Business as usual will fail us on cancer control, SDGs

Shobha Shukla / Bobby Ramakant *

World Cancer Day 2019 Webinar

193 governments including those of India, committed to reducing burden of non-communicable diseases (NCDs) such as cancers by 25% by 2025 and one-third by 2030 (UN Sustainable Development Goals or SDGs), but many cancer rates are rising, not declining, especially in several high burden countries. Cancer is the second leading cause of death globally (cardiovascular diseases (CVDs) are the top killers). Estimated 9.6 million people died due to cancer in 2018. Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths.

Two most common cancers according to the World Health Organization (WHO) are lung cancer (2.09 million cases and 1.76 million deaths in 2018) and breast cancer (2.09 million cases and 627,000 deaths in 2018), said Professor (Dr) Surya Kant, Head of Respiratory Medicine Department of King George’s Medical University (KGMU) in the World Cancer Day 2019 Webinar. Prof Surya Kant reiterated that according to the WHO, at least one third of common cancers are preventable through tobacco and alcohol control, healthy diet, maintaining healthy weight and being physically active.

Dr Pooja Ramakant, noted breast cancer expert and Associate Professor, Endocrine Surgery Department, KGMU said in World Cancer Day Webinar that early detection, screening and diagnosis saves more lives, improves quality of life and reduce cost and complexity of treatment of breast cancer.

Thuy Khuc-Bilon of Union for International Cancer Control (UICC), official convener of World Cancer Day global campaign, said in World Cancer Day Webinar that there is a compelling financial argument for committing resources to cancer control. Financial investment can be cost-effective and can potentially save the global economy billions of dollars in cancer treatment costs and offer positive gains in increased survival, productivity and improved quality of life. The total annual economic cost of cancer is estimated at US$1.16 trillion.

2019 World Cancer Day Webinar was dedicated to celebrate the memory and legacy of late Dr Veena Sharma, who did research on some aspects of Leishmaniasis (Kala Azar) in India's prestigious Central Drug Research Institute (CDRI), and was a noted educationist having served as Principal, Vice Principal and teacher at several schools, colleges and degree college. Her daughter Dr Vismay Sharma (dental surgeon and public health expert) paid the tribute.

Lung cancer is preventable and treatable

Dr Nguyen Viet Nhung, Director of National Lung Hospital, Vietnam; head of national tuberculosis programme of Vietnam and honorary faculty at University of Sydney, Australia said that lung cancer is not only the most common cancer but also the deadliest of all cancers worldwide. In Vietnam it is estimated that lung cancer cases will reach 34,500 by 2020 (22,900 in males and 11,600 in females). Five-year survival is as low as 20% in many low- and middle-income countries but if we detect early such as in developed nations, then five-years survival could be much higher too, said Dr Nhung.

“Tobacco smoking causes over 71% of lung cancer. If we are to reduce lung cancer disease burden and avert untimely deaths, we have to ensure tobacco use ends. Early detection of lung cancer can improve treatment outcomes and 5-year survival too. But major challenge is to ensure that essential health services are available for all people in needs at all levels. Patients need to access modern techniques for comprehensive care and treatment of lung cancer at reasonable costs without overloading central healthcare system” said Dr Nhung. Dr Nhung said that tobacco control is working in Vietnam and as a result smoking rates have dropped in males and females both during 2010-2015. Ending tobacco use is a public health imperative, said Dr Nhung.

Breast cancer is deadliest cancer among women

"Breast cancer (along with lung cancer) incidence is highest among cancers globally, but in this case, winner is a loser. Breast cancer is also the most common cancers in India among women, and deadliest cancer among women” said Dr Pooja Ramakant, breast cancer surgeon at KGMU and Associate Editor of Indian Journal of Surgery.

“Breast cancer incidence is occurring more in younger women in India. Breast cancer is very aggressive in biology when it happens in younger women. Women present late to us unfortunately as 50-70% of patients who present to us are already in advanced stage or metastatic when they are first diagnosed. Late diagnosis of breast cancer is directly proportional to survival rates” said Dr Pooja Ramakant, who is former member of Editorial Board of Indian Association of Endocrine Surgeons (IAES).

Lack of breast cancer awareness and screening programmes, and other modifiable and non-modifiable risk factors are responsible for the public health challenge breast cancer is posing said Dr Pooja Ramakant. “There are factors that are modifiable, such as, obesity, unhealthy diet and sedentary lifestyles. Tobacco and alcohol in any amount (no safe level) is also responsible for carcinogenic mutations. Exposure to certain environmental compounds also increase breast cancer risk, such as, polycyclic aromatic hydrocarbons (PAH). Alarmingly India is among the top countries emitting PAH, but this could be modifiable if we protect environment. Non-modifiable risk factors are like genetic (5-10%) and early menarche and late menopause but majority of 90% risk factors for breast cancer are modifiable. This World Cancer Day we all must act upon reducing cancer risks and addressing the risk factors that are modifiable, appealed Dr Pooja Ramakant.

In India, breast cancer incidence peaks around 30s-40s-50s age groups, but in the developed countries it peaks around 50s-60s age groups. In USA for instance, the five year survival for breast cancer is around 90% but in India it is 66.1%, mostly because of late stage of diseases when women present. In other developing nations such as South Africa it is as low as 40.1%, informed Dr Pooja Ramakant.

Educating women, men and transgender people (small part of breast cancer incidence also happens in men and transgender people) about healthy lifestyles to reduce cancer risk is important. We have to raise awareness about breast self-examination, and if any change or inconsistency is found then people should check with the doctor, said Dr Pooja Ramakant.

Patient support groups give hope!

Patient support groups play a key role in helping complement healthcare as well as give moral boost for patient and families too. Quality cancer care includes dignity, respect, support and love and considers not just the physical impact of cancer but respects the emotional, and social wellbeing of each individual and their carer, emphasized Dr Pooja Ramakant.

Tobacco is single largest preventable cause of cancer

“Smoking is linked to 71% of lung cancer deaths, and accounts for at least 22% of all cancer deaths” said Prof Surya Kant who heads the Tobacco Cessation Clinic of KGMU and was elected as National President of Indian College of Asthma, Allergy and Applied Immunology (ICAAAI).

“Tobacco use is the single largest preventable cause of cancer and stopping smoking and tobacco use in any other form, is one of the best things we can do to reduce our risk of cancer. Use of tobacco has been found to cause around 15 different types of cancers including oral cancers, lung, liver, stomach, bowel and ovarian cancers, as well as some types of leukaemia (blood cancer). Quitting tobacco use at any age can make huge a difference, increasing your life expectancy and improving quality of life” added Prof Surya Kant.

Environment pollution, including indoor and outdoor air pollution is also linked to elevating cancer risk, said Prof Surya Kant.

No excuse for inaction!

"When one-third cancers are preventable as per WHO then we have no excuse but to prevent and reduce this avoidable disease burden, and avert untimely deaths, said Shobha Shukla, health activist with Asha Parivar and head of CNS. Not just cancers, but ending tobacco and alcohol, healthier diet, increasing physical activity, improving disease screening and early diagnosis, increasing access to health services for those marginalized, among other such measures will have a far reaching positive impact on overall health security, emphasized Shobha Shukla, who superannuated as senior faculty of Loreto Convent College.