Cancer, traditionally regarded to be a disease of old age, is becoming a source of concern among young people and children.
According to the Indian Council of Medical Research (ICMR), there will be an estimated 12 per cent rise in cancer cases in India in the next five years.
An expert panel discusses the measures to subside this graph. The panel included: Dr Suman Lal, Sr Gynaecologist and Cancer Specialist, Max Hospital; Dr Hitesh Verma, Additional Professor, ENT, AIIMS; Dr Sushil Mandhaniya, Sr Medical Oncologist, AIIMS; Dr Dodul Mondal, Sr Consultant, Radiation Oncologist, Indraprastha Apollo Hospital; Dr Shweta Verma, Dental Surgeon, AIIMS.
Cancer is often associated with the probability of death. How significant do you think is awareness today?
Dr Sushil Mandhaniya: there is an upward trend in the number of Cancer cases since the last 30 years. There is a dramatic decrease in the death rate due to cardiovascular diseases, but very marginal decreases in deaths due to Cancer. This is because the extreme ignorance, late diagnosis and the myths that surround. A lot of time is wasted in unnecessary medications in patients. This is why we need to create awareness. In breast cancer, nearly 49% of malignancies are seen in individuals less than 50 years of age. This is the difference between the western and Indian population. We observe stage 3 or stage 4 malignancies in nearly 50 per cent to 60 per cent of the cases. We have different demographic pattern and types of malignancies than the western population.
Number of cases of breast cancer and cervical cancer are rising in younger women, especially in rural areas. A woman dies of cervical cancer every 8 minutes in India. Is lack of awareness the biggest issue you would pin-point?
Dr Suman Lal: When we talk about the gynaecological cancer, they are very prevalent in India. If we detect early, we can detect it properly. For cervical cancer, we say that it is not genetic, but occurs due to human papillomavirus. If we conduct pap smear test thrice a day, we can reduce the burden to a huge extent. Even if a woman goes for a pap smear test atleast once a year, we can detect the cancer in the society as a whole in most of the cases. Women who are sexually active should go for pap smear test and if they are positive, they should get treated by their gynaecologist immediately rather than living with the cancer.
Screening is important when it comes to breast cancer, especially after periods. If a women haves a history of breast cancer in paternal or maternal family, they should be more vigilant. Self-palpation, palpation by the expert and mammography after the age of 40 is recommended to detect the cancer in early stages.
What do the policymakers need to do as far as awareness and improving infrastructure is concerned?
Dr Dodul Mondal: We talk about spreading awareness among the patients, but we forget that similar awareness is required on the part of the policymakers, bureaucrats and the doctors also since they all are a part of the system. Many a times the patient is troubled due to lack of awareness on the part of the physician. Breast cancer, Cervical cancer, Oral cancer are really prevalent in our country. Oral cancers are majorly caused due to tobacco, smoking and it is the enforcement by the administration that needs to be implemented.
Government is doing over and above what it can to prevent the use of tobacco. What more needs to be done on our part?
Dr Shweta Verma: As we all know tobacco and alcohol can cause oral cancer. To reduce the number of oral cancer cases by large, we need to spread awareness against this at the school level so that the children, many of whom grow up to become consumers of such products, know what harm it does to one’s health. Other reasons for oral cancer are: Oral sex or sex with multiple partners and poor oral hygiene. Annual oral health check up can prevent one’s risk of developing oral cancer.
How can early detection help the patient and the family in terms of mortality and the treatment costs?
Dr Hitesh Verma: When it comes to cancer, one has to go through different treatment modalities like chemotherapy, radiotherapy and surgery. One of these modes is sufficient for the patient when diagnosed at an early stage and survival chances are very high. When the tumour advances, they have to go through prolonged surgery and additional treatment therapy and the survival chances reduces by 10 or even 20 folds in 5 years period.
What is the difference between the treatment one undergoes when diagnosed early and when diagnosed at later stages?
Dr Sushil Mandhaniya: Early detected cancers are highly curable as they are local advanced diseases while in later stages they become metastatic disease. We generally talk about the quality of life and not cure during stage 4 disease. For most of the solid organs, mostly the modality remains surgery and many of the patients are scared of the malignancies.
A major myth surrounding cancer surgery is that “Cancer spreads by the touch of a tool” and is mainly a reason why people do not opt for surgery and switch onto taking alternate medications instead which wastes a lot of months that could have been invested in their cure.
When we talk about Cervical Cancer, HPV vaccines are given between a certain age.
Dr Suman Lal: As a gynaecologist, I believe that we have a responsibility to raise awareness, but I believe that the first step should be to include safe sex in the curriculum, with women commencing intercourse and using contraception such as a condom or other methods. The virus’s chances of spreading will be reduced, thus discussing safe sex in the school curriculum will be crucial. If we go for cervical cancer vaccine at teenage, 70 to 80 percent of cancer will be averted in later life. When women come to us for reasons like pregnancy, infertility and other reasons, we should take a pause and talk about the genetic history.
We should examine them once. If it appears that the cervix haves infection, we can talk about cervical cancer and slowly, we can talk about the pap smear and we can examine the breast at that time.
