Cancer – getting the story right

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DESPITE the almost daily dose of information on some aspect of cancer or the other in the national and international media these days, the confusion around cancer persists. The reports and their headers are calculated to catch the public eye rather than inform: “tetanus shot may boost brain cancer survival”; “extra oxygen could help you fight cancer”, etc. The reality on the ground is far removed and infinitely more complex.

To begin with, cancer is one word used to describe a number of different diseases. Furthermore, despite the progress made, we are still far from curing a majority of cancers, from preventing them or finding them early enough to ensure long term survival. The progress that has been made is largely in the West and can be attributed to screening techniques which are able to detect cancers earlier than they did before. In fact, some would argue, too early.

The question being asked is: should we be meddling with pre- cancerous or early stage tumours that are unlikely to ever become life threatening?  Studies show that in some people, for no clear reason, these tumours do not progress. Once again, the baffling question is: Are these tumours best left alone? And if so, at what stage should we begin to engage with them? Only now are we learning that the mammogram touted as the gold standard for detecting breast cancer works best for women over 50 years of age. Before that age there are too may false positives with their attendant consequences to ethically warrant its regular use as a diagnostic tool. Shame that it took medical science so long to work this out. In the meantime, thousands of women have had surgeries and gone through emotional trauma they could have avoided.

The changing contours of the cancer discourse, so evocatively charted by Siddhartha Mukherjee in his bestselling book, The Emperor of All Maladies, gives us an insight into the role that multiple actors as well as sheer coincidence have played in taking the fight against cancer forward in the West. One wonders a bit about this, as this so called progress has come with a sting in its tail. For the ordinary person; the crab looks more and more like a scorpion.

Cancer has become a lucrative multi-billion dollar business from start to finish, with the promise of more money to come. The main battlefield of the “war against cancer”, begun in the last century in the West, has now shifted to our part of the world as cancer rates there are tapering off. India and China are already seeing a surge in the incidence of many types of cancers and established pharmaceutical companies are fighting to maintain their dominance and secure their profits in our markets. Court cases are being fought to extend patents on the flimsiest of grounds and stop generic drugs from being made. The medical establishment has unfortunately become a willing partner. Part of the strategy is to use the media to keep us confused and misinformed.

We are told that the rise in the number of cancer cases is because of the following reasons: we are living longer, our lifestyles have changed and we have the wrong habits. In other words, we are to blame. No one talks about the fact that the policies followed by our self-serving leaders in the name of growth and development have left us with no choice. To cite an example, it is now well known that the “green revolution” was responsible for introducing toxic carcinogens into the air, ground and water of vast swathes of the Punjab, so that today we talk about a cancer belt in the Malwa region. Instead of trying to fix the root of the problem, our political leaders sensing an opportunity, have joined forces with private interests and handed publicly funded cancer facilities over to them. The poor farmers now take a train called the “cancer express” to be treated in the adjoining state of Rajasthan where care is more affordable.

It is no different in our towns and cities where our current model of urbanisation ensures that we have no place to walk or cycle but must perforce  breathe lethal carcinogens day in and day out as private vehicles are given primacy of place on our roads. The rising incidence of diabetes as well as of certain types of cancers can be attributed largely to this. It begins at a young age as even children no longer have places near their homes where they can run and play.

Rather than turning the spotlight on themselves for this sorry state of affairs, those who benefit would rather accept the cancer story put out by the West. So, women are told that they are getting breast cancer because they marry late, do not have enough children and do not breast feed. The statistics in India for breast cancer give a lie to this as we are witnessing a rise in breast cancer among women who marry early, have children and breast feed.

Moreover, people in this country, except for the affluent and westernised elite, do not eat processed foods, smoked meats, animal fats, etc, as a matter of course. Their diets by and large include lentils (when they can afford them) and grains, while vegetables and fruits make a seasonal appearance – a diet that is not necessarily a balanced one but which by and large is rich in fibre, besides being primarily vegetarian. Also, people living in rural areas get plenty of exercise as not only do the majority not own private vehicles but they have to exert themselves physically to earn a living. This is reflected in the types of cancers that predominate in India which are not related to life style choices but rather to low socio-economic status and lack of education.

The number one cancer among the majority of women in this country is cancer of the uterine cervix. The rural registry in Barshi, Maharashtra reveals that it accounts for one-half of the cancers that women get.  Even in a city such as Delhi, the figure stands at one-quarter of the total female cancers recorded. The causes can be attributed to early marriage, multiple pregnancies, the sexual behaviour of partners who infect them with the papilloma virus, and lack of personal hygiene (due to inability to access clean water).

Among Indian males, the cancers that predominate are those of the oral cavity and of the oesophagus. If one takes into account the figures from Barshi, our rural registry, cancer of the penis may be added to the list. These too can be related to the conditions in which people live and work. Not only is there overcrowding and lack of hygiene but people drink liquor, chew tobacco and smoke biris. What one needs to understand is that the reasons why people do this are very different from those of cigarette smokers. While the latter may be aspiring to a more sophisticated lifestyle, the former are reacting to the tough circumstances in which they find themselves. The sad fact is that tobacco quells hunger while liquor helps one forget. Banning advertising by cigarette companies is not going to solve the problem. The majority of tobacco users in this country chew tobacco and smoke biris. One will have to address the reasons why they do this which are more related to poverty and rapacious tobacco manufacturers  rather than to an affluent lifestyle.

One also needs to realise that people are at high risk from cancer in this country due to the degradation of the environment and their exposure to carcinogens at home and in the workplace. Here again lack of awareness and economic disparities play a role. Thus workers in high risk industries such as in the paint and dye industries wear no protective gear and neither are they in a position to demand this from their employers. This is true for farmers in the rural areas as well who use pesticides and insecticides without taking any precautions. Asbestos cement pipes are still widely used for supplying water and sewage disposal in our country, while asbestos sheets provide many a home overhead cover. A few years ago a study revealed that Indians had the highest levels of DDT in their bodies – a substance which like asbestos is a recognised carcinogen and is banned in the West.

In other words, if India is to make any progress in stemming the rise of the cancer mortality rate it is time for those who talk about cancer prevention to press for poverty alleviation, better hygiene and living conditions and education. Making appeals for changes in a lifestyle associated with the west will not alter the ground realities that are associated with the predominant cancers in our country.

Never at a loss for an explanation and adapting to shifting sands what we are being told now is that the answer lies in our genes and may even be plain bad luck. It is forcing women to panic and undergo radical surgeries prophylactically. It also has companies that monopolise these genetic tests, laughing all the way to the bank. But in fact, it is well near impossible to say with any certainty why certain genetic mutations take place in cells and whether they will in fact lead to full blown cancer. As any scientist worth her salt will tell you, biology is not your destiny. There are so many other factors that weigh in.

In short, the real story of what causes cancer is yet to be told. It will certainly not win a Pulitzer.

Harmala Gupta is Founder-President, CanSupport

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