Intro: Why is there an increase in cancer cases of late?

Age (longevity), awareness, affordability, better diagnostics, improving treatment options and risk factors (reversible and irreversible) are some of the causes.  

Longevity – people are living longer now. Cancer is a stage in one’s evolution of life, we believe. There is an increasing longevity in our population. The average lifespan of an Indian today is nearly 70 years. The longer we live, higher is the risk of having a type of cancer. Data and statistics suggest that if you live up to 80 years, there is a 1in 6 to 1 in 7 people having a type of cancer. 

With improving healthcare, better diagnostics and treatment – we are picking up early cancers and curing them. Advances in technology and training have helped patients to live longer after cancer treatment. 

Awareness about cancers, cancer symptoms, Diagnostics and treatments have helped the population to reach out to healthcare. 

The stigma around cancers is much lesser now. 

Affordability and accessibility is better with the government playing a dual role of being a healthcare provider and insurer. Corporate care is on par with the best in the world. Risk factors and the high risk lifestyle are on the rise. 

Adoption of western practices and neglect of traditional practices are leading to a faster pace of life. Fast Foods, delayed conception, lack of breastfeeding are only some of the causes. Smoking, alcohol, unhealthy diet, unhealthy eating practices, obesity, contaminated food, water and Stressful life chasing time.  

The role of stress cannot be underestimated. 

Environmental (air, water, food) pollution and genetic predisposition are some of the causes for increasing incidence and prevalence of cancers. 

Cancer is the leading cause of mortality in the world. In our country about 5 lakh new cancer cases are detected annually. 

2. Risk factors in today’s context – lifestyle etc.?

Nature, Nurture and the mind play an important role as risk factors for cancer. The risk factors can be broadly categorized into environmental factors, patient related factors, socio- cultural and civilizational poverty.  Patient related factors can be further categorized into physical, physiological and psychosocial factors. 

Risk factors:  Majority 95% of cancers are sporadic. 5% of them are genetically 

driven. The causation is multifactorial. Lifestyle, exposure to carcinogens, lifestyle 

and diet has a significant role to play.  Irradiation, chemicals and pesticides, 

obesity, smoking, red meat, lack of fibre, fried fast food, oral contraceptive pills, 

delayed pregnancy, lack of breastfeeding , air pollution etc are a few to mention

Environmental factors: Polluted air, water, and food products / processed and refined food / increased preservatives within the food products / industrialisation / exposure to harmful radiation etc.

Patient related factors: Longevity is a desirable risk factor. We are living longer and our average lifespan in India today is 70 yrs. Westernised lifestyle with changing eating and drinking habits. Sedentary lifestyle, Alcohol, Tobacco, Obesity, Red meat, processed meat, high fat diet, lack of dietary fibre and fruits, lack of exercise, Changing work pattern to desk jobs from manual work and increasing stress. Diabetes, metabolic syndromes and westernisation have all lead to civilizational poverty. 

Family history & genetic predisposition: Presence of a family history increases the risk of cancers and having a genetic predisposition puts him at high risk of having cancer early. 

3. Who is at higher risk – hereditary etc.?

Risks are generic and organ specific – General risks include obesity, chronic inflammatory pathology of the organ, family history, genetic predisposition and exposure to risk factors. 

Some of the examples may include 

Breast cancers – smoking, alcohol, obesity, Oral contraceptives, elderly pregnancy, nulliparity and lack of breastfeeding are some of the avoidable risk factors. BRCA1 or BRCA2 genes can increase the risk for breast cancer and ovarian cancer in women and the risk for breast and prostate cancer in men, as well as other cancers.

Gastrointestinal cancers: General risks include red meat, processed food, smoking, alcohol, obesity, inflammatory bowel disease like Crohn’s disease and ulcerative colitis; family history of cancer or polyps; familial adenomatous polyposis (FAP), a genetic syndrome; and Lynch syndrome, an inherited condition that increases your risk of colon cancer.

