THE
POSSIBILITY OF A WOMAN CANCER FREE WORLD: A REALITY OR A MIRAGE
ADELEKE
OLADIMEJI ABDULLAH
MALE
07032328463
OR 08111011551
LADOKE AKINTOLA UNIVERSITY OF
TECHNOLOGY (LAUTECH)
1643 WORDS
THE
POSSIBILITY OF A WOMAN CANCER FREE WORLD: A REALITY OF A MIRAGE
More
than being a mere disease condition, cancer is a major public health issue that
poses a heavy economic burden, and a high chance of mortality. Even more agonizing
than the mortality is the physical and emotional suffering that accompanies its
diagnosis. At present cancer kills more than 7million people per year; a value
higher than that resulting from tuberculosis, malaria and Acquired
Immunodeficiency Syndrome (AIDS) combined.1 The fact that the last
two decades recorded the greatest advances in cancer prevention and control is
undeniable; however, the success is still infinitesimal if matched with the
global impact of this scourge. With the current global health status, to say
the possibility of a woman cancer free world is a reality is being too
optimistic, and to say it is a mirage is being too pessimistic.
Historically
evidence of the first cancer was documented in the Edwin Smith papyrus about
3000 BC; however, it was not called cancer until around 400 BC when Hippocrates
coined the term from karkinos (Greek
for a crab).2 While Percival Pott, a British surgeon, was the first
to pin point an environmental cause of cancer, linking scrotal cancer to chimney
soot; Sir Rudolf Virchow, using microscopic pathology, founded cell mutation as
the root cause of cancers.2
Although
Egyptian papyrus stated that cancers have no treatment, advances in
biotechnology had nullified this as the twenty-first century came with a myriad
of prevention and treatment measures for cancers, ranging from health education
and health promotion to various excision surgeries, radiotherapy, combination
chemotherapy, hormonal therapy, and immunotherapy.3
Dorland’s
illustrated medical dictionary defines cancer as a group of diseases caused by
an uncontrolled division of abnormal cells in the body, the natural course of
which is fatal. Cancer is only second to cardiovascular diseases as the leading
cause of death in developing countries. 4 A study of the global
economic burden by the American Cancer Society, and livestrong suggested that
approximately $895 billion is lost each year as a result of premature deaths,
and morbidity caused by cancers.5
According
to estimates from the world cancer research fund international, approximately
14.1 million cancer cases were diagnosed worldwide in 2012; of which about 6.7
million women were affected. By 2035 the global burden of cancer is expected to
rise to about 24 million new cases. 6 Of all cancers diagnosed in
2012, breast cancer alone accounted for about 25%, and together with colorectal
and lungs cancer accounted for about 43%, cervical cancer cases contributed
nearly 8% of all, while stomach, endometrial, ovarian, thyroid, and liver
cancers constituted a total of 20.1%; ranking fifth to ninth commonest women
cancers respectively.6
While
age, race, sex and genetic make-up have been identified as predisposing factors
to most cancers, other factors seem to be peculiar to some cancers. For
instance, a woman who starts menstruation at an early age, had first pregnancy
at a late age, above age 30, and uses combined oral contraceptive pills (COCP)
is more likely to develop breast cancer than others. Moreover, a women exposed
to sex at an early age, has multiple sexual partners and smokes is at a higher
risk for cervical cancer.
Smoking,
on its own, is a major risk factor for lung cancer, and together with intake of
low fiber diet, vegetables, and fruits increase the chances of gastric, colon,
and ovarian cancers. Obesity has been associated with breast, endometrial, and
gall bladder cancers. Common signs and symptoms of cancers include: unexplained
weight loss, loss of appetite, constant fatigue, abnormal vaginal bleeding,
offensive vaginal discharge, breast ulceration, and swollen legs and arms to
mention a few.
Patients
and their relatives often ask: “when will there be a cure for this scourge?”
while ignoring the fact that prevention is always better, and cheaper than
cure. Research as shown that one-third of cancer deaths are due to preventable
causes including viral infections, poor nutrition, alcoholism, and widespread
tobacco use.1 Thus, an effective cancer control strategy should
strive to prevent development of risk factors for cancers, detects cancer cases
early, treat, and hopefully cure the disease to increase the survival and
quality of life of the patients.
Breast
cancer is the most frequently diagnosed cancer in women worldwide, with an
estimated 1.4 million new cases and 458,400 deaths in 2008. 7 While
the efficacy of life style modification, breast feeding, healthy diet, and
regular physical activity in decreasing the incidence of breast cancer cannot
be undermined, experts opinion also support mammography as a useful screening
tool.
