Cancer prevention


Cancer is the second biggest killer disease globally. In 2020, one crore persons died from cancer globally, that is about one in six deaths. In India, one in ten persons will get cancer and one in fifteen will die of cancer.

Can cancer be prevented? To answer that, we must know what cancer is and why it happens. Only then can we think of how it may be prevented. And if it cannot be prevented, then how the risk of getting it may be reduced.

What is Cancer?

Our body is composed of many different types of cells. These cells grow and divide in a controlled manner to produce more cells as required by the body. Also, the older cells and the damaged cells die.

However, sometimes, the genetic material of one cell gets damaged or changed [mutation] and the cell becomes immortal: that is, it will not die. When this ancestor cell divides, its descendant cells are also immortal. This gives rise to a limitless number of immortal descendant cells. The number of cells is far more than what the body needs. The extra cells then form a mass that is called a tumour.

These immortal cells are called cancer cells. The cancer cells are immortal; are capable of limitless division, and thus of limitless growth in the number of cells; and can spread [Metises] to other parts of the body through blood and lymph system.

There are more than 100 types of cancers. Not all cancers form tumours: cancers of the blood and the bone-marrow [leukaemia], for example, do not form tumours.

Most cancers are named for the body part in which they begin: colon cancer, prostate cancer, ovarian cancer, breast cancer and so on.

Only about 10% of cancer deaths are because of primary tumour. Most of the deaths are because of metastasis – spreading of the cancer to other parts of the body. Once metastasis happens, it is exceedingly difficult to treat. Early detection of cancer is therefore of utmost importance.

Why Cancer Happens

We do not know why cancer happens, that is why the cells turn cancerous. The main reasons are genetics and certain environmental or behavioural triggers. Some types of cancer are believed to be inherited, that is the genes you were born with might carry a predisposition for cancer.

Can Cancer be Prevented?

Cancer is a 3200-year-old disease. It is endogenous, a part of life-process. So, it can neither be eradicated, nor prevented, nor cured. Yet.

Genes and behaviour are the two factors for the occurrence of cancer. We do not have control over genes. But we can modify our behaviour to reduce the risk of cancer. Reducing the risk is all the more important because cancer treatment success rate is not particularly good.

Cancer Treatment Success Rate

If the cancer is detected early, that is at Stage 1, prognosis is excellent and usually chemotherapy is not required.

If detected in Stage 2 & 3 prognosis is progressively poorer with a greater risk of recurrence.  Surgery, chemotherapy, and radiation are required.

If detected in Stage 4, that is metastatic cancer (spread to distant sites), prognosis is poor.  Surgery, radiation, chemotherapy, and targeted therapies are used. But the 10-year survival rate is 5% without treatment and 10 % with optimal treatment.

Since cancer cannot be prevented, late detection of cancer is fatal, and the success rate of cancer treatment is poor, reducing the risk of getting cancer is important.

Reducing the Risk of Getting Cancer

One-third (33%) of cancer deaths are due to five factors: obesity (high Body Mas Index), low fruit and vegetable intake, low physical activity and alcohol and tobacco use. Tobacco use causes 22% of the deaths. Cancer causing infections like hepatitis and human papilloma virus (HPV) cause 25% of deaths in low- and middle-income countries.

We can reduce the risk of cancer by a few lifestyle modifications. These are:

Tobacco. Cut out use of tobacco and tobacco products.

Diet. Eat plant-based foods: plenty of fruits and vegetables of different colors, leafy green vegetables, whole grain, and beans. Women who eat Mediterranean diet, extra virgin oil, legumes, and nuts have a lower risk of breast cancer. Avoid high calorie foods, animal fats like butter, refined sugar, and processed food, especially processed red meat. Chose fish over red meat.

Alcohol. Risk of several types of cancer – including cancer of breast, colon, lung, kidney, and liver – increases with the amount of alcohol you drink and the length of time you have been drinking. Avoid alcohol, or drink only in moderation.

Weight. Healthy weight, within your Body Mass Index (BMI), reduces the risk of several types of cancer including the cancer of the breast, prostate, lung, colon, and kidney.

Physical activity. Run, jog, brisk walk, swim, cycle – it will help control your weight and reduce the risk of cancers of breast and colon. Do at least 30 minutes of aerobic activity every day; and least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity or a combination of the two. The longer the better.

Avoid exposure sunlight

Skin cancer is one of the most common, and one of the most preventable, cancers. Sunlight is the major cause of skin cancer. So, avoid the sun, especially between 10 a.m. and 4 p.m., when the sun’s rays are strongest. Stay in the shade. Use sunglasses and a broad-brimmed hat. Cover exposed areas. Wear tightly woven, loose fitting clothing that covers as much of your skin as possible. Opt for bright or dark colors, which reflect more ultraviolet radiation than do pastels or bleached cotton. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously and reapply every two hours — or more often if you’re swimming or perspiring. Avoid tanning beds and sunlamps. These are just as damaging as natural sunlight.

Vaccination

Cancer prevention includes protection from certain viral infections.

  •  Hepatitis B. Hepatitis B can increase the risk of liver cancer. Those at high risk of hepatitis B — such as adults who have sex with multiple partners, have sexually transmitted infections, who use intravenous drugs, men who have sex with men – should have Hepatitis B vaccine.
  •  Human papillomavirus (HPV). HPV is a sexually transmitted virus that can cause cervical and other genital cancers and squamous cell cancers of the head and neck. The HPV vaccine is recommended for males and females ages 09 and 45.

Early Detection

Since prevention is not possible, ‘prevention is the cure’ is modified to ‘early detection is the cure.’ Early detection of cancer can greatly improve the five- or ten-year survival rate.

Regular self-exams and screenings for various types of cancers — such as cancer of the skin, colon, cervix, and breast — can increase the chances of discovering cancer early, thus improving the chances of successful treatment.

Conclusion

Over the past 2000 years, the survival rate for many cancers has improved dramatically: life expectancy increased by 20-30 years. But for a few other cancers – metastatic pancreas cancer, metastatic breast cancer, inoperable gallbladder cancer – improvement has been marginal: life extended by just a few months.

Late detection of cancer is fatal. The causes for late detection are many but lack of awareness is the principal cause. Other main causes are: patient being shy, social stigma and doctors’ ignorance because of which the treatment is delayed. An awareness program will address all these issues.

Present state of our knowledge makes us believe that cancer prevention or cure is not possible because cancer is a product of the processes essential to the life process.

Will some radical discovery in the future make cancer prevention and cure possible? We don’t know. But we can always hope.

Because as Richard Clauser, Director, NCI, USA, says about the future of cancer cure, “There are far more good historians than there are prophets.”

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Disclaimer

Views expressed above are the author’s own.



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