Every year since 2000, 4^th February is observed as world cancer day to create cancer awareness and encourage its prevention, early detection and treatment. This is an opportunity to renew our commitment to reduce cancer related suffering and deaths. In last few decades, we have made significant progress in our understanding of the cancer biology, standardization of treatment protocol, development of newer diagnostics, innovative drugs, better realization of the survivorship and quality of life issues. One of the main challenges in cancer care is to ensure uniform delivery of care. The treatment tends to gets influenced by availability of resources, both technical and socioeconomic. To address this issue the theme for this year’s world cancer day is ‘close the care gap’.

The covid 19 pandemic has disrupted normal life for more than two years. About 5.5 million people have died due to Covid 19 since beginning of pandemic. Compare this to cancer mortality of 10 million deaths every year, which is fairly unnoticed. Even alarming is projection that cancer related deaths would increase to 13 million per year over next few years. In such situation, we need to redouble efforts for cancer awareness, prevention, early detection and innovative therapies. But the real challenge is to deliver a standard of care to everyone and overcome the gaps in the cancer care.

Head and neck cancer or ‘Indian cancer’ (which includes cancer affecting mouth, throat among others) is one of the most common cancers in India with estimated 500,000 new patients being diagnosed every year. These are group of cancers predominantly caused by tobacco smoking or chewing. Since these cancers commonly affect people from lower socio-economic strata the deficiencies in care are glaring.

Gap in awareness:

90% of head and neck cancers are associated with habit of tobacco chewing/smoking. Therefore, primary prevention with effective tobacco control would reduce the number of head and neck cancers drastically. Each one of us should join efforts to create awareness and discourage particularly, the youth from trying tobacco even once.

Cancers detected in early or precancerous stage have a good outcome and treatment protocol are less intense. Unfortunately, in India 80% of the head and neck cancers are diagnosed in advanced stages. These cancers affect vital organs and the symptoms are evident quite early; thereby providing an opportunity for early detection. There is compelling evidence to suggest that opportunistic screening among the high-risk population (tobacco users) helps in early detection and lowers cancer related deaths. Creating awareness about symptoms and community level screening is most effective. Technology can be useful to bridge this gap. Social media can be used effectively to create awareness. Oral cavity being an accessible area provides with a unique opportunity to utilize mobile phones and camera for oral cancer screening. Photographs of lesions captured during community screening can be transmitted to experts located at remote location for opinion. The suspicious lesions flagged by the experts can be recommended for further evaluation.

Gap in resources:

Equitable distribution of health care is always a challenge and more so for the cancer care. A comprehensive cancer care requires a multidisciplinary team supported by resource intense imaging facility, radiotherapy machine, chemotherapy suite, operation theater etc. Most of these resources are concentrated in major cities with limited availability in rural parts. In recent years, both government and private sectors have invested in improving the rural health care. However, it will take time to achieve uniformity across all regions. In interim, technology can provide access to quality care for patients located in remote areas. Teleconsultation have gained pace during pandemic, but may not be sufficient in delivering standard cancer treatment. A systematic approach with effective use of technology for communication between patient, local care providers and remotely located experts can be a game changer.

Gap in finances:

Affordable health care is an elusive goal. A diagnosis of cancer not only devastating but financially draining. The cost not only includes the direct treatment related expenses but often overlooked are indirect cost due to loss of employment, hospital travels, special dietary and support requirements. Indirect costs have to be borne by the patient and family even if treatment cost is covered insurance or government schemes. Lack of resources is primary reason for cancer patients to discontinue the treatment mid-way.

Robust penetration of the insurance cover for oncology care without exclusions is needed. Tobacco users are often denied insurance coverage, since tobacco associated cancers forms bulk of cancer burden in the country, necessary policy modification should ensure that tobacco users also get insurance coverage although at a higher premium cost.

