Reducing The Incidence Of Cancer In India, By Increasing Awareness And Prevention
What can be done?
There is an urgent need to focus on: -
1. Creating an awareness in the whole populace, about the issues discussed above, and about the early warning signs of possible cancer
2. Prevention, especially by decreasing the use of tobacco (in all forms) and alcohol consumption, Vaccination against Hepatitis and HPV, reducing pollution and cleaning up our rivers, change in farming practices to eliminate chemical pesticides, change in dietary habits and sedentary lifestyle (since obesity is linked to a couple of cancers).
3. Early detection, by creating the awareness, as well as screening the “at risk population”
4. Appropriate treatment at the earliest, whether it is with the aim of cure in early-stage cancers, or Palliative / symptomatic and supportive treatment in late stages.
5. End of life care, whether institutionalised hospice care or domiciliary support
Creating AWARENESS & PREVENTION
As mentioned in my previous article, approximately 60% of the cases of Cancer are preventable, by the measures mentioned.
Tobacco- 80% of all cancers which occur in the upper aero-digestive tract (UADT), which starts from the nose/mouth, involves the whole oral cavity and pharynx, right down the larynx to the lungs and down the oesophagus to the stomach and 40 % of all cancers which occur in the body (including those in the Pancreas, colon, kidney, urinary bladder and cervix), are caused by the carcinogens found in tobacco (used in any form).
Alcohol potentiates the effects of cancer, especially in the UADT.
The numbers are alarming when we consider that 35% of all Indians, i.e around 274 million people, use tobacco in some form or the other. Of these, 163 million use smokeless tobacco (chewable in some form or the other), 69 million are active smokers and perhaps an equal number are passive smokers and 42 million are mixed users. “Vaping” is a new trend which can also cause cancer. Hence it has been estimated that 45% of all cancers in males (up to 57% in the North-east) in India and 17% of all cancer in females (up to 28% in the North-east) in India are due to tobacco. Thus tobacco usage causes 1 death every 8 seconds in India, since it also causes heart and lung diseases, apart from stroke and blindness, tooth disease and infertility. So creating awareness about the ill-effects of tobacco and de-addiction centres for those who wish to leave it as well as alcohol and drugs, would make a huge impact in decreasing the incidence of cancer and improving the health and finances of the user. This awareness needs to be created at all levels, right from the schools and colleges, to involve the whole community.
Infections:-
(a) Hepatitis B & C are responsible for the majority of Liver cancers in India & south-east Asia. Since India has the 2nd highest number of people affected with Hepatitis B, compulsory vaccination against Hepatitis B should bring down the incidence of liver cancer considerably.
(b) Human Papillomavirus (HPV), especially types 6,11,16 &18, are responsible for 99% of the cases of Cancer Cervix, which is the second commonest cancer amongst females in India and also related to poor genital hygiene, multiple/ infected sexual partners. The virus also causes nasopharyngeal cancer, which has a high incidence in certain states in the north-east. 2 types of Vaccine against HPV are marketed by MNC’s in India, the Quadrivalent (effective against all 4 strains) and the bivalent vaccine (effective against HPV type 16 & 18). Compulsory inoculation of this vaccine (an Indian vaccine is also in an advanced stage of development) in pre-puberty girls, should decrease the incidence of cervical cancer considerably, in the years to come.
Environmental Pollution
(a) Air:- Today India has the dubious distinction of having 14/15 of the most polluted cities in the world. So for those staying in our cities, one does not need to be a smoker to be inhaling all sorts of carcinogens in the air that we breathe, spewed by the factories and vehicles of every type (especially the old auto-rickshaws, buses and trucks), as well as the methane and hydrogen sulphide and other toxic gases generated by the unsegregated waste undergoing anaerobic decomposition in our landfills. Smoke from coal-fired “chullahs” can also cause lung cancer. Hence there is an urgent need to control all these sources of pollution.
(b) Water and land:- Dumping of carcinogens into the nearest water body is the easiest and cheapest means of disposal by all industries. This is easily visible by the foam in the lakes of Bangalore and other cities and the colour of our rivers which have become stinking drains. Studies have shown a statistically significant high incidence of Gall bladder cancer and all cancers, in the population living in the Gangetic plains (where the tanneries and other factories dump heavy metals into the water) and around other water bodies. The water is also polluted by farmers using a large amount of pesticides which leach through the soil into the underground aquifers, which eventually we drink or eat through our vegetables and meat products. The end result is the high incidence of cancers in these regions, like in Moga district of Punjab. So unless we can control these practices by strict punishment for offending industries polluting our water and changing over to organic farming/ use of traditional Indian pest-resistant seeds, we will continue to ingest chemical poisons in our food and drink and develop cancer.
(c) Radiation due to Radon gases in houses has been documented as a cause of cancer in the west, especially in USA. Anecdotal cases of cancer in those living close to high tension power lines and exposure to microwaves from mobile towers as well as due to continuous use of cellphones at the ear, has been mentioned as harmful, but no statistical correlation with cancer has been documented.
(d) Similarly, inhalation of fine asbestos particles, in old buildings, or as occurs in the ship- breaking Industry in Gujrat (Occupational exposure), has been documented to cause a type of cancer in the pleura (which lines the chest wall and lungs).
Diet - A high fat and protein, low roughage (western) diet, has been correlated with a higher incidence of colon cancer. Hence switching back to the traditional Indian diet is better. Ingestion of salted smoked meat can cause stomach cancer and eating poorly preserved food (which allows the growth of moulds with Aflatoxin) can cause liver cancers and partly accounts for the higher incidence of some cancers in the North-east of India.
Obesity- Diet, as mentioned above, and lack of exercise, combine to cause obesity. Obesity has been linked to a higher incidence of Breast, Ovarian and Gall bladder cancer, which are the leading causes of cancer amongst women in India. So we need to control our diet/ calories and get fit by avoiding sedentary lifestyles.
Genetics (as explained in my previous article), plays a big role as to who will develop cancer, as well as therapeutic strategies since for each type of cancer a specific gene mutation has been found. However, only 10% of all cancers are hereditary (e.g. BRACA 1 & 2 mutations can cause Breast and Ovarian cancer). Hence “genetic mapping” and “prophylactic mastectomy”, has been resorted to by some women especially in the west, with a predicted high chance of developing breast cancer (made famous by a Hollywood actress). “Gene therapy”, to replace defective genes, is the next big thrust in future treatments for cancer.
Reproductive factors- Late pregnancies/ Lack of childbearing or breastfeeding, increases the chances of breast cancer. Prolonged use of certain compositions of contraceptives or hormonal therapy to postpone menopause also has the same effect. So getting back to the natural way of life lived by our great-grandmothers would probably decrease chances of breast cancer.
Age- In the west, the incidence of cancer (like cardiovascular diseases, stroke and diabetes) increases with increasing age. This is similar to a car giving more trouble in all its parts and becoming more difficult repair, as it grows older. However, in our country we see cancer occurring in younger ages, which are more aggressive and present in later stages of the disease, with worse outcomes. Hence there is a need for increased awareness about the causes of cancer and the early warning signs of cancer (which I shall discuss in my next article).