4. How do you prevent it?

Prevention is better than cure. Risk factor reduction and improving once lifestyle is important.

Risk reduction can be done by adopting a healthy lifestyle, regular exercise, balanced diet with fruit, vegetables, whole grains and foods containing fibre, staying aware of the symptoms and seeking help when concerned. 

Utilization of food products free of fertilizers, contaminants and chemicals is useful. Consumption of healthy pure drinking water is vital. Breaths of fresh, unpolluted air are of paramount importance. Adoption of a traditional, cultural practice of having a cooked balanced meal, in addition to regular physical exercises and practices that can calm the mind such as yoga, prayers and positive thinking can have an agreed impact on the psycho neuro-immunology of an individual. Reduction in red meat, increase in green leafy vegetables, increase in fruits and fluids have all shown to be beneficial. Obesity is the biggest foe – that needs to be fought. Avoid smoking, alcohol, fatty food and elderly pregnancy. Fulfilling the physiological needs of conception and breastfeeding, is shown to reduce breast cancers.

Awareness, Health checks, Screening and early clinical consultation when symptomatic are vital. 

Mammography, Prostate Specific Antigen for prostate cancer, Colonoscopy for Bowel cancers can all be lifesaving. A colonoscopy done at that point can remove pre-cancerous polyps or identify cancers at a very early stage.

5. Does early diagnosis mean sure cure?

Early diagnosis is the key to cure. Awareness of symptoms is Vital. Awareness is half the job done. It is important to understand the cancer symptoms. Symptoms are those manifestations, which are not normal to oneself, cannot be explained by reason and have persisted for more than 6 weeks. Examples would include 

– A breast lumps on one side, which persists to grow.

– A change in bowel habit, which cannot be explained by reason.

– Blood in sputum, vomit, urine or stools

– A palpable lump

– Unexplained anaemia

– Unexplained weight loss

When any of the above symptoms are seen in oneself or their family members – it is vital to seek medical help. Taking help from Technology such as Google, might be a double edged sword. The risk of well, becoming worried well is high. 

An early cancer identified in early stages (stages 1 -2), are more or less guaranteed cure. There is a high cure rate in stage 3 in conjunction with chemotherapy and molecular targeted therapies. 

prevention is better than cure. CRC is not entirely preventable. Risk 

reduction can be done by adopting a healthy lifestyle, regular exercise, 

balanced diet with fruit, vegetables, whole grains and foods containing 

fibre, staying aware of the symptoms and seeking help when concerned. 

A routine check after the age of 40 years can be useful in certain high 

risk groups or when symptomatic. A colonoscopy done at that point can 

remove pre-cancerous polyps or identify cancers at a very early stage.

6. Why does it relapse?

This is an era of precision based onco-surgery / targeted therapies and advances in molecular medicine.  Despite all the advances we see recurrences and relapses in about 20% of the patients. This is due to tumour metamorphosis / circulating tumour cells / field changes and immune deficiency failing to control the malignant cells. 

7. What’s on the horizon in advanced cancer care – stem cell therapy etc.? 

Chemotherapy, which is nonselective and affects all rapidly dividing cells. 

The targeted therapy drug affects only the abnormal protein. Targeted molecular therapy is a type of personalized medical therapy designed to treat cancer by interrupting unique molecular abnormalities that drive cancer growth. 

Immunotherapy is a type of cancer treatment. It uses substances made by the body or in a laboratory to boost the immune system and help the body find and destroy cancer cells. Immunotherapy can treat many different types of cancer. It can be used alone or in combination with chemotherapy and/or other cancer treatments.

8. Gold standard in preventive check-ups everyone should undergo? 

A routine check after the age of 40 years can be useful in certain high risk groups or when symptomatic. There are cancer screening health checks curated for men and women which are extremely useful and can pick cancers early. However, they are not entirely foolproof. Symptoms should drive clinical consults and early diagnosis and intervention. Screening can be of great value in high risk individuals.