Each year 127 lakh people discover that they have cancer and of them, 76 lakh die. Two-thirds of these distressing deaths occur in low and middle income countries.
The World Health Organization projects that unless immediate action is taken, deaths from cancer will increase by nearly 80 per cent by 2030; most of them occurring in low and middle income countries. That translates to nearly 260 lakh newly diagnosed cases and about 170 lakh deaths every year! In fact, cancer kills more people than do AIDS, malaria and tuberculosis combined.
Research suggests that “one-third of cancer deaths can be avoided through prevention” and “one-third through early detection and treatment”. The Union for International Cancer Control (UICC) states that the world's cancer burden is rising and, without action, the poorest countries — those currently least equipped to cope — will witness the largest increases in mortality by 2015. As per the UICC, whose headquarters is in Geneva, Switzerland, the number of deaths due to cancer every year is more than the population of the whole of Switzerland.
There are so many known causes acting directly or indirectly on the systems to produce cancer. Many of them are related to “lifestyle” and avoiding these can prevent or protect against cancer.
Measures to prevent cancer include eschewing tobacco, having good dietary habits, physical activity, maintaining a healthy diet, environmental health, prevention of cancer causing infections and limiting alcohol intake.
Tobacco
Many people relate tobacco to cardiac and respiratory diseases. But beyond that, smoking is the single biggest cause of cancer in the world. It is responsible for more than 25 per cent of all cancer deaths; it kills one person every six seconds.
It also accounts for one in 10 adult deaths and kills more than 50 lakh people every year.
Smoking not only affects the person who smokes but also people around him through second-hand smoke. Children born to mothers who smoke are also affected.
The risk of oral cancer increases 27 fold in men and six fold in women who smoke. Laryngeal cancer is 10 times more common in men and eight times more common in women. There is an eight to 10 fold increase in oesophageal cancer and 50 per cent increase in gastric cancer in tobacco users compared to non-smokers.
It has been noticed that there is a two-fold increase in pancreatic cancer among smokers. If they smoke more than 40 cigarettes a day, there is a five-fold increase.
The risk increases significantly if the individual has the habit of drinking also.
In many situations we find that many cancer patients have been smoking and drinking for years.
Diet
This is a factor that concerns everyone. Diet plays a significant role in the prevention of certain cancers, not necessarily in the Gastro-Intestinal system.
A “Healthy Diet” can prevent many cancers, more so if it is combined with physical activity. Many medical societies fighting cancer recommend the following:
— Be as lean as possible without becoming underweight
— Be physically active for at least 30 minutes every day
— Avoid sugary drinks
— Eat plenty of vegetables, fruits, whole grains and pulses
— Limit consumption of red meat and avoid processed meat
— Limit consumption of alcohol
— Limit salty food
It is also better to avoid reheated oil for cooking.
Cancer-causing infections
An estimated 22 per cent of cancer deaths in the developing world and six per cent of deaths in industrialised countries are related to cancer-causing infections.
Significant among these are Human Papilloma Virus causing cancer of the cervix and Hepatitis B and C causing liver cancer.
Environmental carcinogens
Environmental factors do play a role in certain cancers; poor air quality indoors and chemical pollutants can cause lung cancer. Similarly, food chemicals can be responsible for gastro-intestinal cancers.
Research done by the Department of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, along with the Department of Clinical Nutrition, Ethiraj College for Women, on gastric cancer produced revealing insights.
Of 100 patients analysed, 98 had the habit of consuming preserved food in the form of leftover rice, dried fish, pickle, or — for a majority — a combination of leftover rice and pickle. Moreover, 97 patients had the habit of reusing oil — 77 people reused oil more than three times; 88 were non-vegetarians; 78 consumed 25-30 grams of salt per day; and 74 consumed about 20 grams of chilli in their meal every day. In addition, 73 were smokers, 37 had the habit of tobacco chewing, 33 consumed alcohol every day, only 21 had the habit of exercising, and only two out of 100 consumed fresh fruits and vegetables regularly.
Indian scenario
As per results published by the Tumour Registry , in men, lung cancer tops the list followed by cancers of the stomach, oral cavity, oesophagus and oro-pharynx.
In women, breast cancer leads, followed by cancer of the cervix, ovary, oral cavity and stomach. Also, if reproductive organs are excluded, stomach cancer is the second most common cancer affecting people living in Tamil Nadu.
Similarly, oesophageal cancer is the fourth most common in men and in women [third if reproductive organs are excluded]. As per a publication by the Registry in 2010, cancers from the oral cavity to the stomach constitute 25.4 per cent of all cancers in men and 14.4 per cent in women.
Of these “Tobacco Related Cancers” — namely cancers of the oral cavity, oro-pharynx, larynx, lung, oesophagus, pancreas and urinary bladder — constitute 44 per cent of all cancers in men and 16 per cent in women.
What is being done ?
The Union for International Cancer Control is aiming for a “World Cancer Declaration”. The declaration outlines 11 targets to be achieved by 2020, which include:
— Significant drop in global tobacco consumption, obesity and alcohol intake
— Universal vaccination programmes for Hepatitis B and Human Papilloma Virus to prevent liver and cervical cancer
— Universal availability of effective pain medication and
— Dispelling myths and misconceptions about cancer
Every year February 4 is observed with a focus and for 2011 it is “teach children and teenagers to avoid UV exposure by being “Sun Smart.”
What do we have to do?
It is a common observation that many people in our society present cancer at an advanced stage. Various studies done across India shows that 60-70 per cent of the patients present at an advanced stage where cure may be impossible.
The main factors which contribute to this include: Myths and misconception about cancer, lack of awareness, negligence and dietary and lifestyle modifications including tobacco use and regular consumption of preserved foods.
The major task before the health authorities is to create awareness, dispel myths and misconceptions and provide the best advice to people on healthy lifestyle, eating habits and the need for exercise. More importantly, people should not “ignore the symptoms” and must consult a doctor to get the appropriate treatment without delay. All of us can play a role to create a cancer-free world. You need not to be a doctor to spread this message. Let us all join hands to fight against cancer.
(The writer is Head of the Department of Surgical Gastroenterology, Centre of Excellence for Upper GI Surgery, Rajiv Gandhi General Hospital and Madras Medical College, Chennai.)
