Pointing out that it is much more expensive to treat cancer than to prevent it, US cancer expert Edward E. Partridge, M.D has a few lessons for us By Smriti Daniel Sri Lanka can learn from the U.S – not what we should do, but what we shouldn’t do, says Dr. Edward E. Partridge, M.D. [...]

The Sundaytimes Sri Lanka

Sri Lanka, take note, don’t go the US way


Pointing out that it is much more expensive to treat cancer than to prevent it, US cancer expert Edward E. Partridge, M.D has a few lessons for us

By Smriti Daniel

Sri Lanka can learn from the U.S – not what we should do, but what we shouldn’t do, says Dr. Edward E. Partridge, M.D. “The problem that we have in our country, which you will eventually have in your country because we see developing countries following in our footsteps, is that as we became more and more developed, we did several things that were not healthy…Today, people die in the United States because of tobacco use, unhealthy eating, not getting enough exercise and not getting appropriate screening,” says the American expert on cancer. It’s a message worth listening to since cancer is on the rise in Sri Lanka, having taken its place up there among the top three Non-Communicable Diseases.

Here on a Rotary invitation: Dr. Edward E. Partridge. Pic by Athula Devaptiya

A former President of the American Cancer Society and currently the Director of the University of Alabama Comprehensive Cancer Centre, Dr. Partridge’s primary interest lies in cancer control and prevention, specifically in the context of breast and cervical cancer. It is why he likes to focus attention on the causes of cancer. Though pollution of the air we breathe and the water we drink are sometimes identified as key issues, Dr. Partridge says that these “pale in comparison” to the damage caused by bad habits like smoking and thoughtless eating.

“Our rates peaked at 52% of adults smoking, I think in Sri Lanka it’s something like 27%, so that was the first problem. The second problem was that as average income went up, we began to develop unhealthy habits. We were simply consuming too many calories. What has happened over the last 40 years is that we’ve gained almost 10 pounds per decade, so we are almost 40% heavier now than we were in 1970.” He’s been doing his research and says that while obesity was hardly an issue in Sri Lanka a few decades back, now an estimated 7.2% of women and about 3% of men are obese. Those numbers are only likely to rise if dramatic measures aren’t taken.

In the US, these issues have led to a national healthcare crisis, with 17% of the country’s GDP being poured into the healthcare sector. The incidence of breast cancer is rising, but Dr. Partridge explains that obesity is now threatening to overtake tobacco use as the number one cause of cancer. “Almost 35% of our women are in the obese category. That’s the greatest threat to our health system,” he says. For him, the answer is simple. “We’re beginning to understand that we really have to change the way we’re doing things to have a healthy country, and to avoid a full blown economic crisis.”

The change involves a shift in focus from treatment to effective screening and early intervention. “If we had to do it over, and this is where you really have a chance, we would focus on prevention and early detection rather than treatment,” he says. It’s the route he hopes countries like Sri Lanka will take. It’s why he’s here at the invitation of the Rotary Club of Colombo to visit the Club’s Cancer Prevention and Early Detection Project and to deliver the keynote address at a charity dinner.

The Cancer Prevention and Early Detection Centre in Colombo, operated by the National Cancer Control Programme is supported by Dialog Axiata PLC. It is billed as the only comprehensive Cancer Control facility in the country dedicated to screening, early detection and prevention to offer its services entirely free of charge. Since they opened their doors over 22,000 people have been screened for cancer, with an estimated 4000 being identified as having symptoms requiring further investigation.
Such screenings can significantly reduce the toll on the healthcare system and improve the chances of an individual successfully battling the disease. “Screening and early detection does make a difference,” says Dr. Partridge. “If you detect a breast cancer by mammography alone – that is, there is no lump – the survival, the chances are 98% -99% which is phenomenal.” Such early detection makes possible a simpler surgical procedure like a lumpectomy instead of a mastectomy that can leave a woman disfigured. As in Sri Lanka, many women avoid taking these tests though, afraid of what a diagnosis of cancer might mean for them and their families.

To help circumvent such natural concerns, Dr. Partridge points to the success of community based programmes where women are approached by other women they know and trust. “Just the word of mouth can actually spread the message,” he says.

However, some doctors have expressed their reservations about early screening programmes, pointing to the possibility of over diagnoses. Commenting on the issue, Dr. Partridge shares his opinion that the real debate is about whether regular screening for breast cancer should begin at age 40 or age 50. If the woman who is being screened is younger and therefore less likely to have the disease, then the chances of over diagnoses and unnecessary biopsies are higher. “The older you get the less of an issue it is because the incidence goes up,” says Dr. Partridge, emphasising that it makes complete sense to screen women in the most vulnerable age group, i.e over age 50.

As for cervical cancer, the last decades have seen a dramatic shift in the way it is treated. It is now fully accepted that the condition is typically caused by a virus known as the human papillomavirus infection (HPV). When women become sexually active, they are exposed to it and it can be identified by a simple pap smear test. Doctors in the U.S recommend their patients begin taking pap smears from age 21 onwards, but Dr. Partridge acknowledges that such regular screenings might be expensive and difficult to implement in large, previously unscreened populations. It’s why he’s been thinking about the advantages of screening for HPV once, when a woman is 30 years old. A woman who is free of HPV at that point would be at an extremely low risk for ever getting cervical cancer.

In addition Dr. Partridge explains that he is working with John Hopkins University on developing an affordable vaccine for HPV which will fall into the $2 – $3 range instead of the current $300. “We wouldn’t even have to vaccinate a 100% of the population. If we could get 70% of the world vaccinated it would be enough,” he says.

As medical professionals and governments are being forced to re-examine their approach to treating breast and cervical cancer, part of the logical argument for early intervention is sparing the individual and the state the hefty financial burden it represents. An advanced cancer might require chemotherapy that costs anything from $2,000 to $40,000 per session. With several such sessions required, patients can find themselves bankrupted by the costs. While the treatments have had some success – an estimated 12 million survivors of cancer exist in the U.S alone – complications from the therapy can have patients struggling to fully reclaim their health, further adding to the healthcare bill.

“The bottom line is that prevention and early detection is always better for the economy and the individual in the short and the long run than treating disease,” says Dr. Partridge. “It’s much more expensive to treat cancer than to prevent cancer.”

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