IMPORTANCE OF CANCER AWARENESS

Non-Communicable Diseases (NCD) are at present, the talk of the town. Non- Communicable diseases can also be called chronic diseases that tend to be of long duration and are a result of physiological, genetic, environmental, and behavioral factors. The leading types of NCD are cardiovascular diseases such as stroke and heart attacks, cancer, chronic respiratory diseases, and diabetes. Non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 74% of all deaths globally. In India, deaths due to NCDs account for an estimated 66% of all deaths.

As we are experiencing the Epidemiologic transition, our focus as a society has shifted from communicable to non-communicable diseases with the change in times. The Epidemiologic transition characterizes changing patterns of population distributions in association with the changing patterns of mortality, fertility, life expectancy, and leading causes of death. Currently, we are at the stage of epidemiologic transition where there is a shift away from endemic deficiencies and infectious diseases toward chronic diseases such as obesity, adult-onset diabetes, hypertension, stroke, coronary heart disease, and most importantly cancer.

Cancer is a global disease and is spreading rapidly. Healthcare systems across the world are facing stiff challenges to tackle this issue. This appears formidable when India's 1.3 billion population, which is considered to, be spread across 29 states and 7 union territories with varying degree of population genetics, environment, lifestyle, etc. lead to a heterogeneous distribution of disease burden.

In India, the incidence of cancer is increasing rapidly; therefore?it is important to step up cancer literacy and knowledge amongst the population. We hope that this will lead to early detection which is important in the management and treatment of cancer and also prevention by making necessary changes in lifestyle.

Breast Cancer?is rapidly rising among women in urban areas and it is the most common cancer in India. Early detection is essential in its management and treatment. Due to ignorance, fear, and social stigma, many women present with stage III or IV cancer which requires surgery and extensive treatment. If detected early, then in most cases there will be less aggressive treatment and better chances of recovery.

Cervical Cancer?is the second most common cancer among women in India. It is the only preventable cancer and it can be detected in the pre-cancerous phase and cured.

Oral and Lung cancers?are highest among men and women in urban as well as rural populations and these can also be prevented to a large extent. Therefore, making people aware of the dangers of chewing tobacco and smoking is of great importance.

Cancer is and has always been an ongoing Pandemic, affecting people worldwide. Many call it the ‘Silent Pandemic’. If you think Covid- 19 has killed a lot of people since its arrival, then you have another thing coming if you’re underestimating the morbidity and mortality numbers Cancer has, as it was one of the leading causes of death for decades before Covid – 19. Cancer is Global and Deadly, being the second leading cause of mortality worldwide as it killed around 9.5 million people in 2020. Out of the 66% of deaths due to NCDs in India, 10% of these deaths solely depend on Cancers. According to the WHO’s Globocan database, the number of prevalent cases of cancer was approximately 2.7 million in India in 2020. The 5 most incident cancers in India were of the breast, lip & oral cavity, cervix uteri, lung, and colorectum with a total incidence of 1.4 million cases. The disparity in the incidence of cancer can also arise due to the determinants in urban and rural settings. The number of incident cases might be high in the urban areas, but there is an increased number of deaths in the rural areas as compared to urban, primarily due to a lack of awareness, financial constraints, and inaccessibility to services which leads to late diagnosis.

Cancer has several risk factors. tobacco use, alcohol consumption, unhealthy diet, and physical inactivity, just to name a few. Cancer symptoms generally are very subjective and have a variety as well. Some of them are fatigue, lump or thickening that can be felt under the skin, weight changes, changes in the skin, changes in bowels or bladder habits, unexplained bleeding and bruising, and many more.?You may assume that because of cancer’s chronic presence globally, awareness about the disease would be prominent. Alas! That is not the case. According to a few studies conducted, the perception of cancer awareness and the awareness itself was not very high, even among the educated group of the population. Knowledge of the various risk factors and carcinogens and their willingness to get a check-up if any warning signs arise were extremely low.

This indicates that there is a lack of information on the risk factors and signs and symptoms. Here socio-economic status and education also affected their level of awareness. Awareness was generally found to be deficient in people belonging to low socio-economic status groups or ethnic minorities. We can state that a better income level would equip them with better access to knowledge. Literature has shown that lack of awareness has been an important factor in delays in seeking timely medical consultation. In low- and middle-income countries, patients with cancer generally have a poorer prognosis compared with the patients in high-income countries, the reason being lack of awareness, late diagnosis, and inequitable access to affordable curative services.

