Saturday, November 24, 2012
Incidence of Cancer: Prevntion and Early Detection for Effective Management
From National Seminar On Cancer Management
After the informative speech and presentations, it was time for questions to be raised by the delegates which were appropriately addressed by the speaker.
Incidence of Cancer: Prevntion and Early Detection for Effective Management
Speaker: Prof. Dr. Purvish Parikh MD, DNB, FICP, PhD, ECMO, CPI, MBA Medical Oncologist & Hematologist, Mumbai
The technical session began with the introduction of Dr. Parikh by Dr. S. Kumar. Dr Purvish M Parikh is a medical oncologist and hematologist who has broken a new ground in stem cell therapy in India. He is responsible for the first umbilical cord blood transplant as well as the first haploidentical transplant in our country. While working as a professor and head of medical oncology at Tata Memorial Hospital, Mumbai, he strived to lead several innovations in the field of medical oncology.
Adding to list of achievements Dr. Parikh has visiting fellowship at Harvard International, Boston and Oxford University, Oxford. He has also undergone extensive training at Royal Marsden Hospital, London; Memorial Sloan Kettering Cancer Center, NY and Johns Hopkins Hospital, Baltimore.
Finding time in his busy schedule Dr. Parikh contributes to various government undertakings while being a Convener of Indian Cooperative Oncology Network, President of Indian Society of Medical and Pediatric Oncology, International Editor for JCO, USA, editor in chief of IJC and managing director of AmeriCares India Foundation.
Dr. Parikh began his presentation with statistics about the survival rate Childhood acute lymphoblastic leukemia (ALL) which is a type of cancer in which the bone marrow makes too many immature lymphocytes (a type of white blood cell). With great improvements shown in medical science, the diagnosis and treatment has a high success rate at present for ALL. The overall survival rate at present for children with ALL has reached 90%.
He also showed stats of where breast cancer has overtaken the cervical cancer as the most fatal cancer among the women of India. The reason as to why the incidence of cervical cancer came down is just simple fact that the awareness of personal hygiene created among the women. Awareness is the best tool to combat cancer. Watching out at the trends would give hints to prevent cancer. For e.g. The number of cases of cervical cancer is more in rural areas and cases of breast cancer are high in urban areas which is a clear indicator of different lifestyle increasing the risk of these cancers among women.
According to Dr. Parikh, 85% of cancers are caused due to unhealthy lifestyle followed by people. Making positive changes to lifestyle would lead to prevention of cancer thus saving the cost of treatment and human resources available in oncology treatment.
High Fat diet is increases the risks factor for cancers like breast cancer, colon cancer, pancreatic cancer and cancer of small intestine, where as high calorie diet is responsible for incidences of cancers like prostate cancer, type 2 diabetes and heart disease. The low fat, low calorie diet, consisting of fruits and vegetables will help a great deal in prevention of cancer.
Maintaining proper oral hygiene can bring down incidences of oral cancer. Also if the medical practitioners and dentists are able to identify conditions that may lead to cancer in future and take precautionary measure, that would contribute a great deal in prevention of oral cancer.
He called upon doctors to look out signs which could lead to cancer like
1. Trismus - Limited jaw mobility due to tonic contraction of the muscles of mastication.
2. Leukoplakia – Leukoplakia appear as patches on the tongue, in the mouth, or on the inside of the cheek, which mainly affects the mucus membranes of the mouth
3. Erythroplakia - A fiery red patch that cannot be characterized either clinically or pathologically as any other definable lesion.51% of cases of Erythroplakia are known to end up an cancer.
Proper examination and treatment of such conditions are necessary to bring down the incidences of oral cancer along with avoiding consumption of tobacco, alcohol and other cancerogenic products. His emphasized the need for focusing on prevention of cancer rather than treating it, along with urging the government to bring about a revolution in cancer treatment along with other non-communicable diseases such as hypertension, diabetes and cardio vascular diseases through the 12th 5 year plan.
Dr. Parikh expressed his concern where majority of people affected by cancer were not being treated by oncologists as there was shortage of oncologists in our country. They only had access their family doctor or local physician. For this reason, efforts should be made to train the non-oncology medical practitioners in identifying signs of cancer. Proper examination of the patient with susceptible signs indicating cancer is a must.
With excellent power point presentation to back him up, Dr Parikh moved on address the most deadly cancer of the women in India where the lack of awareness about the basic self-examinations for breast cancer which is the only window to early diagnosis. The tests necessary for diagnosis of breast cancer are:
· Self examination of Breast
· Clinical examination of breast by a medical practitioner
· Core biopsy
· Focused ultra sound
Once the diagnosis has been made, treatment should be delayed. Appropriate chemotherapy is necessary in tackling cancer well, along with other standard treatment like surgery and radiation.
Dr. Parikh also elaborated breast cancer that is HER2 postive; meaning it tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. The HER2 gene normally helps cell growth, division and self repair. Unfortunately when cancerous cells have the HER2 gene they divide, grow and repair themselves faster, making it a more aggressive disease which higher chances of recurrence. The solution is a highly targeted treatment by a specialist the first time.