It is important to ensure cancer treatment is not discontinued due to lack of financial resources. Robust bridge funds should be created with help of charitable trust, CSR funds and private donations to ensure completion of treatment, support unforeseen complication or side effects and special needs such as travel, diet and nursing care etc. Similarly, drug banks should be set up in rural parts to provide high end drugs at an affordable cost.

Gaps in Learning:

Quality healthcare can be only delivered trained health care personals. There is need to strengthen oncology specific educational programs for doctors, nurses, technicians with capabilities of delivering care in rural set up. There has to be a greater engagement between industry particularly pharma and tech companies, researchers and medical staff. India specific issues require local and innovative solution.

While it may seem that there are wide gaps in cancer care, but challenges are not insurmountable. A bit of effort from government, medical community, policy makers, donors, insurance, industry and each one of us would bring a paradigm shift. We need to resolve to fill in the gaps in cancer awareness, prevention, early detection and ensure high quality cancer care accessible to all.

Dr Vikram D Kekatpure

Senior Consultant, Head and Neck Oncology

Aster CMI Hospital, Bengaluru

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Bangalore, February 03, 2022: To commemorate World Cancer Day 2022, Aster CMI Hospital in association with Datar Cancer Genetics, a leading cancer research company launched Comprehensive Cancer Screening Programme. With an aim to help patients detect cancer at its early stage that can save lives and drastically reduce the cost of cancer treatment, the hospital is bringing in EasyCheck360 (multiple cancers), EasyCheck FemmeSafe (women’s) and EasyCheck Prostrate cancer screening tests. EasyCheck is a revolutionary, radiation-free, globally recognized simple blood test for early cancer detection. It is clinically validated by one of the world’s largest clinical trials registered with the WHO clinical Trial Registry brought to you by Datar Cancer Genetics.

EasyCheck360 is a simple blood test that can detect more than 30 cancers. It is intended to be performed annually as a screening test, in individuals without any symptoms suggestive of cancer and aged > 30 years. And it can help detect cancers early that originate in the Oral Cavity, Lung, Breast, Esophagus, Stomach, Liver, Pancreas, Gallbladder, Kidney, Ovary, Cervix, Prostate, Bladder and specified Sarcomas. EasyCheck-FemmeSafe for women can detect cancers early that originate in the Breasts, Ovaries, Endometrium and Cervix. FemmeSafe is the outcome of intensive research efforts of the last several years by internationally recognized scientists and doctors.  EasyCheck prostrate is a blood test that can detect Prostate Cancer and it is intended to be performed annually as a screening test, in individuals with no symptoms.

The technique employed is a proprietary technology which is a pathbreaking innovation, designed to detect circulating tumour cells (CTC) and their clusters before they become symptomatic or clinically detectable.  The tests analyse CTC in the peripheral blood of an individual, are intended to detect the presence of malignant cells and have been clinically proven to have 88.19% Sensitivity and 99% Specificity in detecting cancer.

Speaking on the launch of the Comprehensive Cancer Screening Programme and the need for early detection for cancer, Dr. Vijay Agarwal, Lead & Sr. Consultant – Medical Oncology & Haematology, Aster CMI Hospital said, “In India, every year 1.2 million cases of cancer are diagnosed which accounts for 7,60,000 deaths. Due to changes in lifestyle as well as other risk factors, these numbers are slated to increase in the future. When cancer care is delayed there is a lower chance of survival, greater problems associated with treatment and higher costs. Hence, early detection and providing timely treatment are important which can significantly improve survival rates. Early detection of cancer requires early diagnosis and screening. Early diagnosis focuses on detecting symptomatic patients as early as possible, while this screening consists of testing healthy individuals to identify those having cancers before any symptoms appear. I am sure that with the launch of this Comprehensive Cancer Screening Programme, one can avail to undergo testing which can help diagnose various types of cancers at the earliest.”

