There is no denying the fact that treatment technology has transformed so much from incurable disease to personalized treatment protocols and painless care that has made cancer treatment journey an endurable one. Even with the latest innovation pertaining to cancer treatment that has achieved near cure success, it still affects the quality of life of an individual after and during the therapy sessions.
We will look into the aspects of cure and prevention and why is a prevention step ahead of cancer diagnosis and treatment. For this, we need to understand the implications imparted by cancer in the patient and his caregiver’s life.
- Financial Implications – According to the latest WHO data, India has a cancer mortality rate of 79 per 100,000 deaths. Also, cancer mortality is projected to increase to over 900,000 deaths by the end of this decade. In India, out of the pocket expenditure on cancer treatment is among the highest for any ailment. More so, it is higher in private facilities than public facilities. This expenditure is in excess of 20% of the annual per capita household expenditure of the majority of households in India. The cost remains high for almost all cancer management. With socioeconomic situations like India, people simply cannot afford it.
- Social Implications – Cancer does not just affect an individual but the entire family. Cancer diagnosis, treatment, and sessions of chemo and radiotherapy take a long time of not only the person affected but also of the person’s family. In India, the majority of households have a single earning member, and if in case the breadwinner itself is the patient then there is a huge financial and social implication on the family. There is also a compromise in the quality of life of the patients post-treatment, which further puts a socio-economic burden on the entire family. Although these days, with the advancement in treatment techniques and reduction in side-effects of treatment and proper rehabilitation of patients post-treatment, the quality of life is not a big challenge and is well maintained.
- Emotional Implications – Talking of objective assessment of psychological implication because of cancer in our country, it was found in a study from Bangalore, that psychiatric morbidity ranged from 41.7% to 46%, with most common disorders being anxiety and depression. Depression rates ranged from 4.4% to 89.9% and anxiety rates range from 1.2% to 97.8%. This wide range could be due to the heterogeneity in sociodemographic factors. India is a plural society in terms of religion, social class, literacy, place of stay, family structure, and all of these have implications for the occurrence of emotional distress following the diagnosis of cancer. Such high incidences of psychological distress are not only prevalent in patients but are also seen in their caregivers. This makes a great impact on the entire family of the cancer patient.
Looking at these aspects which get affected from the time when cancer is diagnosed, to the time when treatment begins and ends and also after the entire treatment, makes us realize the great importance of preventing cancers and detecting them early so that individual’s life is not affected to such an extent.
In our country, there are five most common cancers among males which are lung, head and neck, prostate, stomach, and large bowel. In women, these are stomach, cervix, ovary, oral, and breast cancer. These cancers together account for almost 47% of all cancers and these are preventable cancers. Hence, knowing the preventive aspects of these cancers can save us from the above mentioned holistic damage done by cancers.
Preventive strategies are divided into primary and secondary prevention and these depend on the risk factors associated with cancers which are divided into modifiable and non-modifiable risk factors. The modifiable risk factors are generally the ones associated with lifestyle and habits like smoking and alcohol consumption, unhealthy food habits, sedentary lifestyle, lack of exercise, etc. The non-modifiable risk factors include the genetic and hereditary causes of cancers which cannot be prevented but may be diagnosed early to keep a check on the cancer occurrence.
So, primary prevention aims at a set of interventions that keep a cancerous process from ever developing. It includes health counseling and education, environmental controls, and product safety as examples. Secondary prevention is that set of interventions leading to the discovery and control of cancerous or precancerous processes while localized, i.e., screening, early detection, and effective treatment.
Examples of relevant primary prevention are cessation of smoking and alcohol consumption, which account for the majority of cancers in the human body. Smoking in any form is dangerous. Both active and passive smoking are equal contributors. Even a single puff of smoke puts oneself at risk of developing cancer. Risk is never zero but decreases significantly after cessation. Similarly with after quitting alcohol, the risk never goes down to zero but decreases dramatically. These two major culprits not only are big contributors to cancer development but are also responsible for other diseases like hypertension, heart illness, diabetes, kidney failure, liver failure, etc.
