People who are diagnosed earlier with cancer are not only more likely to survive, but importantly also to have better experiences of care, lower treatment morbidity, and improved quality of life compared with those diagnosed late
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Cancer ranks as one of the leading causes of death in the world accounting for nearly 10 million deaths in 2020. World Cancer Day is celebrated every year on February 4 to create awareness, spread hope, support and motivation for courageous patients.
The emergence of the COVID-19 pandemic has interrupted several essential health services globally and early detection of cancer services is one of them. Routine cancer screenings have dropped in many developed countries since the crisis. Several key health issues are inadvertently being overlooked, bearing an impact on mortality and other outcomes, particularly for patients with cancer.
Female breast cancer has beaten lung cancer as the most diagnosed cancer. India has the highest estimated breast cancer cases (178 361, 13.5%) and the second-highest number of lip & oral cavity (135 929, 10.3%) and cervix uteri (123 907,9.4%) cancers in the Asian sub-continent. Not only does India has a high burden of cancer, but the majority (75-80%) of patients have advanced disease (stage 3-4) at the time of diagnosis. Overall, the pandemic has forced most patients to approach healthcare centres only for emergency treatments, thereby reducing the frequency of early clinical examinations and hence detection of cancer.
Initially, in the early phase of the pandemic, the fear and panic linked with the announcement of lockdown and virus spread have forced patients to postpone their health check-ups. Even after the easing of Covid-19 restrictions, there is a progressive gradual drop of new consultations (12.1%).
Hence, it is imperative that early detection facilities should be kept functional in outpatient settings so that at least the patients coming to hospitals with early signs and symptoms of cancer can be diagnosed as early as possible. To ensure that patients can identify early signs and symptoms of common cancers there is a dire need of health awareness for self-examination by patients for early signs and symptoms of cancers such as white patch (leukoplakia) or red patch (erythroplakia)/ non-healing ulcer in mouth, lumps in the breast/nipple discharge from the breast, post-menopausal/inter-menstrual/ sexual contact bleeding per-vagina, cough or hoarseness that does not go away and weight loss or gain of 10 pounds or more for no known reason.
People who are diagnosed earlier with cancer are not only more likely to survive, but importantly also to have better experiences of care, lower treatment morbidity, and improved quality of life compared with those diagnosed late. When cancer care is delayed there is a lesser chance of survival, greater problems associated with treatment and higher costs of care.
Early diagnosis consists of three components which are- being aware of the symptoms of different forms of cancer and the need of seeking medical advice if you are concerned; access to clinical evaluation and diagnostic services; and timely appointment to treatment services.
Two important steps can help with an earlier cancer diagnosis. These are attending cancer screening, which aims to detect cancer before it is symptomatic and visiting on time to primary care with potential cancer symptoms.
Screening aims to identify individuals with specific cancer or pre-cancer before they have developed symptoms. When abnormalities are identified during screening, it clears out if further treatment is needed. Patient selection for screening programmes is based on factors like age and risk factors to avoid excessive false-positive studies. Examples of screening methods are HPV testing for cervical cancer; visual inspection with acetic acid (VIA) for cervical cancer; and mammography screening for breast cancer in settings with strong or relatively strong health systems.
An individual sees an oncologist post-screening when the primary care physician suspects that the patient has cancer. CT scans, MRI, HPV testing, mammography as well as blood tests, can be used to confirm the diagnosis. If the tests reveal signs of cancer, the primary care doctor may recommend that the patient visit an oncologist. The first oncology appointment may last for only a few hours. During the first appointment, the oncologist gathers information about the patient’s health. The oncologist is still likely to perform a physical exam even if the primary care doctor performed one.
Some of the most common cancer types such as breast cancer, cervical cancer, oral cancer, and colorectal cancer, have high cure rates when detected early and treated according to best practices. Few cancer types, such as testicular seminoma and different types of leukaemia and lymphoma in children, also have high cure rates if appropriate treatment is provided, even when cancerous cells are present in other parts of the body.
A timely cancer diagnosis is essential for appropriate and effective treatment because every cancer type requires a specific treatment regimen. Treatment usually includes radiotherapy, chemotherapy and/or surgery. The primary goal is to cure cancer or to substantially prolong life. Improving the patient’s quality of life is also an essential goal. This can be achieved by support for the patient’s physical, psychosocial well-being and palliative care in terminal stages of cancer.
The writer is a consultant medical oncologist at Bombay Hospital & Research Centre, Mumbai. Views expressed are personal.
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