World Cancer Day is a global initiative, led by the Union for International Cancer Control(UICC), to raise awareness about cancer. The global cancer epidemic is behemothic and is set to increase if left unchecked. Observed on the 4th of February every year, World Cancer Day aims to prevent millions of deaths each year by raising awareness about cancer, addressing inequalities in access to quality cancer health services and sensitising governments and individuals across the globe to take action against the disease. Presently cancer is the second leading cause of death worldwide and globally about 10 million people die from cancer each year. However, almost one-third of cancer-related deaths can be prevented through routine screening, early detection and treatment.
In our country cancer is not only a major public health issue but also an economic issue and its burden is set to spiral. The number of cancer cases in our country is projected to go up from 14.6 lakh in 2022 to 15.7 lakh in 2025, according to the Indian Council of Medical Research-National Cancer Registry Programme (ICMR-NCRP). Northeast has a high incidence of cancer, largely attributed to the widespread use of tobacco and areca nut consumption. The East Khasi Hills in Meghalaya, Aizawl in Mizoram and Papaumpare district of Arunachal Pradesh have reported high incidences of this disease. The six most common cancer types in our country are breast, oral, cervical, lung, stomach and colorectal cancer. A World Health Organization (WHO) report released in 2020 has predicted that 1 in 10 Indians will develop cancer in their lifetime and 1 in 15 will die of it. Modification of lifestyle and avoidance of harmful habits like tobacco consumption can certainly reduce the risk of getting this disease.
The theme for World Cancer Day 2024 is “Close the Care Gap”. The theme highlights the inequalities in access to quality cancer care that exist around the world. The goal is to ensure that everyone, regardless of where they live or their socioeconomic status has access to quality cancer prevention, screening, treatment and palliative care. As responsible citizens, we can support organizations working to improve cancer care by offering them our time, money or skills. We can talk to our friends, families and communities about cancer and the importance of prevention and early detection. We can urge our legislators and policymakers to ensure that the government invests in healthcare infrastructure and make cancer care more affordable as also promote research for newer and better cancer treatments. Every single one of us can make a difference, big or small, and unitedly we can make real progress in reducing disparities in cancer care. The ultimate aim should be to ensure that everyone diagnosed with cancer has an equal chance to live a long and healthy life.
Cancer is a disease in which some of the body’s cells grow uncontrollably. It can start anywhere in the human body and spread to other parts of the body. Normal cells can repair themselves if their genes become damaged(DNA repair). They self-destruct if the damage is too bad( Apoptosis). Cancer cells ignore signals for both the processes – repair and destruction. They look different from normal cells under a microscope – in size and shape and often have a nucleus(control centre) that looks abnormal. When cancer spreads through blood or lymph systems and forms new tumours in other parts of the body, it is called metastasis. There are more than 100 types of cancer which are usually named for the organ or tissue where it forms. For example, lung cancer starts in the lung. Cancers may also be described by the type of cells that formed them such as ‘Squamous cell’ or ‘Epithelial cell’. Many cancers form solid masses but cancers of the blood such as leukaemia, generally do not.
The development of cancer is the result of the interaction of both environmental factors and genetic inheritance and is multifactorial. Cancer can happen to anybody but risk factors include getting older, smoking and chewing tobacco, alcohol consumption, sedentary lifestyle, unhealthy diet, being overweight, too much sun exposure, family history, some chemicals like asbestos and some viruses like the human papillomavirus (HPV), Hepatitis B Virus, Hepatitis C Virus and Epstein Barr Virus. Bacteria like Helicobacter pylori increase the risk of stomach cancer while parasites like Opisthorchis viverrine and Schistosoma haematobium can lead to cholangio-carcinoma and bladder cancer respectively. Immunosuppression as in the case of post kidney transplant and AIDS may predispose to an enhanced risk for cancer. Viruses may cause aberrations in cell signalling pathways or weaken the immune system predisposing to cancer. Some infections cause chronic inflammation which can lead to cancer.
Although every patient may present differently depending on the part affected, some general signs and symptoms of cancer include CAUTION - Change in bladder or bowel habits, A sore that does not heal, Unusual bleeding or discharge/Unexplained weight loss, Thickening or lump in the breast or elsewhere, Indigestion or difficulty in swallowing, Obvious change in wart or mole and Nagging cough or hoarseness. If any of these symptoms have occurred for more than two weeks, it is imperative to consult a doctor. It is best to go for routine screening to ensure early diagnosis which greatly affects the curability of the disease. For example, mammography screening for breast cancer has resulted in reduced breast cancer-related deaths. Preventive steps include avoidance of tobacco and alcohol, regular physical activity, maintaining a healthy weight, a healthy diet rich in fruits and vegetables, reducing exposure to environmental pollution and occupational carcinogens and vaccination against the Hepatitis B Virus and the Human Papilloma Virus. The treatment of cancer depends on the location and stage of the cancer, the person’s age and general health. It may include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy or a combination of some or all of these. In advanced cases, palliative care helps to maintain and improve the quality of life of patients and their families. Hope and courage, which are essential to battle cancer, are both highly contagious and hence the role of caregivers including medical personnel as well as family and friends in helping cancer patients harbour these attitudes is important.
The burden of cancer is not evenly distributed. Most cancer deaths happen in low and middle-income countries as they face significant challenges in accessing essential cancer prevention, diagnosis and treatment services. Low Income, lower education, rural geographic location, disabilities and gender discrimination are important factors that can affect cancer care negatively. Lack of access to healthcare facilities can impede cancer screening and early diagnosis while financial constraints may discourage people from seeking care even if they are aware and eager. In addition, cancer is often associated with stigma, especially in cases of breast and cervical cancer. Lack of awareness about modifiable risk factors and the role of vaccines in the prevention of cancer is another reason for the increasing incidence of cancer in our country. India needs to invest more in health care and strengthen the existing public health system. With improved infrastructure and manpower dedicated to cancer care in each district hospital, the menace of cancer can be fought. Telemedicine services and mobile units may provide services to remote patient populations. Nutritional support should be provided just like the ‘Nikshay Poshan Yojana” for TB patients. Tobacco, alcohol and ultra-processed food industries need better regulation. The government should address cancer as a public health crisis and decentralise cancer care to ensure equal access to all patients. Prevention offers the most cost-effective long-term strategy for cancer control. Instead of a reactive approach to cancer, the need is a proactive approach.
(The author is a medical practitioner. All views and opinions expressed in the article are the author’s own)