Meta
analysis of outcomes of mammography conclusively shows a 25 – 30% reduction in
the chance of dying from breast cancer with annual screening after age 50.8
However, for women in low and middle-income countries, where mammography
may not be readily available, the recommended early detection strategies are
self and clinical breast examination as well as knowledge of the early signs
and symptoms of the disease.
Like
cancer of the breast, colorectal cancer is another common cause of women death.
It accounted for about 8% of all cancer-related death in 2008. 9
Almost all cases of colorectal cancer begin as asymptomatic precancerous polyps
in individuals at risk for the disease. Accepted colorectal cancer screening
methods include: fecal occult blood test (FOBT), flexible sigmoidoscopy,
double-contrast enema, and colonoscopy.
FOBT,
though not satisfactorily accurate, is inexpensive and easier to perform; thus
the most practical screening method in many areas of the world. However,
studies have shown that one-time flexible sigmoidoscopy screening between ages
55 and 64 reduces colorectal cancer incidences by 33%, and mortality by 43%.10
Against this back drop the American cancer society suggests annual FOBT
screening and flexible sigmoidoscopy every five years starting from age 50.
According
to the world health organization (WHO) 2014, cervical cancer is one of the
deadliest, but most easily preventable cancers. It accounts for more than
270,000 women death annually, 85% of who live in developing countries.11
Since the high risk type Human Papillomavirus (HPV) acquired mainly via sexual
contact, is the primary cause of the disease, cervical cancer is almost never
found in virgins, nuns and orthodox Jews.
The
pap smear screening test which is about 90 – 95% accurate in detecting both
precancerous lesions and early cancers has solely reduced the mortality rate
due to cervical cancer by 50% in the past 30 years.12 However, many
low resource countries lack the infrastructure to support its use; in which
case visual inspection using acetic acid and HPV DNA testing are useful
alternatives. Immunization of reproductive age women with HPV vaccines which
protect against more than 70% of HPV is another invaluable newer trend in the
prevention of the disease.
Worldwide
lung cancer is only second to cancer of the breast as the commonest cause of
women cancer related death. 13 Cigarette smoking is the most
important risk factor accounting for more than 50% of cases in women; 13
though passive smoking, exposure to radon, asbestos, and radiation have also
been implicated. Reduction of smoking initiation among adolescents and
increasing smoking cessation among adults has been advocated as an effective
control measure.
At
this juncture, an appropriate question is “if all the aforementioned preventive
and control measures are already in place, why is there no commensurate
decrease in the incidence and prevalence of cancers? An appropriate answer is
that cancer control strategies are not without their own challenges, some of
which include: Industrialization and westernization that encourages harmful
lifestyle, unhealthy diet, and production of carcinogens, inequity in health
care delivery, lack of modern cancer screening methods and gross
underutilization of available ones, poor skills of health providers, inadequate
or ineffective treatment option, inadequate manpower, low national income, poor
political will, weak intersectoral collaboration, poor monitoring and
evaluation to mention a few.
Health
education and promotion strategies should be developed to increase public
awareness of cancer risk factors and how to avoid them. Efforts should be
directed at discouraging actions injurious to health and promoting healthful
practices including smoking and alcohol cessation, dietary fat reduction,
fruits and vegetables consumption, healthy sexual practices as well as regular
physical activity.
Unscreened
individuals within the underserved population groups should be identified and
enlightened on the risks and benefits of avoiding or taking the procedures. Data
from the Centers for Disease Control (CDC) 2008 revealed that through routine
screening and early detection, incidence of breast, colorectal and cervical
cancers can be reduced by 20 – 60%.14 Organized screening method
should be developed, implemented, and appropriately delivered at an affordable
cost to enhance early diagnosis, prompt treatment, and follow up.
Infrastructures
at rural, district, and provincial health facilities should be improved to
support cancer screening, diagnosis, and treatment services. In the same vein
regular recruitment, training, and retraining of health care providers should
be undertaken to improve manpower and skills, and update them on current trends
in cancer related service delivery. Also interdisciplinary collaboration and
intersectoral partnership should be strengthened to ensure synergy of actions.
While
many great interventions can be made at local level to improve cancer care,
significant improvement is only achievable via good political will. A national
cancer control plan should be drawn, and integrated within a broader multisectoral
noncommunicable disease action plan, with timebound benchmarks and targets,
effective governance and accountability, adequate and sustainable financing for
program implementation, monitoring and evaluation.
In
conclusion, despite the immense advances in the area of research oncology over
the years, various national and international cancer control programs, and
contributions from numerous non-governmental bodies, the dream of achieving a
woman cancer free world is still far from reality. Considering the dreadful
impact of this scourge on mankind, and to save the forthcoming generations, the
need for more concerted proactivity at all levels of cancer prevention and
control is strongly advocated, and should be rigorously pursued by all if a
woman cancer free world stated as our aim is to be achieved.
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