Speaking on the launch of EasyCheck360®: Breakthrough in Early Cancer Detection Ms. Samara Mahindra, Director, New Cancer Initiatives, Datar Cancer Genetics said, “Cancer has become a chronic disease and one which can be treated successfully if detected early. The key to beating cancer is screening and early detection.  Early detection will lead to a high chance of survival in most cases. EasyCheck360® is a breakthrough test and will go a long way in helping witness a cancer free India”

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Breast cancer is one of the leading causes of mortality among patients suffering from cancer worldwide. According to the recent data given by Globacan 2018, breast cancer among Indian women is the highest worldwide. There is an increase in the trend of new cancer patients, and the age group of new patients coming annually have gradually dropped from <55 years to under 40 years of age. As per the data recorded in ICMR 2018, over 1.5 lakh new breast cancer patients have been recorded in India last year.

In India, one in twenty five people are diagnosed with breast cancer annually which as compared to developed countries like US/ UK is less where 1 in 8 patients are diagnosed annually. However due to the fact that awareness among the developed countries being quite prominent, such high number of cases are diagnosed and treated in early stages and hence the survival rates are better. When considered the Indian scenario, the survival rates are quite low due to high population ratio and low awareness. One out of two diagnosed die within next five years which attributes to 50% mortality rates. Many patients in the urban are diagnosed at stage two when the T2 lesions are palpable lumps, but in cases of rural areas, these lesions are diagnosed only after they transform to metastatic tumors.

Globally, 7% of the population under the age of 40 years is suffering from breast cancer, whereas in India, the rate is double i.e. 15%. And out of which 1% of the patients are male, which put together has the highest count of breast cancer patients from India globally. Apart from being hereditary, many other risk factors like sedentary lifestyle, bingeing on alcohol, smoking, increasing obesity among youngsters, stress and poor dietary intake have been attributed to increase in the incidences of breast cancer among the young Indian women. According to a study conducted by NCBI 2016, vegetarian women are 40% less vulnerable to breast cancer.

Why we have more advanced cancers?

The grades and stages of breast cancer in Indian patients are higher as compared to other countries. Even among the literate population who resort to curative rates and opt for alternative treatment options. Many misconceptions and lack of awareness regarding chemotherapy or mastectomy surgeries keep them away from getting treatment on time and they opt for alternative medicines. Initially such treatments are luring for the patients but as the stages grow and are beyond their control, patients opt for allopathic treatment. Such conditions prevent them from getting timely treatment.

Early diagnosis is the key to treatment

Over the last decade, even though there is a rise in incidence of breast cancer, but with awareness, access and changing paradigms in cancer care, the mortality rate has come down gradually.

Even though symptoms may not be persistent while diagnosing and sometimes screening may be done at early stages which may require different treatments and therefore the specialist may prescribe the best suitable treatment. Though treatment for breast cancer has undergone major breakthroughs, its cure and treatment solely depend on the grade and stage at which it has been diagnosed. Based on this, you will be advised to undergo one of these treatments, or a combination: Surgery, radiotherapy, chemotherapy, hormone therapy and biological therapy (targeted therapy). The doctor will consider the following while deciding the treatment –

1. The stage and grade of the cancer (size and area spread)

2. Overall Health (Co-morbidities)

3. Time of menopause

There are two main types of breast cancer surgeries:

1. Breast Conserving Surgery: where the surgery is performed to only remove the cancerous lump called tumor. Depending on the type, size and amount of tumor, the surgery ranges from lumpectomy (removal of tumor with little surrounding tissues) or partial mastectomy. Usually, post-surgical radiotherapy is offered to destroy any remaining cancer cells is as successful as total mastectomy in treating early-stage breast cancer.

2. Mastectomy: surgery where whole breast is surgically removed. With advancement in science and technology, a mastectomy can be followed by reconstructive surgery to recreate a bulge to replace the removed portion of breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.

Awareness should be created among the masses to get most breast cancers detectable at early stages, as most women with breast cancer arrive with advanced disease.  In metastatic or advanced stages of cancer, it isn’t completely curable, and the treatment aims to achieve remission (where the tumor shrinks or disappears).

