A leading oncologist recently made a claim that due to globalisation, changing lifestyle and ageing population, India is set to face a ‘tsunami of chronic diseases’ such as cancer. This claim, although startling, is backed by decades of experience, scientific evidence and data. In fact, a study published by ICMR estimates that nearly 1 in 9 Indians are at risk of developing cancer. From personal experience, I can assert that 30-50 per cent of the cases that I see on a yearly basis, are caused by preventable risk factors such as smoking, diet, sun exposure, alcohol, environmental pollutants, infections, stress and physical inactivity amongst others.
While scientists and researchers are expanding the scope of cancer treatment with expansive studies and trials, some of which have resulted in cancer vaccines, liquid biopsies, genomic profiling, gene editing and so forth, cancer, as of today, has only one cure–prevention. And at a population level, that is the only way we can reduce incidence and mortality related to the disease.
But where does prevention really begin? It begins with understanding the risk factors. It begins with acknowledging that only 5-10 per cent of cancers that have ever been diagnosed have been linked to genetics and it begins with accepting the fact that our health is not separated or isolated from our actions but are vitally linked to each other.
In India, the most common cancers among males include cancer of the lungs, mouth, stomach, and oesophagus whereas breast and cervical cancer are the most common ones among females. While the symptoms of cancer are often not very specific, depending on the type of cancer, it may present as a change in bowel/bladder habits, indigestion or difficulty in swallowing, a wound that does not heal, a thickening or lump in the breast or other areas, change in a wart/mole, unusual bleeding or discharge and unexplained hoarseness or a nagging cough. Since the symptoms often mimic other conditions, they should not be dismissed or treated as fatigue-related or as a part of ageing. It is important to stay alert to any such changes and a healthcare professional must be consulted at the earliest.
Environmental and lifestyle factors play a major role in enhancing cancer risk such as:
? Use/exposure to tobacco (>27% of all cancers in India are attributed to this cause)
? Lifestyle factors (e.g. alcohol consumption, inappropriate diet, physical inactivity, high body mass index, presence of diabetes)
? Infections [e.g. human papillomavirus (HPV) causes cervical cancer]
? Certain chemicals (e.g. asbestos)
? Radiation (e.g. excessive exposure to sunlight)
Here’s what you can do to reduce the risk of cancer:
? Avoiding the use of tobacco in all its forms (chewing tobacco, cigarettes, bidis, cigars, pipes, etc.) and keeping away from second-hand smoke too
? Avoiding or reducing alcohol consumption
? Eating a healthy diet that is low in sugar, salt, and fat and rich in fresh leafy vegetables and fruits
? Maintaining a healthy weight
? Developing a routine of adequate physical activity
? Keeping up to date with all the necessary vaccines (e.g. Hepatitis B and HPV)
? Reducing exposure to indoor and outdoor air pollution
? Preventing excessive exposure to sunlight by using sunscreen and protective clothing
Regular screening for cancers can help in detecting the disease early. For example, cancers of the breast, cervix and oral/lip account for more than 33 per cent of the cases in India. Cervical cancer can be prevented by the HPV vaccine and is most effective in the younger age groups (from age 9 onwards).
Breast cancer too can be detected by regular self-examination. Some changes in the breast that need to be watched out for are:
? Dimpling or puckering of skin (like the surface of an orange)
? Pain in the breast or armpit
? Thickened areas or lumps
? Nipple-related changes such as altered shape or position, presence of a rash on or around the nipple, discharge from one or both nipples
Regular screening conducted by healthcare professionals aids in detecting these cancers early and improving survival outcomes. As per national guidelines, for individuals above 30 years of age, screening for breast, cervical and oral/lip cancer can be conducted once in 5 years by
? Oral visual examination for oral cancer
? Pap smear and HPV testing for cancer screening
? Clinical breast examination
Screening may need to be more frequent in those at enhanced risk. If any abnormalities are detected during the screening, further tests along with referral to a specialist can help in initiating treatment immediately.
The causes of delay in diagnosis in India range from patients ignoring the symptoms, delay of up to three months in seeking professional help, lack of access to specialised facilities, stigma attached to cancer and financial constraints.
Hence, in addition to preventive measures, it is essential to regularly screen for cancer and contact a professional when unusual changes are detected to reduce subsequent physical, emotional, and financial consequences. These small steps can go a long way towards making a difference in cancer care.
The author is Senior Director, Medical Oncology and Hemato Oncology, Fortis Group of Hospitals, Bangalore. Views expressed are personal.