Life after cancer? A loud YES

GUEST COLUMN: Dr. N. Prabhudev

You may have Cancer but don’t allow Cancer to have you.

Never give up. Life is worth living. There is life after cancer. Life after cancer can be a time of relief, hope, celebration and freedom, but also a time of uncertainty, fear, emotional challenges, and physical side effects. No matter where you are in your cancer journey, you have undoubtedly faced some of the most difficult challenges you’ve ever experienced. You’ve had to come to terms with the frightening reality of your own mortality. You’ve undergone treatments that took a great toll on your emotional and physical well-being.

“Cancer” is a generic term for a group of diseases that covers around 200 different types of disease. It is unlikely there will ever be a magic bullet cure for them all. It’s far more likely that advances in treatment will result in more cancers becoming “manageable” chronic diseases. People will live with their cancer, and still maintain a good quality of life.

Cancer is a word, not a sentence. Cancer is not a death sentence anymore! The likelihood of dying from cancer has dropped steadily since the 1990s. Now, 5-year survival rates for some cancers, such as breast, prostate, and thyroid cancers, are 90% or better. The 5-year survival rate for all cancers combined is currently about 67%. There are so many new developments in Cancer treatments. Patients are living longer and having a better quality of life. Cancer is not a contagious disease.

Cancer is caused by changes to genes that control the way our cells function, especially how they grow and divide. Genetic changes that cause cancer can happen because: of errors that occur as cells divide, of damage to DNA caused by harmful substances such as carcinogens in tobacco smoke and ultraviolet rays from the sun or inherited from our parents.

Cancer Statistics in India:
The cancer death rate has dropped by about a third -32 % from its peak in 1991 to 2019 — from about 215 deaths for every 100,000 people to about 146 for every 100,000 people.

• Estimated number of people living with the disease: around 22.7 lakh; Incidence is 1.5 to 3 times higher than the reported cases.

• Every year, new cancer patients registered: Over 11,57,294 lakh – 4.5 to 5% of the rise in cancer cases every year

• Cancer-related deaths: 7,84,821;

• Risk of developing cancer before the age of 75 years- Male: 9.81%. Female: 9.42%.

• One woman dies of cervical cancer every 8 minutes

• Tobacco kills 3500 people every day
Cancer is not yet a notifiable disease. Making cancer a ‘notified disease’ will not only ensure a robust database of cancer and also the accurate incidence and prevalence of the disease in the coubtry.
Cancer ranks either first or second among the leading causes of death before the age of 70 years. The sharp increase in India’s cancer cases, estimating that it could further increase by 12% in the next five years. The total cancer burden is projected to double by 2040 to about 2 million cases.
Most of the increase in incidence in cancer is attributable to its increased use of cancer diagnostics. If cancer diagnosis catches up in rural India and all suspected cases are subjected to CT scans and FNACs- fine needle aspiration cytology, many more cancers will be diagnosed and the burden will increase.

In the past two decades, life expectancy has increased by 10 years. The incidence of cancer in the 54-64 age group is almost twice that in the 34-44 age group, longevity is a major contributor. Public cancer facilities in India are woefully inadequate.
India is leading with the third-highest number of cancers. The most prominent cases are of breast, cervix, and lung cancers. More than 40% of cancer cases like lung cancer, mouth cancer in India are preventable. Tobacco related cancers are estimated to contribute 27% of the total cancer burden.

Some cancers are declining while others continue to rise!

• The incidence of cervical cancer has dropped in India over the last 50 years from 45 to 10 per 100,000 population. The decline is because of late marriages, fewer children, better hygiene, and vaccination -human papillomavirus vaccine – HPV.
• There is an increase in rates of breast cancer, especially in urban centers -45 per 100,000.
• Despite restrictions on Tobacco, Lung cancers, however, remain a cause for concern.
Has there been progress in cancer treatment?
Yes, the cure rate for various cancers is rising. Prostate cancer has gone up from 60% to 100%. Breast cancer has improved from 50% to 90% with newer treatments.
Shortcomings:
Good care starts with a correct diagnosis. 60 to 70 percent of all decision making in health care is influenced by diagnostic testing. India has a poor early cancer detection rate of 29%.While at one hand incidence is rising, deaths due to cancer has remained among the top 5 causes of deaths.

Focus on Awareness and Prevention –
Detection and diagnosis –
Treatment including palliative care
There seems to be general attitude of indifference towards cancer. Prevent, screen and spread awareness with least anxiety, low cost and avoiding unnecessary stigma of cancer. Treat with goal of the basic choice, early access and modest cost.

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