The other modifiable and important factors of lifestyle alteration are exercise and food habits. There has been too much westernization of Indian food habits, which has diverged from healthy, endemic eating style to unhealthy western style of eating. It has been proven that less consumption of fruits and vegetables and more consumption of processed foods lead to bowel cancer, breast cancer, and also to diabetes, hypertension, and heart diseases. We, Indians should focus on eating habits that are native to our country. Our country is diverse in different kinds of food production and consumption suiting diverse population variety residing here.
Lately, the lifestyle risk factor which has also shown its impact on the rising incidence of breast cancer in India is the modern lifestyle practice of late marriage, late childbirth, no childbirth, or no breastfeeding. All these contribute to an increase in estrogen hormone in the female body which eventually is responsible for developing breast cancer. In India, there has been a trend towards an increase in breast cancer incidence over the past 2 decades which could be explained on the basis of these observations. But, the other reason for the rising incidence is also contributed by awareness about breast cancer in our society now. More screen-detected and early-stage cancers are now diagnosed, treated, and cured with cure rates of above 90%.
One of the examples of primary prevention is vaccine immunization. Vaccination against Human Papilloma Virus (HPV) for prevention against cervical cancer has shown promising results and is now recommended in girls aged 9 years and above with either 2 doses for age group 9-14 years or 3 doses for age >/= 15 years.
Hepatitis B vaccination is a part of the routine immunization schedule in our country now. The primary goal of Hepatitis B vaccination is to control chronic HBV infection in early childhood and prevent future development of complications such as Cirrhosis, Hepatic Decompensation, and Hepatocellular Carcinoma (Liver Cancer) in late adulthood.
There are ongoing researches on vaccine development against Epstein-Barr Virus (EBV) which is associated with several malignancies, including Nasopharyngeal Carcinoma, Gastric Carcinoma, Hodgkin Lymphoma, Burkitt Lymphoma, and Lymphomas in immunocompromised persons.
A very important contribution to early diagnosis and treatment is done by secondary preventive measures which mostly included the screening tests. By definition, screening means checking for cancer (or for conditions that may become cancer) in people who have no symptoms.
Screening programs have shown good results in cervical cancer prevention in our country. It is done with the help of simple tests like Pap Smear or HPV DNA/RNA in samples of cells taken from the cervix. It is done in females of sexually active age group and has shown to decrease deaths due to cervical cancer by 30%.
Screening with the help of Mammography and Self-breast examination has shown good results in detecting early breast cancers. Mammography of both breasts is a simple low dose X-ray procedure that can help detect lumps/swelling in the breasts. It has to be started after the age of 50 years or early in some cases and to be continued every 2 years.
Another simple blood test like a Prostate-Specific Antigen (PSA) test is done in the elderly males after the age of 50 years to diagnose prostate cancer. Some blood tests are also available for some bowel/gastrointestinal/liver cancers which can be advised. For families, where colon (gut) cancers are common, colonoscopy can be helpful in early detection. These days there is an upcoming role of low dose CT scan for early detection of lung cancer in people who are known smokers and are at high risk for lung cancer. Head and neck cancer (mouth and throat cancers) are very very common in India especially because of gutka/pan masala consumption. These cancers have pre-cancerous conditions known as Leukoplakia/Erythroplakia which can be picked up on oral examination which can be done at home also.
World Health Organization (WHO) has given 7 warning signs of cancer which should alarm any person and seek medical advice if these symptoms persist for more than two weeks. These are:
- Change in bowel and bladder habits
- Any sore anywhere in the body that doesn’t heal
- Unusual bleeding or discharge from any opening in the body
- Unexplained weight loss or loss of appetite
- Difficulty in swallowing or chronic indigestion
- Lumps anywhere in the body
- A nagging cough or persistent hoarseness of voice
Over and above these symptoms, we should also keep a watch on Anemia (fall in the blood).
With all the above information in mind, it is rather safe to understand how better is cancer prevention in saving time, money, and avoiding all that suffering. We should not forget the fact that cancer, if diagnosed and treated early, has cure rates of around 90% in some cases. With modern diagnostic and treatment techniques that minimize treatment side-effects, even the cancers diagnosed in late stages could be treated successfully while maintaining a sound quality of life. So let’s not fear cancer, rather understand it better and fight with it in a spirited way.