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In recent years, a number of significant advances in our knowledge of cancer have changed our outlook. Now we can think not only of long disease-free survivals but also preventing cancer. The significant advances in knowledge have changed the gloomy outlook of cancer. It was the realisation that 60 to 90 per cent of all cancers are determined by environmental factors. This means that if we can pinpoint the agent or agents in the environment, which leads to cancer, we can then either completely remove it from the environment or at least reduce exposure to it. In other words there is a possibility that the majority of human cancers are preventable.
The gap between the start of cancer and when it is clinically noticeable or gives rise to symptoms is in the range of fifteen to thirty years. Cancer is an insidious, slow growing disease, which for many years in its earlier stages does not affect the health of the individual. If the disease can be detected during the course of these years it can be effectively and more easily treated. It can thus be prevented from becoming a serious condition. With increasingly better understanding of the basic cellular mechanisms involved in cancer, specific methods of treatment for different forms of cancer are being discovered.
It is unlikely that there ever will be single magic cure for all forms of cancer, but gradually a more effective method of treatment is being found for different cancers. Individuals with some form of cancers, if the treatment is planned well, can look forward to a meaningful complaint-free survival for many years, where previously the life expectancy was counted in months. Over the years, data collected on the frequency of various cancers have shown that, some of them change with a passage of time, and this change can be linked to some change in the environment or social practices.
An interesting example of this is the sharp increase in the incidence of cancer of the mouth and throat in the community in which the habit of taking pan, betel leaf, with tobacco is very high. As the number of pan and tobacco chewers in the population goes down, the incidence of cancer of the mouth and throat also goes down. Similar is the experience with the habit of cigarette smoking; with its increase there is steep increase in lung cancer cases.
So far all efforts made to discontinue such habits have failed. On the contrary the habit of cigarette smoking is on increase. The most difficult and the most vital part of any cancer control programme is translation of research findings into practice, especially where they involve change in well-established social customs, business practices or personal habits. Many improvements in early detection of cancer have been made recently, and intense work is going on to discover even better methods. The greatest success to date in this area is of course that of carcinoma cervix, a fairly common cancer in this part of the world. With the help of yearly cytological examination of the high-risk women, most of the carcinoma cervix cases can be detected while still restricted to the superficial layer of the cervix.
A minor surgical operation is all that is required to remove the disease layer. In countries where this programme has been in operation for a number of years, there has been a drastic fall in the number of women dying of carcinoma cervix. Persuading the healthy to have regular check-ups for cancer will go a long way in reducing cancer-related suffering and death.
Once cancer has spread far enough to cause symptoms, treatment becomes more difficult and the chances of improvement decrease. Even in this stage, the earlier the person comes for treatment, the better are the chances of improvement. Ignoring the complaints or tying unproven remedies makes it worse. Treatment at this stage of disease is prolonged, and extensive and also expensive.
Cancer is a disease of which we should take note of its seriousness, but not by ignoring it or running away from it, but by systematically planning ways and means of combating it. With the knowledge presently available there are some cancers, which can be prevented from occurring, which is called primary prevention, and others, which can be detected early, and so treated successfully called secondary prevention. For those cancers, which so far as we do not know how to prevent or detect early are concerned, there are newer methods of treating them.