Author: Rashmi Hosamani, Assistant Professor, Department of Microbiology, University College of Science, Tumkur.
Cancer is a group of diseases that impose a heavy burden on the public health and pose a challenge to science. While the century-long trend of increasing cancer mortality in this country was reversed in the mid-1990s, cancer remains the second leading cause of death, the toll on human suffering is profound, and its economic costs to society are substantial. Furthermore, cancer presents an intellectually complex set of problems because of multiple sites and causation, inadequately understood biology, and myriad intervention strategies. Impressive progress has been made against cancer, but not solely because of new knowledge about its genetics and molecular biology or new therapeutic approaches. Progress has also followed in the footsteps of understanding the social and behavioral determinants of cancer. From more than 12 million newly diagnosed cancer cases in 2007, the number of newly diagnosed global cancer cases is expected to reach over 17 million by 2020.
Tobacco is recognised as the most important human carcinogen, causing between 25 and 30 per cent of all cancers in developed countries. Tobacco control is likely to have a greater impact on reducing cancer incidence and mortality than any other known strategy. Tobacco use remains the single largest preventable cause of disease and premature death in the US. Each year, smoking results in an estimated 443,000 premature deaths, of which about 49,400 are in nonsmokers as a result of exposure to secondhand smoke. Smoking also accounts for $193 billion in health care expenditures and productivity losses. The carcinogenic agents that people breathe, eat, drink and are otherwise exposed to, largely determine the occurrence of the disease. Personal habits such as the use of tobacco play a key role; people develop such habits in response to the social circumstances of life. Thus, the social origin of lifestyle must be considered in cancer prevention.
The mission of the Cancer Society is to save lives from cancer by helping people stay well and get well, by finding cures, and by fighting back. In 1999, the American Cancer Society set challenge goals for the US that, if met, would substantially lower cancer incidence and mortality rates and would improve the quality of life for all cancer survi-vors by the year 2015. The Society also has developed nationwide objectives for prevention and early detection that set the frame¬work for achieving the 2015 goals. In India, there is no uniform cancer prevention strategy for the entire country. Awareness programmes have been undertaken in a few places, but there is no uniform standardized information, education and communication (IEC) strategy for cancer prevention. There is no education on risk factors, early warning signals and their management. Cancer screening is not practised in an organized fashion in any part of India. There are sporadic attempts at opportunistic interventions and small-scale research studies for field interventions. At least 30% of the future cancer burden is potentially preventable by tobacco control. Spread of tobacco addiction, promoted by commercial interests in the world, is responsible for the lung cancer epidemic that is already taking hundreds of thousands of lives annually; unless checked, cigarettes will in the next decade cause more than 1 crore deaths from cancer.
Improving access to and utilization of cancer screening is a key part of the Society’s efforts to help people stay well. The Society and many other public health advocates consider health care reform necessary because the 50 million individuals in the US who lack health insurance experience barriers to appropriate health care, including preventive services such as cancer screen¬ing. In March 2010, Congress passed and the president signed comprehensive health care reform legislation. While not a cure-all, health care reform legislation is a critical component for improving access to care. The American Cancer Society Cancer Action Network (ACS CAN), the Society’s nonprofit, nonpartisan advocacy affiliate, has worked diligently with multiple partners in advocating for comprehensive health reform legislation to improve access to timely, effective, and high-quality prevention, detection, and cancer treatment services where as the diagnostic infrastructure in the country is limited. There are many districts in the country which do not have a pathologist and pathology/cytology services, which are crucial for diagnosing cancer. Financial and geographic constraints, and lack of manpower have contributed to the urban concentration of facilities. An unestimated number of cancers diagnosed in the population are not treated. Untreated patients are likely to demand more resources from society. Major reliance on treatment as a cancer control strategy, however, favours an expensive and narrow approach to the problem. High technology for cancer treatment imposes a heavy financial investment, tends to select patients inequitably, and detracts from appropriate emphasis on prevention. In the developing as well as developed world, focus on treatment as the main thrust against cancer is a poor strategy.
American Cancer Society Challenge Goals and Objectives 2015
• A 50% reduction in age-adjusted cancer mortality rates.
• A 25% reduction in age-adjusted cancer incidence rates
• A measurable improvement in the quality of life (physical, psychological, social, and spiritual) from the time of diagnosis and for the balance of life, of all cancer survivors.
• Reduce to 12% the proportion of adults (18 and older) who are current cigarette smokers.
• Reduce to 0.4% the proportion of adults (18 and older) who are current users of smokeless tobacco.
• Reduce to 10% the proportion of high school students (younger than 18) who are current cigarette smokers.
• Reduce to 1% the proportion of high school students (younger than 18) who are current users of smokeless tobacco.
• The trend of increasing prevalence of overweight and obesity among US adults and youth will have been reversed, and the prevalence of overweight and obesity will be no higher than it was in 2005.
• Increase to 50% the proportion of school districts that provide a comprehensive or coordinated school health education program.
• Increase to 90% the proportion of women aged 40 and older who have breast cancer screening consistent with American Cancer Society guidelines.
India: Vision 2015
• Affordable and accessible diagnostic, therapeutic and palliative care services should be made available in India.
• Tobacco control has to be strengthened and the present status of women and children as non-users of tobacco should be sustained at any cost.
• Early detection of oral, breast and cervical cancers will have to be made possible through oncology wings in medical colleges and District Cancer Centres through augmentation of infrastructure and capacity enhancement.
• 300 more teletherapy machines will have to be made available in the country, taking into consideration the geographic gaps in the present distribution. Machines should be chosen in such a way that they are environmentally acceptable and recurring costs are minimal (a combination of cobalt and low-energy accelerators and simple brachy therapy [BT] equipment can be selected for this).
• Dedicated paediatric cancer treatment facilities will have to be established in all States.
• 1200 radiographers, 600 radiation oncologists and 300 radiation physicists will have to be made available; 300 surgeons and 300 physicians will need to be given reorientation training in surgical and medical oncology.
• 2400 nurses, 600 doctors and pharmacists trained in pain relief and palliative care will have to be made available.
• Medical and surgical oncology training to be augmented and drug therapy for curable cancers including pediatric cases made available in all RCCs.