India’s cancer puzzle!

GUEST COLUMN: N Prabhudev

Bengaluru, April 17: It is no secret that the diagnosis of cancer is often shocking. It can lead to a range of emotions that can steal one’s peace of mind. The person can become overwhelmed, scared, stressed, frustrated, depressed, irritated, feel lonely, nervous and may even panic. Why me?”, “what have I done?”, “why I have been punished this way- are often the questions in the mind!

The Lancet Oncology – The puzzle- why more women in India are diagnosed with cancer than men? Men report a 25% higher incidence of cancer than women all over the world, but India bucks this trend. Why are so many people under 50 getting cancer?

For oncologists worldwide, India can look like a puzzle when it comes to cancer. 1.5 million New cancer cases every year! India’s cancer rate remains lower than, say, the economically advanced US. That’s about 100 cases per 100,000 people compared with 300 in the US. Indians are a vastly younger people and as people get older, the chances of getting cancer get higher. But survival rates are poor – barely a third of patients survive beyond five years or more after being diagnosed with the disease.

In US the cancer death rate for men and women combined fell 32% from its peak in 1991 to 2019 – This drop translates to almost 3.5 million fewer cancer deaths during these years. Chemotherapy after surgery for breast and colon cancer and Combination treatments for many cancers is responsible for these fewer deaths.

More men die of cancer in India than women. But that is because breast, cervical, ovarian and uterine cancer, that account for more than 70% of the cancers in women in India, allow higher chances of survival on treatment. Indian men suffer largely from lung or oral cancer – both related to smoking and ingesting tobacco – which are more virulent with lower survival rates. At 45-50 years, the peak age of onset of breast – and ovarian cancer – in India appears to be a decade younger than the peak age – above 60 years, in high-income countries.

Will Cancer Ever Be Cured?
The following are types of cancer that are considered more “curable” based on five-year survival rates:
Breast cancer
Melanoma
Thyroid cancer
Hodgkin lymphoma
Testicular cancer
Prostate cancer

Treating cancer means establishing a balance between what’s effective and its side effects.

Today, cancers that respond to treatment are not considered outright cured because there is always a potential they could come back. Instead, they are referred to as being in ‘complete remission or evaluated as having no detectable cancer in the body.
War on Cancer” was declared by Richard Nixon in 1971! Despite immense advances in basic scientific knowledge about cancer the war on cancer went poorly. Cancer stayed Undefeated! War, in general, has a winner and a loser.

The use of war as a metaphor to describe cancer treatment may mislead the patients to believe that they can defeat cancer with a single ‘magic bullet’ cure some day! Cancer is not a single disease and there cannot be a single cure!
Like warfare, the primary focus in cancer therapy has been, and still is, on how to more efficiently kill as many cancer cells as possible under the assumption that this will cure the disease. The battlefield analogies may result in over-diagnosis as well as over-treatment of some malignancies though there is a paucity of data that maximum tolerated doses allow longer survival than minimum effective doses.
This causes “collateral damage” accompanying unnecessary toxicities in normal cells and inevitably reduces the patient’s the quality of life. When the tumour recurs, it is more malignant and uncontrollable than before. Cancer is a disease that lives within our body, and hence better to manage, not fight. We have to change the outlook- to live with the cancer!

It is more realistic to treat cancer as one of chronic, manageable diseases. So, long-term treatment that will allow cancer patients to live with their cancer while maintaining good quality of life. There has been too much emphasis on the “cure for cancer” over prevention during the past 50 year War on Cancer.
Battles rarely involve prevention. The major risk factors for cancer are well identified and prevention is cost effective by eliminating the carcinogenic factors from our environment or minimizing exposure to them.

Over the past five decades, there has been tremendous improvement in the treatment of cancer, particularly new targeted therapies including recently developed cancer immunotherapy. Joseph Biden’s Cancer Moon shot” initiative is a way forward! We need to re-evaluate our triumphs and failures. There should be realignment of the balance between treatment and prevention more in favour of prevention! A national commitment to the prevention of cancer, largely replacing reliance on hopes for universal cures, is the way to go forward!

Avoid the Sin Foods – a deadly combination of ultra-processed foods – like boxed meals, frozen dinners, and packaged snack foods – has increased the rate of diabetes, heart disease, and even Alzheimer’s. Now it looks like it’s giving us all cancer, too. A new Tufts University study found that this poor excuse for a diet is now responsible for over 80,000 cancer diagnoses every year.

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