A plea for cancer awareness
In 2010, about six hundred thousand Americans, and more than 7 million humans around the world, will die of cancer. In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death. —Mukherjee, Siddhartha (2010-11-16). The Emperor of All Maladies. Simon & Schuster, Inc. Kindle Edition.
Dr Mukherjee, in the quote above, states that one in three women and one in two men, in the US, will develop cancer in their lifetime. This is massive. Though we do not have country wide cancer registry in Pakistan, but some of the city registries are showing that the incidence of cancer is going up in these Pakistani cities. And though the percentages will surely be lower than in US, the numbers are likely to keep on increasing and breast cancer, cervical cancer and lung/mouth/throat cancer seem to be the major ones showing increases in Pakistan though some others are also increasing. Since these trends are not from Pakistan wide databases and the conditions under which people live, across the country, vary a lot, we should interpret these numbers with due caution.
There seem to be many reasons for the increasing numbers. Our ability to detect cancer, and earlier, has gone up. Our populations are also aging and cancer does afflict the older population much more than the younger one. These two factors alone explain a significant increase in cancer incidence. But at the same time it does seem that changes in our food, work, environment, and life styles might also be exposing us to more carcinogens (cancer causing agents) and this might also be a factor in the increasing cancer incidence.
The word cancer covers a lot of different types of cancers and it can be caused by variety of reasons. It can attack any part of the body and any organ. There is huge variety in how quickly it spreads and it can travel from one organ/part of body to another as well. We, in fact, might not know all the reasons that cause cancer or its spread. What we do know is that normal cells can get DNA mutations and these can turn them into cancer cells. So cancer cell is not alien to our body. These are cells where some functions of normal cells, like restrictions on division, replicability and mortality, have been altered due to mutations and that makes these cells cancerous. This is what makes them difficult to find, target and destroy too: in some cases they look and act too much like normal cells. But their added features, ability to replicate uncontrollably, ability to adapt to medicines designed to kill them and ability to defy normal cell mortality, is what makes them so difficult to destroy.
A cancer diagnosis still sends shivers down the spine of most people. And it should. Though there has been a lot of progress we still do not have the cure for most cancers and if detected late, a lot of cancers are fatal. The statistics quoted at the start speak for themselves. The problem is that cancer cells are hard to target and hard to kill, without hurting normal cells. There are three main ways of targeting: surgical excision for tumours where the hope is that all of the cancer comes out, targeted killing of cancer cells through exposure to radiation, and chemotherapies where different chemical agents are designed to target fast replicating cells or cells with other specific characteristics that only cancer cells have and kill them. Chemotherapy agents are being developed at a rapid rate but we still do not have specific agents for all or even most cancers.
All of the therapies and cures mentioned are quite expensive and even where they either cure the cancer or manage to significantly prolong life of a patient, they can have a significant effect on the quality of life of the patient. Even a rich country like the US will have to figure out how to manage the cost of treating cancer as numbers continue to rise as predicted.
With a lot fewer resources (money, facilities, human resource) and almost no commitment from the state of Pakistan to take care of the health issues of the people of the country, any increases in cancer incidence would be devastating for many across the country. It makes sense, in our condition, to have a lot more emphasis on awareness raising and prevention as well as early detection campaigns. Awareness and prevention campaigns are hard to finance as it is difficult, methodologically, to show their effectiveness (how do you measure how many cancers were avoided and at what benefit), but they are essential for our environment.
For the carcinogens that we know of and other risk factors known to be associated with cancer, the society, even if the state is not a party to it, should mount campaigns. We know tobacco chewing and smoking is a definite cause. Why is it still available in the country? Why is smoking still accepted? This is one of the biggest causes of lung and mouth/throat cancers. We should do more to control access to the substance.
The list of known carcinogens is long. Asbestos, exposure to radiation, x-rays, diesel fumes, some substances in fertilizer, pesticides, substances put in some deodorants, bathroom and laundry cleansers and so on are all examples. It would be important to have some research, focused on local conditions in Pakistan, as to what are all/most of the carcinogens that we encounter daily or frequently and suggestions on how people can start avoiding them and weeding them out of the system.
On the early detection side, putting in protocols, as people age, and especially for cancers like breast and prostate, would be a big help as well.
Cancer is deadly. And increases in cancer incidence, as it seems to be happening the world over, would be devastating for us especially given the lack of preparation on the part of our health sector. Given the cost of intervention, our best bet is to work with prevention and early detection. But here too the society will have to become more active than the state: cannot expect much from the state. But there is a lot that can be done through prevention and early detection.
The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at [email protected]