Dr. Rohan Khandelwal, Breast Cancer Surgeon 

CK Birla Hospital For Women, Gurugram

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“We Can. I Can”- Unite to fight against cancer.  World Cancer Day unites the world’s population to fight against cancer and rise awareness against cancer among people, about healthy diet and physical activity. 2016-2018 is held under the theme “We Can. I Can” Unite to fight against cancer

Cancer, one of the most deadly challenges in 21^st century, is fast spreading worldwide; it has now emerged as 2^nd top leading causes of death, Heart disease being the first top cause.

Along with human growth in terms of modernization and urbanization the cancer too grew to a greater extent with respect to types, complexity, involving people from all race, regions and age.

World cancer day Feb-2018

 February 4^th of every year is celebrated as “World Cancer Day” globally since 1933 under the direction of UICC (Union for International Cancer Control) and WHO. World Cancer Day unites the world’s population in the fight against cancer. This day was established specially to rise awareness against cancer among people, teaching them about healthy diet, regular and proper physical activity and a lesson on how to prevent themselves from the environmental carcinogens. The campaign for years 2016-2018 is held under the theme “We Can. I Can”.

‘We can, I Can.– is a theme adopted for three years 2016-2018, it explores how everyone-as a collective or as an individual-can do their part to reduce the global burden of cancer.

Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.

World Cancer Day is a chance to reflect on what you can do, make a pledge and take action. Whatever you choose to do ‘We can. I can.’ make a difference to the fight against cancer.

What is Cancer?

Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs, the latter process is referred to as metastasizing. Metastases is a major cause of death from cancer.

Cancer statistics -worldwide

• As per a recent WHO report, 8 million people worldwide died from cancer in 2015. That is nearly 1 in 6 of all global deaths.
• US$1.16 trillion is the estimated total annual economic cost of cancer in 2010.
• 30-50%of cancers could be prevented.

Cancer statistics – India

• One woman dies of cervical cancer every 8 minutes in India
• For every 2 women newly diagnosed with breast cancer, one woman dies of it in India
• As many as 2,500 persons die every day due to tobacco-related diseases in India
• Smoking accounts for 1 in 5 deaths among men and 1 in 20 deaths among women, accounting for an estimated 9,30,000 deaths in 2010

According to the statistics, it has been noted that most of the cancer cases and cancer deaths (47% and 55% respectively) occur in less developed areas of the world. If it is not controlled, this condition may get worse by 2030. So, it is very necessary to get control over such situation at all the corners of the world.

Cancer Fact sheet- India

• There are more than 100 types of cancers; almost any part of the body can be affected.
• The five most frequent cancers (ranking defined by total number of cases) in India in men and women are breast, cervical, oral cavity, lung and colorectal.
• Cancer is the second most common cause of death in India (after cardiovascular disease).
• Use of tobacco products (e.g. smoking cigarettes) are the single most preventable cause of death worldwide.
• More women in India die from cervical cancer than in any other country.
• Breast cancer is the most common cancer in women in India and accounts for about a quarter of all cancers in women in Indian cities.
• The average age for breast cancer in India is almost a decade lower than that in the West.
• Cancers of major public health relevance such as breast, cervical, oral and colorectal cancer can be cured if detected early and treated adequately.
• Cancers of the oral cavity as well as lung cancers due to chewing or smoking tobacco can be prevented.
• Cancers of oral cavity and lungs in males and cervix and breast in females account for over 50% of all cancer deaths in India [9].

Common myths and facts about cancer

 Below are listed some common myths and facts about the cancer among people which are necessary to be removed and to understand the reality about the cancer to get control over it.

• Generally people think that cancer tissues are just healthy tissue, however it is not.
• Common people think that cancer is a disease for wealthy and old age people however; it is a global and epidemic disease which can affect all age groups.
• Common people think that suffering from the cancer is like a punishment however, most type of cancers are now treatable.
• Common people think that having cancer is their fate however approximately 30% of the cases can be cured and prevented.

