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 Cancer

september 2012

How Late Is LATE In Cancer Care?

Dr Shona Nag
 
Cancer is fast emerging as a major public health problem in India and compounding it is also the high mortality rate associated with the disease in our country. Cancer treatment requires specialized infrastructure and a large human resource, both things we lack.

While cancer treatments today are more effective and we can cure a lot more people, the single most crucial determinant for curing a cancer patient is the stage at which it is diagnosed. Early diagnosis, where cancer is found in its initial stages, is hope for success.

Magnitude Of The Case & Dealing With It
It is estimated that one million new cancer cases show up in India every year, and at a given time there are 2.5 million cancer cases in the country. This data is according to the hospital and population based cancer registries and is probably an under-representation of the actual numbers. The problem needs to be tackled on two major footings:
  • At the public level, we need to raise awareness by disseminating correct information on prevention and treatment of cancer.
  • At the individualistic level, we need to allay the fears, abolish the stigma associated with the word “cancer”, and draw people for testing right at the start of the problem.
Problem Of Late Diagnosis
In the fight against cancer, India is still largely faced with a scenario where the disease has already progressed to the later stages by the time the patient meets the doctor. The situation restricts the scope of treatment to controlling the disease and not aim at complete cure, even with the current availability of new and advanced drugs.

Breast cancer, for one, is on the rise in our metropolitan cities. The westernization of urban Indian women leading to late marriages and childbearing, lack of breastfeeding after childbirth, high fat diet and stressful lifestyles are some of the reasons attributed to the increased incidence. But, almost 30-40 per cent of these cases are detected in a later stage where they cannot be cured. Let alone lack of awareness, plain complacency and even reasons as trivial as a wedding in the family and maintenance of family dynamics are found to be grounds on which women delay a necessary check up.

There is a great stigma attached to the word “cancer” in our country. It is never mentioned in the same breath as heart disease or diabetes, even though it is really a lifestyle disease. Bringing cancer and issues on its prevalence out in the open, removing the misconceptions and accepting and integrating cancer patients in society especially after their treatment is important.

Ways And Means Of Prevention
Primary Prevention
Secondary Prevention
The aim is to educate the public about
the risk factors for cancer and reduce
its incidence by modifying them. For
example, 50 per cent of all cancers in
males are tobacco related and anti-tobacco programmes, especially in
the teenage groups when these habits
are first picked up, can prevent a large
proportion of them
While lifestyle changes may not be possible for everyone, the next best thing is secondary prevention. This means, healthy people taking to regular health check-ups or cancer screening tests.
Also, most women detect breast lumps themselves; practising breast selfexamination once a month can lead to early detection of breast cancer
  • Woman: After reaching 21years, it’s a good idea to have a PAP smear and a clinical breast examination once in two years along with other gynaecological check-ups. A regular mammogram is also recommended when aged 45 and above.
People must know that a few simple steps are all it takes for a healthy lifestyle and the fear of losing out on all enjoyments need not be:
  • Man: An oral examination and colonoscopy is helpful. After the age of 50, a PSA (Prostate- Specific Antigen) blood test to detect prostate cancer may be useful.
  • Go for lots of fruits and vegetables, more fibre and less fat. It makes a reasonably healthy diet.
Extremely aggressive efforts with screening programmes have been effective in reducing the incidence of cancer in developed countries. Even while cancer screening programmes are costly in India, we must explore appropriate programmes for early diagnosis across our primary and secondary health centres.
  • Restrict alcohol to weekends (and it’s not to mean binge drinking!).
  • Incorporate exercise in the daily schedule.
  • Learn and practise some relaxation techniques.
  • Keep junk food for that one special treat a week only.
 
Dr Shona Nag is Senior Consultant Medical Oncologist, Apollo Hospitals [Jehangir Hospital], Pune.