Is there a significant reduction in the risk of cervical cancer if you are vaccinated? Is there an HVP vaccine?
Dr Suman Lal: If a woman is getting vaccinated against cervical cancer, the risk factor reduces by 70%. As a result, if we vaccinate 100% of our young population, especially the female population, the cervical cancer burden would be reduced by 70%. For the remaining 30%, pap smear examinations become important, and we must explain when we are providing the vaccination. Sex education while vaccination is very important for the young girl.
Can you explain what is proton beam therapy and how it differs from standard radiotherapy? How does a patient determine which treatment or therapy to pursue?
Dr Dodul Mondal: Patients should not arrive with any preconceived notions. It should mostly be left to the expert. The distinction between proton and standard radiation is mostly X-Ray based. It’s a new kind of radiation altogether which is more precise than the conventional radiation and it reduces the risk of side effects and the treatment is really intensified. As a result, a higher dose of radiation can be provided or, because of the reduced Side Effects, a better quality of life can be achieved. Now, a simple recommendation to these young cancer patients is that they should be treated with proton, radiation facilities if they are accessible. It’s also important to consider the cost, which is unquestionably expensive when compared to traditional radiation.
How do you dispel myths around cancer? What would you tell those who waste their crucial time that they could use to go to a doctor and get treated?
Dr Hitesh Verma: Cancer treatment primarily allopathic treatment, hence surgery, radiotherapy and chemotherapy are a part of the treatment. Whenever you feel, there is some kind of abnormal thing in your any body part, which is persisting for a period of time, like swelling, any pain, etc. you should visit some allopathic doctor. Early-stage biopsy is required, which is primarily done by a surgeon, increasing survival rates since we remove that part, hence improving the quality of life subsequently. But when the cancer is in an advanced state, in that case, the burden of surgery very high, like excision is wide vision would require some kind of collapse which can create a defect and some sort of radiotherapy or chemotherapy is required.
What should people living in rural area do? Do you see early detection increasing in rural India? What really do we need to do?
Dr Sushil Mandhaniya: I had worked in a tribal village located deep in forests, for two years that. I know that the problem in the rural population is that they hardly have anything to eat and therefore health is not a priority for them. So how we should Target them? There are two ways: first, target the local PSE doctor because every hospital in Maharashtra haves a qualified doctor.
Secondly, we need to train and motivate the community leaders because they are the ones that the local population obeys. People have hesitancy in disclosing their issues to the doctor but they can talk about it to their community leaders, hence making the latter a bridge between the people and doctors.
We started training all the local doctors that were posted in Public Health Centres over there. Each PSC has got 8-10 subcentres. If the patient can openly discuss their issues with the doctor, the doctor can refer that patient the right place at right time which can eventually save a lot of precious lives.
What would you like to tell people, especially as Dr Mandhaniya spoke about rural population, their health is not the priority. Another part of our population, women do not prioritize their health. What would you like to tell the women of the country?
Dr Suman Lal: If our government will make the vaccinations for diseases like Cervical cancer to the younger population free of cost, we can save lots of lives. It is my sincere request to make this vaccinations free for the rural population and it should be mandatory for all the young girl, nine years to 11 years or less than 12 years.
Dr Mondal what would be your advise to the policy makers?
Dr Dodul Mondal: Biopsy should be done whenever required, Surgery should be done whenever required, Radiation has to be given whenever required, Chemotherapy should be given whenever required. Early detection and proper treatment under specialized Center and experienced team of doctors will lead to success.
Dr Verma, you’ve spoken about the significance of the basic Dental visits not ignoring or even the slightest one early sign. Oral cancer really is something which can be cured at an early stage. What would you like to tell the people about reducing mortality?
Dr Shweta Verma: My advice would be Avoid tobacco at all, as it’s not healthy at all in any terms. Avoid alcohol, and if you are still taking it, limit the consumption amount. Visit your dentist each year and do not ignore any symptoms that may be an alarming sign. HPV is a major reason for oral cancers which is spread through sex with multiple partners and hence we should disseminate awareness regarding this. Brush twice a day and if you see any white patch on your lips, teeth or inner cheek, which is does not heal within two to three weeks, visit your dentist as this might be a sign of oral cancer. Oral cancer detection at early stage will hep you regain a better lifestyle. And if you avoid those symptoms, you will land up into surgeries and therapies that are required at later stages.
Dr Hitesh, do you wish to add something that was just mentioned? Can lifestyle changes, as previously said, lessen the risk of cancer?
Dr Hitesh Verma: We have a wide variety of preserved foods and salty meals, all of which are linked to a higher risk of cancer in some way, such as in the digestive tract. Regular exercise is important as it reduces risk of acidity, mucosa bleeding and cleans airways.
If you feel any change in your body persisting for more than two to three weeks, you should see your doctor to see if anything is out of the ordinary. If the doctor says everything is fine after a few tests, you can go forward. Aside from that, early detection is feasible. If you visit your doctor early in the course of your symptoms, your chances of being cured are quite good because your disease is limited and you just have one therapy option rather than several options and exhausting yourself throughout your treatment.