Higher the Income Higher the chances of Cancer

• A survey conducted by WHO in 2015 shows that people belonging to upper-middle class and rich categories suffer with cancers of stomach, liver, colon & rectum and breast cancers compared to poor and low economic class people.
• This demonstrates clearly that occurrence of cancer is more common in rich, though the deaths due to cancer is more seen in people with low economy due to insufficient knowledge and money to get timely treatment.

 What causes cancer?

Cancer arises from the transformation of normal cells into tumor cells in a multistage process that generally progresses from a pre-cancerous lesion to a malignant tumor. These changes are the result of the interaction between a person’s genetic factors with  3 categories of external agents, such as:

• physical carcinogens, such as ultraviolet and ionizing radiation;
• chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and
• Biological carcinogens, such as infections from certain viruses, bacteria, or parasites.
• Tobacco use, alcohol use, unhealthy diet, and physical inactivity are major cancer risk factors worldwide.
• Ageing is another fundamental factor for the development of cancer.

Can we prevent Cancer?

Between 30–50% of cancers can currently be prevented by avoiding risk factors and adopting healthy life style. Early detection of cancer plays a major role in cancer management. See the picture depicting the warning signs of cancer which should be immediately brought to the attention of the physician. Many cancers have a high chance of cure if diagnosed early and treated adequately.

Role of Diet in Cancer

 There is a famous saying in Kannada –ಊಟ ಬಲ್ಲವನಿಗೆ ರೋಗವಿಲ್ಲಾ, which means one who knows what to eat, how to eat, how much to eat, when to eat usually is free from disease.

Foods that Increase Cancer Risk

• 1 out of 10 cancers (10%) may be linked to diet and over half of these are caused by eating less than 5 portions of fruit and vegetables a day.
• A diet rich in saturated fats, red meat and salt and poor in fiber is associated with increased risk of cancer. The people who eat more of red and processed meats are more likely to develop stomach and bowel cancers.
• The way we cook might also increase our cancer risk. Chemicals are released when we cook food at high temperatures which can damage body cells putting them at risk of becoming cancerous.
• Some studies have shown that the calcium in milk reduces the risk of bowel cancer, while others have linked high intake of dairy proteins with prostate cancer.
• Most additives, colors, flavors and sweeteners have not been found to increase the risk of cancers.
• Alcohol and pickled food consumption have been shown as independent risk factors for stomach cancers. Alcohol can increase the risk for a number of cancers including that of liver, mouth, bowel, throat, food pipe and breast.
• Other Indian foods associated with cancer risk are high rice intake, spicy food, and excess chilly consumption, use of soda and consumption of dried salted fish.

Foods that Reduce Cancer Risk

• Insoluble grain fiber in coarse grains (e.g., rye, sorghum, maize, barley and millets).
• Micronutrients like vitamins and trace elements.
• Vitamins A, E, and trace minerals such as selenium, zinc.
• Vitamin-D and calcium are also found to give protection against colorectal cancer.
• Green tea and its compounds.
• Retinoids (found in orange and red vegetables and fruits like sweet potatoes, mangoes, pumpkins, peaches and carrots) have been found to inhibit cancer growth in epithelial tissues.

National Institute of Nutrition (NIN) recommends a diet that includes high intake of fresh vegetables, fruits, garlic and spices such as turmeric in adequate amounts for cancer prevention.

 Cancer treatment — calling all Pathies to be united and adopt an Integrated approach….

I would like to quote this — “The Physician’s high and only mission is to restore sick to health, to cure, as it is termed”, a quote from a book known as ‘Organon of Medicine, which tells about the fundamental principles, disease understanding, medicinal powers and application of medicinal knowledge to treat diseases through Homeopathy, which was written by 18^th century German, Allopathic doctor Dr. Samuel Hahnemann who founded system of Homeopathy later.

