Cancer may be a silent disease and its incidence rises with increasing age.
New cases of cancer are expected to be around 15.7 lakhs in India and 1.21 lakhs in Bengal by 2025. If both new and old cases are counted the number may be 3 to 4 times the stated figures which is phenomenal. However, every individual has the right to know whether he/she has cancer in spite of being apparently healthy.
Preventive oncology is a special discipline in oncology that focuses on key measures that can prevent cancer development or delay the progress of the malignant process. Thus, it deals mostly with the normal population.
It was declared as a separate specialty by Michael Shimkin in 1975 at the University of California, San Diego.
Today, there are hardly any families that do not have cancer in their generations. Genetic counselling has assumed great importance. Those addicted to tobacco and alcohol or both are also at a higher risk.
The risk of dual addiction is not actually double, rather it can be tenfold.
Obese females are at a higher risk of breast or uterine cancer and males have increased risk of oesophagus and colorectal cancers.
There are frequent enquires that why a person develops cancer who has no addiction or why an apparently healthy person with no definite symptoms is diagnosed with cancer at the last stage.
Preventive oncology may provide an answer to this as an ordinary chest X-Ray or abdominal ultrasound at a proper time can save a life.
Unfortunately, the very concept of preventive oncology hardly exists in Bengal. Such a department is usually absent or even if present is not being adequately publicised.
All is well
All is apparently well in the healthy individuals, though it is not always true.
Although a silent disease, cancer can start off with some minor symptoms:
- Ulcers that do not heal
- Old cough or change in voice
- Indigestion or difficulty in swallowing
- Bleeding or increase in the size of a mole
- Painless lumps anywhere including breasts
- Alteration of bowel habits
- Bleeding from any orifice
- Weight loss of over 10 per cent within six months
These symptoms do not confirm cancer or any other disease but they need evaluation.
Risk reducing surgery for breast or ovarian cancer after genetic counselling is optional.
Adequate lifestyle modification, including habits and diet, is welcome.
Unprotected sex can transmit viral infections like human papilloma virus (HPV) that causes cervical cancer or Hepatitis B virus which can develop into liver cancer. Vaccinations are available for both.
HPV is also transmitted during oral sex causing oro-phanyngeal cancers.
Apparently healthy persons should visit a preventive oncology department at least once in a year.
Falling ill is not a discredit, but extreme reluctance to visit a doctor is not acceptable.
Department
A separate Preventive Oncology Department was created at Tata Memorial Hospital (TMH), Mumbai, almost three decades back.
It was initiated by Prof. Raja S. Rao, then director, TMH and a legendary head and neck oncosurgeon.
He developed and personally looked after the activities of the department.
- A separate OPD was created which was delinked with the main hospital OPD and the investigation reports were provided on the same day
- Separate staff with a head of department was appointed
- Cancer awareness leaflets
- on common cancers like breast and cervix were provided
- Mouth self examination (MSE) and breast self examination (BSE) were taught
- White or red spots in the mouth or inability to open the mouth fully (sub mucous fibrosis) are pre cancerous. These were explained in detail
- Colposcopy for cervical cancers were started
The department started various studies on tobacco and common cancers. Teachers, students and parents were explained preventive oncology and the benefits.
It reached the lower socio-economic group. This work was widely appreciated by ICMR, TMH governing council and the Union of International Cancer Control.
Tests
Preventive oncology package is available in the department at TMH, Mumbai, at a subsidised rate of Rs 900.
A total of 21 items are listed valid for 180 days. Detailed clinical test is done.
Routine tests like complete blood count, X-Ray Chest, USG-abdomen, small biopsies are included. Some specialised items included are:
- Risk Assessment profile
- Paps smear for cervical cancer
- HPV DNA (Qualitative) test
- Mammography or USG breasts for females
- Prostate Specific Antigen (PSA) for men
- Tobacco cessation counselling
In Bengal, many medical, surgical or radiation oncologists are available but preventive oncology specialists are hardly seen though fellowships are available worldwide.
A preventive oncology department is mandatory as it not only helps prevent cancer but also detects the disease early, increasing its chances to be cured.
Bengal certainly deserves a widely publicised department as initiated by Prof Raja S. Rao in Mumbai almost 30 years back.
For corporate hospitals it should be cost effective, though hoardings on this subject are rarely seen anywhere.
Cancer has an answer, if detected early.
Gautam Mukhopadhyay is secretary of the Bengal Oncology Foundation and clinical director of the department of surgical oncology, Peerless Hospital