases were found to for 63 % of all deaths, and cancers account for 9% of deaths. The data, based on both Hospital based cancer registries as well as population-based cancer registries show, true to the theme of the year, heterogenicity of the incidence of cancer, with women projected to be afflicted more than men, bucking the international trend. The incidence of cancer in the year 2025 is likely to be 1569793 no of cases of which tobacco related cancers were likely to be almost 27.2 %, cancers of the digestive tract 19.8%, and cancers of the breast and uterus/cervix/ovary 14.8 and 5.1 respectively. Cancers common in the men are lung, mouth, prostrate, tongue, and 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.
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. Some startling facts come from the reports of the National Family Health Survey-4 which state 8.7 and 53.8 percent women and men consume alcohol in the state of Telangana, and 2.8 and 28.2 percent women and men consume tobacco in any form in the state. Less than one third of women have undergone examination of the cervix at least once in their lifetimes, and examination of the breasts and oral cavity is less than 10%. The Telangana State Cancer Fact Sheet, a research report released by ICMR and National Centre for Disease Informatics and Research (NCDIR), based on current trend, new cases of cancer will increase in Telangana by 12.5%. According to the report, one in 7 women, and one in 9 men below the age of 74 years are likely to develop cancer by 2025. The commonest cancer in the men is mouth cancer, and that in the women is breast cancer.
A lot of discussion happens as to is cancer 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, and colonic cancers, 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 and alcohol are the commonest causes of cancer. 30% of cancers are due to tobacco, and 70% of cancers are due to preventable causes. 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.
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.
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, vomitus 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.
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.
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.
The covid times have posed new challenges to cancer victors and those fighting cancer. The NCCN guidelines have formulated strategies for vaccination against 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 intensive 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 advance 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.