Cancer Prevention - The pressing need of our time

Introduction

Cancer is a loaded word with dark connotations, one which can cause even the most equanimous people to experience some degree of anxiety. It is also an increasingly prevalent condition; one which often becomes a chronic illness that the patient learns to live with. It also puts a great deal of pressure on already stretched healthcare systems and on caregivers, besides being a substantial drain on personal and societal resources and finances. 

Cancer attracts an enormous and steadily increasing amount of interest and coverage in the popular media, not all of which is helpful or productive. Social media, which has revolutionised information sharing at the click of a button, too has proved to be a double-edged sword, with the benefits of easy connectivity being sullied by the perils of fake news and information.

• There have been some excellent books written by medical professionals, exploring Cancer with great sensitivity.
  • The coverage of Cancer in media ranges from sensible to sensational, from factual to fraudulent

Check out - An Introduction to Cancer

As our lifestyles change and life spans lengthen, it is estimated that one in every three persons would be diagnosed with cancer at some point in their lives. It is therefore a matter of great importance that we as individuals treat cancer prevention as a matter of utmost importance, and pro-actively work towards mitigating the risk through simple measures like lifestyle modification and surveillance.

Through this blog, I aim to provide an outline of the simple steps and measures that one can take towards leading a healthy and Cancer free life.

As we go on, I will define the scale of the current challenge, gaze into the past to get a historical perspective, identify the scientifically validated high risk factors, and discuss ways to eliminate these from our lives.

Finally, I will deal with some prevalent myths and urban legends that are in sore need of being debunked and consigned to the dustbin of our collective memory.

Background

Estimates show that annually there are over 14 million cancer cases and 8 million cancer deaths worldwide, despite overwhelming evidence that many malignancies are preventable.

In the developed world, Cancer has overtaken Cardiovascular disease as the commonest cause of death.

Taken together, Cancers still comprise the second most common cause of death in India (after Cardiovascular disease). As per the Indian Council of Medical Research (ICMR) data, India had 1.4 million cancer patients in 2016, and the disease burden has doubled in the last quarter-century. Breast Cancer, Cervical Cancer, Oral Cancer, and Lung Cancer together constitute 41 per cent of this load. This number is expected to rise, driven by several factors. It is estimated that India lost nearly 6.7 billion USD in 2012 due to Cancer, amounting to 0.36 per cent of the total GDP.

Historical Perspective

Cancer is a disease of the genes; the history of cancer is probably as old as that of the cell itself, and far predates the evolution of our species. Palaeopathology, the science of studying ancient remains, has tentatively identified cancer in preserved mummies and other human remains found in many parts of the world. The best studied of these are from Egypt and Greece. It has been noted with interest that cancers appears to be much rarer in ancient remains than in modern human populations. This could be a function of both, factors related to preservation of tissues and of the limitations of current diagnostic techniques, but scientists also have strong reasons to believe that the seemingly increased rates of malignancies in the modern human societies are linked to environmental factors like diet, pollution and tobacco use.

• One million year old vertebral bone fossil showing metastatic cancer- From CNN Health website

Ancient and indigenous health systems recognised malignant tumours as a distinct clinical entity. There are several Egyptian Papyri (For e.g., the ‘Edwin Smith Papyrus’ which deals with surgery for breast cancer) devoted to the description, examination and classification of tumours. The treatments recommended involved excision, cautery, fumigation, magic spells, and often prudently leaving the swelling untreated.

Hippocrates, the ‘Father of Medicine’ identified the cause of cancer as an excess of ‘black bile’, an opinion adopted and developed by Galen of Pergamum. The crab-like nature of cancer was noted by the Greeks, and Hippocrates used the words carcinos (crab) and carcinoma to describe a range of tumours and swellings, a nomenclature which has endured.

Ayurveda too recognises the clinical manifestations of benign and malignant tumours (‘Arbuda’).  In principle, its emphasis on treatment with alkalis, cautery and surgery echoes the modern approach to cancer management with chemotherapy, radiation and surgery

Can Cancers be prevented?

As an Oncologist, this question chases me relentlessly. In the real world, as in the virtual, it is directed at me by a diverse range of people cutting across gender, age and social class. The answer is complex but unambiguous. About two thirds of all cancers are directly linked to modifiable lifestyle factors like smoking, diet, obesity and inactivity. So yes, Cancers can be prevented. The nuance is that not all cancers can be prevented, and non modifiable risk factors like heredity and random chance also play a smaller but still significant part in carcinogenesis.

So what can we really do?

Lots, really. We will touch upon lifestyle factors, including diet and micronutrients, environmental factors, the role of diet, the role of infections and using specific drugs and medications as the blog progresses. Let us commence by scrutinising lifestyle factors in greater detail.