As per this quote the main aim of the doctor is to cure the sick, to get him out of his suffering, which demands all kinds of skills and knowledge to be employed by physicians. A good willed doctor, who is concerned about patient’s welfare, should never hesitate to adopt/suggest a multidisciplinary approach in the challenging cases like cancer. Oncologists should work together with AYUSH physicians and vice versa. I am sure such an approach will definitely benefit cancer patients.

Unfortunately the current scenario is such that doctors of AYUSH and Modern Medicine have become rivals, we should realize that DISEASE is our common Rival who is growing stronger and we are losing our strength as Health care providers. Unless we unite and fight against challenging diseases like Cancer, Auto immune diseases etc, we will lose the respect from suffering humanity.

Role of AYUSH (Ayurveda, Unani, Siddha & Homeopathy) systems in the treatment of Cancer.

Ayurveda is the most ancient system of medicine, It can be said that almost all systems of medicine including Modern medicine have their roots in Ayurveda.

“Gatra pradeshe kwachidev doshaaha

Sammruchhita manasamasruk pradushya

Vruttam sthiram mandrujam

Mahantamanalpamulam chirvruddhyapakam

Kurvanti mansocchrayamtyagaadham

Tadarbudam shastravido vadanti.

This Shloka which tells about cancer (Arbuda in Sanskrit) is mentioned in ancient Ayurvedic literature called Sushruta Nidanastahan which says—

Due to vitiation of the flesh and blood by deranged and aggravated Doshas (vayu, pitta and kapha) a large vegetation of flesh appears at any part of the body which becomes rounded, immovable, slightly painful and has its root considerably deep in the flesh (affected part). This growth is termed as ARBUD by the learned physician.

Homeopathy system of medicine has adopted holistic approach towards diseases like cancer. Homeopathy doesn’t consider cancer just as a pathological change in tissues or organs. A true homeopath assesses why a particular person is prone to cancer and why not others? It looks beyond tissue changes, laboratory findings.

According to Homeopathic concept, cancer is one of the manifestations of Syphilitic Miasm. (Miasm- A predisposition to disease).

How Homeopathy can be helpful ?

• Early stages of cancer can be effectively treated though Homeopathy
• Homeopathy can work in sync with other pathies to optimize the effects, so that cancer patients can be benefited to a larger extent.
• In terminal cases of cancer, where only palliative treatment is the choice, homeopathy can be considered as a main mode of treatment, as homeopathic medicines in minute doses do not cause any side effects.
• Homeopathy can be useful to counteract the side-effects of chemotherapy and radiotherapy ( e.g.- nausea, vomiting, loss of appetite, weight loss, Hair loss, Anemia infections etc)
• Homeopathy can be useful in cancer patients where certain allopathic medicines are contraindicated.

Yoga & Naturopathy– the benefits of yoga and naturopathy methods is well known. The secret of longevity and healthy life of our ancestors is due to yoga and Naturopathic practices they adopted in their life.  Healthy food habits and healthy practices definitely help to optimize our physical and mental health, thus can play a major role in prevention as well as in the treatment of cancer patients.

Siddha and Unani systems of medicine too can offer good benefits through their treatment for cancer patients. The healing properties need to be explored more and brought into the light.

So friends cancer is no more a dreaded disease, it can be prevented, early detection and treatment can cure it, and a cancer patient can live a long and happy life like anyone.

The medical fraternity, government authorities, private bodies and likeminded individuals and doctors should come forward and get united  only then can we defeat this common enemy i.e., cancer and help thousands of people suffering from cancer.

Dr. Tejaswi K.P.
Reader- Dept. of Surgery, Bhagwan Buddha Homeo Medical college, Mallathalli, Bangalore
Consultanat- Surabhi Homeo clinic, Vidyaranyapura, Bangalore-97
Mob-97311 33819    Email-drtejas2000@rediffmail.com

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