Keeping cancer at bay

Can we avoid cancer which by next year will become the No. 1 killer in the world? Here consultant clinical oncologist Dr. Prasad Abeysinghe talks to Smriti Daniel on what we can do to reduce the risk
Though figures aren’t available for Sri Lanka, second-hand smoke causes the deaths of around 50,000 non-smokers in the U.S every year.

The news isn’t all bad, though. Among Sri Lankan youth, exposure to the best known Group A carcinogen, cigarette smoking has decreased dramatically, from 4.0% in 1990 to 1.2% in 2007.

By Smriti Daniel

Ahangamage Sewwandi Bagya Gayarathne seems far too small and vulnerable to bear such an imposing name. The 10-year-old sits in the children’s ward in the Maharagama hospital, under a candy pink mosquito net, surrounded by textbooks.

Diagnosed with a brain tumour in 2008, 10-year-old Sewwandi has been undergoing radiotherapy followed by extensive chemotherapy for nearly a year. Her mother Shyamali proudly informs me that despite the cancer Sewwandi did very well in her Grade 5 scholarship exams. But her future is uncertain. Sewwandi personifies the tragedy inherent in a disease that indiscriminately picks its victims across gender, age, and class.
Dr. Abeysinghe

“By next year, cancer will become the number one killer in the world,” says Dr. Prasad Abeysinghe, Consultant Clinical Oncologist at the National Cancer Institute in Maharagama. In cases like Sewwandi’s where the cancer is unlikely to be identified early, and whose progression is terrifyingly swift, little can be done.

But cancer comes in many different forms, each of which shows a different pathology. One might be caused by genetics, another by exposure to carcinogens such as nitrosonornicotine (found in tobacco smoke) or Aflatoxin B1 (produced by a fungus which can found growing on peanut butter, among other things). Treatment, which must be tailored according to the nature of the cancer and how far it has progressed, can be cripplingly expensive and still prove ineffective in later stages. It’s become a matter of simple common sense to put some thought into prevention and early detection.

Cancer prevention must play out at multiple levels beginning with a focus on reducing or eliminating exposure to known carcinogens. Improving diet and physical activity comes next. Vaccinating against viruses such as Hepatitis B and human papilloma viruses (HPV) which are known to cause cancer in humans is also being widely discussed. Causing cancers of the liver and cervix, HPV and HBV infections will be responsible for 22% of global cancer incidence by 2020 according to WHO estimates. However, the simplest, most effective prevention strategy may be built around what you can do for yourself at home.

“Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin,” says Dr. Abeysinghe.

Breast cancer, the most common forms of cancer in women, can be spotted by a woman examining herself methodically once a month in the privacy of her own home. A visit to the doctor might become necessary should you find any lumps or oddities. She will then have to decide on further tests such as a mammography. Regular visits to a gynaecologist are a must.

“Pap smear testing has proven itself as a very effective way of controlling cervical cancer,” Dr. Abeysinghe says, explaining that it is the second commonest cancer in Sri Lankan women.

In men, oral cavity, lung oesophageal cancers are most common, no coincidence when you consider they are far more likely to be smokers than women. Looking into your own mouth might help you spot any pre-cancerous lesions — the white discolouration of leukoplakia or the red patch of erythroplakia — while regular mouth check ups at the dentist can also lead to an early diagnosis.

Other warning signs include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, chronic hoarseness and abnormal weight loss. Recounting tales of patients who have waited till lumps have begun to ooze before visiting the doctor, Dr. Abeysinghe says that a common misconception is that a lump that doesn’t bleed or hurt must be harmless. The truth is that pain and bleeding are often last stage symptoms, only appearing after the cancer has become entrenched.

Being more aware of changes in your body is only one aspect of the lifestyle changes that can help you beat cancer. Quitting smoking is obviously at the top of the list, but so is avoiding second-hand smoke. Second-hand smoke is so deadly that it is included in Group A carcinogens. Though figures aren’t available for Sri Lanka, second-hand smoke causes the deaths of around 50,000 non-smokers in the U.S every year, says Dr. Abeysinghe. The news isn’t all bad, though. Among Sri Lankan youth, exposure to the best known Group A carcinogen, cigarette smoking has decreased dramatically, from 4.0% in 1990 to 1.2% in 2007.

As governments raise taxes and take steps to prevent the sale of loose cigarettes, many people have begun using betel quid as a substitute. “Betel chewing can cause oral cancer,” says Dr. Abeysinghe bluntly, explaining that the areca nut included in the preparation can cause sub mucous fibrosis. This condition, in which a patient is unable to open his or her mouth fully, is considered a risk factor for oral cancer. Also dangerous products like Gutka and masala pan, which are marketed as mouth fresheners. Highly addictive, they have been associated with earlier onset of sub mucous fibrosis.

An apple a day won’t keep the doctor away, but five helpings of fruits and vegetables just might. Keep your consumption of red meat, fat, salt and alcohol low and you’re making good progress. Moderate daily exercise when combined with a healthy diet is also likely to help you control your weight. Keep your body mass index at <25kg/m2 and you reduce your risk of cancer, advises Dr. Abeysinghe.

Unfortunately, despite all your precautions, your risk of cancer only increases with age. Advances in medical science have ensured that present generations have a higher life expectancy than ever before, but we’re discovering that a longer life doesn’t always make for a healthier one. But we aren’t quite helpless. If you’re a smoker, quit now, and within 20 minutes your blood pressure and heart rate will return to normal.

Within 10 years, as far as your risk of oral cancer is concerned, it will be like you have never smoked at all. In fact, if you incorporate his advice into your life, you might never have to make an appointment with Dr. Abeysinghe. He’s keeping his fingers crossed.

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