Goals of the treatment and therapy in cancer should be
· Curing the person of cancer and giving clearance as NED
· Converting cancer into chronic disease
· Prolong good quality of life for the survivors
· Palliative care that focuses on relieving and preventing the suffering of patients.
· Symptom control
He argued that unlike Hypertension and diabetes, cancer was curable; therefore more efforts should be invested in curing this malady.
The first chance is the best chance in winning the war with cancer. Dose intensity plays a great role in keeping cancer cells at bay. Counseling of the patients to let them know the doctors are working for them and will be there with them at every step is very important.
In case of being diagnosed it was important to approach the right doctor, meaning the oncology specialist for treatment. Also it is utmost important to complete the treatment as statistics have proven that incomplete is like getting no treatment at all.
Dr. Parikh divided the India into 3 different socio economic groups.
The 15% of the rich people could afford best treatment with advanced technology; therefore even with delayed diagnosis the rate of survival was good.
The early detection and proper treatment was not meant for the poor because these were the people who were not sure of where their next meal is going to come from. Even with high subsidy they could not afford the treatment. In some cases, if they did not work for a day, they would not be able to feed themselves and their families. In such cases prevention was only solution. Creating awareness about personal hygiene, oral hygiene, effects of tobacco, cigarettes etc would help in prevention of cancer to a great extent.
The main concern for the medical professionals should be the middle class people, who usually demanded quality treatment at affordable price.
Some NGO’s are trying to reach the goal of providing free medicines to curative cancers. CPAA and Cancer society of India have contributed a lot towards betterment of people affected by cancer.
The government of India has almost doubled the number of medical seats for doctors seeking specialization in the field of oncology since 2010, but the goal of having enough oncologists in India is nowhere in sight.
With dedication, sincerity and commitment the medical practitioners could help the patients win the battle with cancer. He stressed his point with a power point show depicting cancer as the tiger which was to get the zebra. The task of the doctors was to provide the zebra with a fast enough motorcycle to escape the clutches of the tiger.
After the seriousness of the debate, he ended this technical session by putting a smile on faces of everyone present.
More information regarding prevention, treatment and management of cancer is available on http://www.oncologyindia.org/
The Paper Presented By Dr. Parikh
Majority of 1 million new cancer patients seen each year in India are diagnosed in an advanced stage, leading to a significant number of deaths. In the light of the current limitations (financial, administrative and others) in the country, it can be expected that preparedness for the future is woefully inadequate. This also means that there is a need for radically different strategies to win the battle against cancer. Tobacco, which is involved in the development of more than a quarter of all cancers, is the single most important factor within our control. Common women's cancers are cervical and breast cancers. As tobacco habit starts in three fourth of instances at an early age, preventive strategies should commence in secondary schools. Periodic oral examination is the best surveillance mechanism. Preventive measures should also focus on common women's cancers like cervical and breast cancer. Proper screening goes a long way in early diagnosis of these conditions. Human Papilloma Virus (HPV) infection is clearly the commonest sexually transmitted disease globally and has a direct correlation with precancerous lesions as well as full blown cancers of the cervix, anus, vagina, vulva and penis. HPV infection therefore becomes the logical target for a preventive vaccine, especially since cervical cancer remains a major cause of morbidity and mortality in India as well as other developing countries. Based on the present vaccine protocol, it can be anticipated that approximately 70% of cervical cancers are preventable by vaccination. WHO has recommended, with certain caveats, that routine HPV vaccination of females be included in national immunization programs. Focussing on males, a total of 93 % of anal cancers are associated with HPV. In addition, approximately 25 to 33% of oropharyngeal cancers are probably also preventable by vaccination. Vaccination of boys will not only prevent cancers linked to HPV occurring in males, but also those due to the transmission of the virus by males to females. Only an extensive program to vaccinate both genders could lead to an eradication of the high-risk HPV types within a foreseeable period of time. Research on hepatitis B virus, and also on high-risk HPV has significantly changed the field of sexually transmitted disease and their consequences. They are applicable to both women and men. They prevent HPV-induced anogenital warts, precancerous lesions, cervical cancer oropharyngeal cancer and anorectal cancers.
As majority of Indian population is unable to access healthcare services due to several limitations, it is ideal to provide them healthcare at their doorsteps using Mobile Medical Units. Having the mobile medical units visit the same community on a regular basis ensures that there is continuity of care, especially for chronic diseases. This model is great because it allows the agency to pass on the benefit of health education, lifestyle modification and early detection in a manner that is trusted and respected by the communities. Combining it with the use of low cost effective screening tools it will have the dual benefit of saving lives by early detection when the cancer is in early stages and still curable as well as reducing the cost of treatment.
Cancer directed systemic therapy (of which Chemotherapy is a major component) has quickly become the mainstay of treatment in most instances. To provide the patients with optimal benefit, several factors need to be considered. Dose intensity impacts on RR as well as overall survival and is best optimized when cancer directed systemic therapy is administered by medical oncologists. Incidence of cancers is growing at an alarming pace. Significant resources are being earmarked by the government to tackle the menace of the big four non communicable diseases (NCDs) - of which cancer is a major component. Chance of cure and optimizing outcome is best when the treatment is given only by adequately trained, qualified and experienced experts.