Poor cancer awareness, therefore, becomes an important factor that leads to poor uptake of screening modalities and delays in diagnosis. Literature shows that majority of the individuals with cancer seek healthcare for the first time at the last stages of the disease. Increasing awareness about cancer will lead to early diagnosis and treatment, which will most definitely lead to improved survival outcomes. Increased awareness has also been demonstrated to be strongly associated with self-examination practices as well. Efforts must be made to educate the masses about the various warning signs and risk factors of Cancer and how to effectively manage and treat them, as this Pandemic needs to be halted.

Screening

• Breast cancer:?One in 25 women has a chance of getting breast cancer in India. Screening by mammography for women over 45 or post-menopause, Clinical breast exam by a doctor, and self-breast exam are methods of early detection.
• Oral cancer:?This is among the top cancers in India due to the rampant use of chewing tobacco and smoking. High consumption of alcohol is also a risk factor. Doctors check for red or white patches in the mouth and lumps in the mouth and throat. A regular dental check for sharp edges of teeth is also recommended.
• Cervical cancer:?This cancer is 2nd?highest among women in India. This can be detected in the pre-cancerous stage and treated before it turns into cancer. Screening tests are Pap smear, VIA, and HPV.
• Colorectal cancer:?This is also common cancer and tests can be done to detect it early.
• Prostate Cancer:?This is cancer that affects older men and there are screening tests for this cancer.

Survivorship is an important component of cancer control programs. However, there is no standardized Cancer Survivorship Program for optimizing the care of survivors of childhood cancer in India. For this growing population of cancer survivors with a whole life ahead of them, more concrete support structures have to be directed toward the evaluation and improvement of post-treatment care. Medical care needs to be complemented with non-medical (psychosocial) care so that the number of survivors lost to follow-up are decreased.

Rehabilitation of Cancer Patients and Survivors through Vocational Training

Vocational Rehabilitation through training in tailoring

• Tailoring course for 6 months during which the patients are trained according to a standard curriculum and are assessed by professional trainers at the end of training.
• Certificates are given after the assessment to successful candidates.
• Sewing machines are donated to eligible candidates at the end of the course.

Psychosocial Rehabilitation

• Therapeutic recreation therapy like visual imagery
• Relaxation techniques
• Dance movement therapy

Nutrition and Financial Support

• A daily midday meal,
• Nutritional supplements
• Minimal stipend
• Conveyance allowance

ICS’s Cancer Registry?is the 1st registry in India and 2nd in Asia covering the entire population of Greater Mumbai. It was established in 1963, followed by Pune (1972), Aurangabad (1978), and Nagpur (1980).

The registry aims to obtain reliable cancer-related incidence data from a defined urban population. The Registry studies the pattern of diseases in the population and documents habits, behavior patterns, and the environmental background that could impact the onset of cancer. The goal is to identify factors leading to a better understanding of cancer, which then leads to improved prevention, screening, and early diagnostic strategies.

The registry has contributed significantly to providing information for planning, implementing, and monitoring cancer control inputs and evaluating cancer control outcomes. The registry data is useful for projecting the magnitude, pattern, and trends of cancer incidence in India. The Registry has published more than 100 research articles in international and national journals and 60 monographs on cancer incidence and mortality, survival, and trends.

Non-Communicable Diseases threaten the progress towards the 2030 Agenda for Sustainable Development which includes a target of reducing the probability of death from any of the four main NCDs between the ages 30 to 70 years by 2030. It is time that we as citizens of this world take it upon ourselves and educate ourselves as well as others about Cancer. With the help of public education programs, effective screening camps, and the promotion of a healthy lifestyle, we can improve awareness trends and mitigate the gap. It is also important that standardized measures are employed to assess cancer awareness, which can help in comparison at national and international levels.

In light of Cervical Cancer Awareness Month, we as global citizens can utilize this opportunity to boost our knowledge and awareness and also become an integral part of snowballing this process.?

Sreelakshmi Shrinivasnaidu Pydi, Intern at GCFORCB. Institute: IIHMR B – PGDM Batch 2022-24.