Fight Against Cancer

Dr. Arsheed H. Hakeem*

*Corresponding Author: Dr. Arsheed H. Hakeem, MBBS, MS, DNB, Senior consultant Head and neck Surgery/Oncology, Apollo cancer institute, Hyderabad, India.

Received Date:  February 22, 2021

Publication Date: March 01, 202

The cancer burden continues to increase globally, as it has become the second leading cause of death, according to the recent WHO statistics. Cancer is responsible for an estimated 10 million deaths in a year worldwide and the number is increasing as years pass by. Every one death in 6 is related to cancer now globally. Cancer is causing more mortality in low and middle-income countries as compared to high-income countries. This has resulted in huge financial strain on individuals, families, communities and health systems. Most of the health systems in low-income countries are not prepared to deal with this increasing number of cancer cases as timely quality diagnosis and treatment is not available to all. Compared to this, high-income countries are better equipped and their health systems can be easily accessed for early detection and necessary treatment, enhancing survivorship of patients with cancer.

Most of the cancer is associated with behavioral and dietary risk factors like tobacco use, alcohol intake, low fruit & vegetable intake and lack of exercise. Environmental factors like air pollution and water pollution are other risk factors that are affecting large populations. The most important risk factor is tobacco use in any form smoking or chewing and it is responsible for approximately 22% of cancer deaths. Cancer-causing viral infections like hepatitis and the Human papillomavirus are responsible for up to 25% of cancers, particularly in low-income countries. Therefore around 30% to 50% of cancer deaths could be prevented by avoiding or modifying risk factors and implementing existing evidence-based prevention strategies. Prevention is the first step a civil society can take to decrease the incidence of cancer-related to tobacco and alcohol consumption. Cancers related to tobacco and alcohol intake are a preventable cause of death and avoiding them has positive effects on an individual's health. Healthy lifestyle changes like tobacco cessation decreased alcohol consumption, healthy diet and physical activity has been shown to improve population health and reduce cancer deaths. The easiest and the efficient way of introducing such healthy lifestyle habits in society is by educating students from a very young age, probably during schooling. Environmental pollution of air and water are directly responsible for the increase in the incidence of cancer in the population. Maintaining air and water quality will reduce the incidence of cancer to a greater extent. Health surrounding environment can be achieved more effectively by implementing measures to reduce air and water pollution by all the governments. All the governments should devise health programs for screening in high-risk populations with an increased incidence of tobacco and alcohol consumption. No health programs will succeed unless and until citizen participation in both screenings and specific vaccination programs for those cancers amenable to it is ensured by governments. At a policy level, population-based mass screening programs should be implemented as they have been proven to reduce cancer mortality substantially, screening programs must be based on solid evidence only. Screening programs for oral cancers, breast, cervical and colorectal cancers have been shown to have significant effects on survivorship.

Effective treatment can be done and better cure rates achieved if cancer is identified in the early stages. This increases the probability of 5-year survival. The treatment in the early stages is less morbid and less expensive. The proven way to detect cancer early is by screening which aims to identify people with abnormalities suggestive of specific cancer or pre-cancer. Treatment options include surgery, radiotherapy and/or chemotherapy. For early stages usually, a single modality like surgery or radiotherapy may be sufficient to achieve a cure, while advanced-stage cancer may need multimodality treatment like surgery followed by radiotherapy and or chemotherapy. Some cancers like haematologic malignancy can be controlled with chemotherapy only. What is best for a particular type and stage of cancer is planned by a multidisciplinary team of cancer professionals after proper assessment of the patient. In low-income countries, 70 % of the cases still present in late stages due to lack of awareness and inaccessibility to prompt diagnostic and treatment facilities. In more than 90% of high-income countries, treatment services are available compared to less than 30% of low-income countries. The economic impact of cancer is significant and is increasing. Only 1 in 5 low- and middle-income countries have the necessary data to drive cancer policy. A cancer registry has to be maintained in every facility associated with cancer care. Data collected from all the regions may help authorities to implement evidence-based screening, diagnostic, and treatment programs. Once cancer has been diagnosed, truly integrated care should be the goal of any health system. Care levels like diagnosis, surgery, radiotherapy, chemotherapy, psychological support, palliative care and rehabilitation need to be well organized to optimize outcomes and improve quality of life for all patients. Since the number of caregivers is high, it is important to coordinate a consensus between them.   Patients, physicians and ancillary health professionals, policy-makers and industry need to help each other to deliver quality care to cancer patients. Survivorship care includes a detailed plan for monitoring cancer recurrence and detection of new cancers, assessing and managing long-term effects associated with cancer and/or its treatment, and services to ensure that cancer survivors' needs are met.

For patients presenting in the very late stage where no definitive treatment is possible,  palliation can be aimed to reduce morbidity and improving quality of life. Lack of Hospice care particularly in low and middle-income countries is what authorities should think about concentrating on. Civil societies should help in partnering as volunteers for hospice cases of terminally ill patients.

Last but not the least, research is an important tool and should continue so that we can invent new and efficient ways to diagnose, adequately treatment and follow up cancer patients. Corporates need to do significant investments in research across the board. Although a lot of investment has been done in epidemiologic research,  spending in research on health system management, translational research, prevention and palliative care has been lacking. This is one major impediment in progress in cancer control. Strong and knowledgeable leadership and coherent infrastructure are need of the hour to effectively manage this increasing menace. Developed nations like the USA and Europe should provide effective guidelines to the developing nations to make their health systems strong with standard treatment protocols.

In short, the effective cancer control approach  rests on four  pillars of action: Prevention, early detection, adequate treatment and research.

Volume 1 Issue 2 March 2021

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