CANCER: Dealing with Holistic Approach

Based on hospitals’ data approximately 8,000‒10,000 new cases of cancer are identified every year in Nepal. Globally, Cancer is the second leading cause of mortality and is alone responsible for 9.6 million death in year 2018 and approximately 70% of deaths from cancer occur in low- and middle-income countries. People of 21^st century have been engulfed by carcinogens in their day to day life whether its spicy lunch or a glass of drink at night, you are certainly leaning toward the cancer. By 2020 the incidence rate of cancer per 100,000 is estimated to be 41.4 in female and 38.5 in male in our country which is still not getting proper attention from government, health settings and society.

Talking about medical advancement, scientist and researchers are still leaning towards genetics and chemotherapy in order to mitigate the cancer while country with low economic status like Nepal, there are just few screening and early detection facilities are limited to the central cities of the nation. So instead of taking burden of higher cost of treatment, lower economic status and unavailability of adequate radiation equipment and limited number and inadequate quantity of chemotherapeutic molecule it should be dealt in new way. So, Cancer should be analyzed and prevented from root level if we are focusing to save millions of lives from all around the globe. Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low vegetable and fruit intake, lack of physical activity, tobacco and alcohol use which are certainly preventable with appropriate health and social approach. Doctors and researchers are focusing on curative aspects and medications taking it as panacea to cancer however efforts on mitigating the predisposing factors seems to be quite lacking.

Coming to end of this decade, people are daily intoxicated by carcinogens in their day to day life and the outcomes is seen as mortality in the figures of million. According to International Agency for Research on Cancer (IARC) the global cancer burden has risen to 18.1 million cases in the year 2018. The incidence of cancer rises dramatically with age, most likely due to a build-up of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older. Dietary factors and obesity are recognized as having a significant effect on the risk of cancers which may be related to up to 30-35% of cancer deaths. Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths. We can significantly decrease this morbidity and mortality rates with certain appropriate measure by reducing the exposure to the risk factor with can be greatly helpful mainly for country with low economic status and traditional medical approach like ours. Similarly increasing trend of obesity and lack of physical exercise in urban areas and developed country have also been a major contribution to cancer.

In order to fight with cancer globally, we need to pursue preventive strategies from root level which will be very much effective in controlling this globally alarming issue. Modifying or avoiding key risk factors can significantly reduce the burden of cancer. These risk factors include: tobacco use including cigarettes and smokeless tobacco, being overweight or obese, unhealthy diet with low fruit and vegetable intake, lack of physical activity, alcohol use, sexually transmitted HPV-infection, infection by hepatitis or other carcinogenic infections, ionizing and ultraviolet radiation, urban air pollution indoor smoke from household use of solid fuels. If we even manage to reduce the exposure to these risk factors, we can greatly reduce the burden of cancer from the mankind. Along with focusing in the preventive aspect, we must find practical, effective and contextual curative remedy to this disease. The rural communities of our country are deprived of screening facility in primary public health care centers. So, proper screening and diagnosing setting should be arranged in every corner of country to solve this issue in time.  The cost of chemotherapy regimen, diagnosis and different surgical procedure and radiotherapy add significant economic burden to the cancer victims. Most of the people do not have proper access to health care system and have not got proper information on cause and remedy of this fatal disease. So, our government should address the escalating cancer burden by introducing various programs and treatment subsidies to cover expenses for treatment, chemotherapies and investigations. All concerned stakeholders should actively focus on control and prevention of cancer before it is too late. Skilled manpower will good technologies should be managed and cost of screening and diagnosing should be economical. Primarily, public awareness and health education should be emphasized to promote the avoidance of risk factors and change unhealthy living and food habits with which we will be able to reduce cancer significantly. To sum up, it is clear that cancer is an urgent global challenge so every government, health settings and individuals must take appropriate measures to scale up prevention, early diagnosis, screening, treatment and care services in order to fight with this alarming issue.

 (Article was written in November 2019)