The War to Save the World

The Telegraph, 8 March 2014

Raising Awareness levels through Campaigns forms the first line of defence in the Battle Against Cancer, writes Arunabha Sengupta

Other than surgery there are basically two other therapies for cancer, namely radiotherapy, done by the radiation oncologists and chemotherapy done by the medical oncologists. Recently biologic therapies or immunotherapies have come into vogue but those are also done by the medical oncologists.

His features were like those of a Greek god. At 28, he was set to travel to the United States of America to further his professional career. A month before he was set to travel, he was diagnosed with advanced cancer of the tongue. She delivered her first child but on the day of discharge, the doctors detected cancer in her uterine cervix. Both lived in this city and were unaware that what undid them was preventable or at least curable if they knew to take certain preventive measures. Neither of these cases, however, tells the singular story of a disease which the author, Siddhartha Mukherjee, calls the “quintessential disease of modernity”. Paradoxically the boon and the curse of modernity — long lives as well as toxic skies and abundant, unwholesome indulgences — work in tandem to provide causes for cancer. Identifying the extent to which these causes are extraneous or man-made marks out the scope of reducing incidents of cancer.

In fact, demographics show how communities to a good measure bring unto themselves the cancers they suffer. If some are geographically destined, cluster of cancer villages in China being the most recent examples, others are undone by their own habits. This holds true of the districts of India’s northeastern states. Smoking from an early age — a practice that is prevalent in both sexes — eating smoked meat preserved with salts without refrigeration, the use of fire wood and exposure to pesticides cause cancers of the stomach, oesophagus, and lung. The rates are higher than the national incidence, even surpassing in females the common forms of cancer of the breast and the cervix.

Geographical variations in cancer occur across the world. Environment, diet and life-style choices have a bearing in this context. After two or three generations, migrant populations begin to follow the practices of their adopted countries.

Carcinogenesis is undoubtedly a slow process. It evolves over many years and does not happen as dramatically as the departed Venezuelan president, Hugo Chavez, wanted us to believe by speculating about a secret American technology being responsible for five influential South American heads of state, himself included, developing cancer at the same time. With diplomacy on his mind, he stretched the idea too far. But his basic premise — cancers being induced by external agents — has been validated, time and again. From scrotal cancers in chimney sweeps and mule spinners, sarcoma of bones in radium dial painters, urinary bladder cancers in aniline dye workers, liver cancers in polyvinyl industries, mesothelioma in asbestos industry to cluster of cancer villages found in West Bengal in the 1980s due to arsenic pollution to the rising incidence of lung cancers in Calcutta on account of increasing pollution — these are but a few examples from a big list of induced carcinogenesis backed by scientific data.

It is indeed a big list consisting of diverse agents, from betel quid and tobacco to solar radiation and even biological agents like oncogenic viruses. The list of carcinogens prepared and grouped according to their carcinogenic potential by the World Health Organisation is certainly getting “curiouser and curiouser”. For instance, the WHO has already put circadian disruption due to night shift jobs (Group 2A, probably carcinogenic) and electromagnetic wave radiation (EMR, group 2B carcinogen, possible but weak evidence) in its list of carcinogens. One observes that the IT hub, Bangalore, now tops the list of breast cancer incidence in India, ahead of Mumbai and Delhi. But such mysteries usually unravel themselves slowly and cause and effect relations become apparent only after years. Few realized that when Catherine de Medici, the much maligned French queen rumoured to be adept in the use of poisons, extended her royal patronage to tobacco plants brought to her by Jean Nicot, she was helping establish a perpetual source of poison to human lives.

How important then is the knowledge about causes of cancer? On the basis of population-based registry data from major Indian cities,the Indian Council for Medical Research estimates that one out of every eight males and one out of every seven females in urban India will develop cancer in their life time if life expectancy is calculated to be 74 years and death does not occur due to other causes. The ICMR has projected 100,588 new cases for West Bengal alone in 2016. The figure for 2001 was 61,153.

Cancer can no longer be viewed as a pesky phobia. It is now a frightening reality and demands concrete action at both State and individual levels. The National Cancer Control Programme is an ambitious project but with an allocation of only 1.4 per cent of GDP to health care, the NCCP’s efficacy remains restricted. Screening programmes for common cancers, intervention programmes like treating pre-malignant diseases, and vaccination programmes against virus-induced cancers remain rudimentary at best. The same is true of formulating and imposing regulations that can curb the use of known carcinogens or reduce environmental pollution. Setting legal limits for air quality standards for major Indian cities or imposing a green tax for polluting industries remains a remote possibility, even though India has been found to be the worst performer among 132 countries in respect to air pollution, which is now listed as a Group 1 carcinogen.

In the absence of a concerted cancer prevention programme working effectively on the ground, individuals would do well to take matters in their own hands because everyone is vulnerable after a certain age. There is another potent reason for individual initiative. Experts in preventive medicine now ask everyone to do a ‘risk estimation’ for oneself and undergo periodic and repeated examinations as each person has a different risk profile according to family history, genetic make-up, life-style practices and other risk factors like obesity. Risk profiling creates opportunities to avoid an affliction. Breast cancer gene testing and prophylactic removal of breasts have gained media attention but simple tests are possible and are conducted regularly for other target organs that may develop malignant lesions.

Fortunately, 40 per cent of cancers in India are either preventable, easily detectable and curable with the right treatment in proper time. Unfortunately, what is lacking is a high awareness level. Cancer treatment has come a long way. But prevention and early detection still remain the first line of defence. Without winning the battle there, the war is lost. Cancer incidence and mortality rates have indeed gone down in the US on account of sustained campaigns according to official data.