Non-Communicable Diseases VII

Cancers

Cancer is the most dreaded of all non-communicable diseases. Indeed, it’s been called the emperor of maladies. It caused about 8.2 million deaths worldwide in 2012 and is rapidly rising now to possibly cause 22 million deaths by 2030 as per projections. The low and middle income countries of Africa, Asia, Central and South America account for 60% of all annual new cancers and 70% of cancer deaths across the world. Indeed, the most common cancers are those of lung, liver, stomach, colorectal cancer, or the cancers of the large bowel and breast cancer. And these are found almost everywhere in the world. They do differ however across gender in terms of men having more of lung cancer deaths and women having more of breast cancer deaths. But even among women where smoking rates are high, now lung cancer is rapidly rising. Breast cancer among women accounts for about 23% of all new cancer cases and 14% of all cancer deaths. Whereas in men, the lung cancer accounts for about 17% of all new cancer cases and 23% of all cancer deaths. In terms of risk factors, while we do classify cancers among non-communicable diseases and cancers indeed are linked to other non-communicable diseases through common risk factors like low fruit and vegetable intake, high body mass index or overweight and obesity, that is a high percentage of body fat, lack of physical activity, tobacco use and alcohol use. There are other conditions which give rise to cancers as well, including infections. About 30% of all cancer deaths however are related to these major risk factors of non-communicable diseases and are therefore eminently modifiable and preventable. Among the very many risk factors for cancer, tobacco is the single most important one. Indeed, 20% of all cancer deaths and 70% of all lung cancer deaths are attributable to tobacco. The idea that tobacco is a deadly killer also came up from the study of lung cancer in the first place. But we now know that apart from smoke forms of tobacco, which cause cancer, even the chewed forms of tobacco can cause oral cancer. About 90% of all oral cancer deaths are due to chewed tobacco. We also know that alcohol is an important risk factor for cancers of the food pipe and also of some of the other organs in the body. So, given that alcohol and tobacco which are imminently preventable risk factors, we ought to focus a great deal of public health attention on those. But in addition we also know that cancer can be caused by viral infections. Hepatitis B virus, hepatitis C virus and the human papillomavirus which causes cancer of cervix, all of these viruses together contribute to about 20% of all cancers in low and middle income countries. Urban air pollution is an increasing cause of cancer risk and again, is becoming a problem in many developing countries. Indoor smoke from households use of solid fuels where women burn solid fuels for cooking also is a contributor to increase in cancer risk. Exposure to radiation is a major  problem whenever there is a massive radiation exposure, for example, what we found after Hiroshima and Nagasaki. But even other levels of radiation, for example, those who are undergoing repeated x-rays or exposed to radiation and other forms also have an increased risk of cancer. Now we know that cancer is not only deadly but causes a huge economic loss both in terms of life years lost and in terms of the costs of treatment. It’s been estimated that about $895 billion dollars represent a loss due to cancer. And when we consider the fact that cost of reducing exposure to key risk factors like smoking, drinking, and poor diet costs only $1.8 billion dollars, there is absolutely no reason why we should not invest more in prevention rather than suffer the huge economic and health consequences of cancer that’s not been prevented. We know cost effective solutions exist. By reducing smoking, by reducing immoderate consumption of alcohol, and by promoting healthy diets we can prevent one in three cancer cases. In terms of cancer control, we ought to be looking at different types of strategies at different levels of prevention. Firstly we have what’s called primordial prevention that

is preventing the acquisition or augmentation of risk in the first place. Like for example, preventing people from taking up smoking, from becoming overweight, or consuming alcohol in huge amounts. Secondly, we also ought to be looking at primary prevention. That means people have already acquired the risk factor, like for example, smokers. They need to be encouraged to give up smoking before they run the risk of developing cancer. Similarly encouraging people to shift to healthier diets or abstain or moderate their intake of alcohol, all these come under primary prevention. Now in terms of secondary prevention, this is where screening and early detection of cancer in its early stages is very helpful, where we can prevent it from going into advanced stages, or where we can actually cure it. Now tertiary intervention is where the cancer has actually advanced and we have treated, but we are preventing recurrence and trying to insure that cancer does not become a problem again in the life course of that individual. But we also have to look at people who have reached a stage of cancer where treatment has failed. And their palliative care and end of life care become very important to make the last few months or years pain free and relatively comfortable even if cancer still is an unresolved problem. Now in terms of prevention, again, it is worth emphasizing that tobacco control remains one of the major public health interventions. Promotion of healthy diets is very important. We now know that fruit and vegetables and healthy fats are important for cancer prevention as well. And a balanced diet is probably one of the best things that we can do in order to prevent cancer. Physical activity does reduce the risk of cancer, especially that of large bowel or colorectal cancer. Exposure to sun, particularly in people who do not have much of melanin pigment in their skin can cause skin cancer and we therefore need to reduce the exposure to skin or protect ourselves against ultraviolet irradiation. At the same time prevention of exposure to viruses or treatment of those viral conditions very promptly is also helpful. Alcohol use should certainly be very moderate if at all and that again is an important measure of cancer prevention. Now in terms of detection, there are several tests that are often used in order to detect cancer early, like the pap test for cervical cancer, mammography for breast cancer, fecal occult blood test for cancer of the large bowel or the colon. And sigmoidoscopy for again, looking at colorectal cancer and prostate specific antigen for looking at prostate cancer in men. Now all of these tests are frequently employed, but we need to look at guidelines where they can be most optimally employed in the most cost effective manner. And periodically these guidelines are produced by expert groups to ensure that we pick up the…. We increase the pickup rate of cancer detection without unnecessarily undertaking extensive high cost screening in all people. Now in terms of cancer care, early detection helps us to initiate early treatment. And cancer screening is often used in order to pick up cancer in the pre-cancerous stage or in the very early stages of cancer where definitive treatments can be very useful in curing cancer and then subsequently we may have to follow with other therapy for prevention of recurrence. Therefore screening should be fairly optimally employed in order to prevent advanced cancer being the first clinical manifestation and where we can actually pick up very early on and prevent complications. It’s been clearly shown that organized screening substantially reduces the age standardized mortality of cancer death rates in populations and that is an important public health measure. In terms of treatment however, we see across the world, huge inequalities between developed and developing countries. For example, many of the developing countries have very few machines or no machines for cancer therapy in their health systems, particularly in their hospitals for treatment of cancer, when already detected. In the United States, there is one machine per 250,000 population, whereas over 20 countries, mostly African countries have no machines at all within their countries. And the existing machines are also poorly maintained or when they are available, do not have trained radiotherapists and physicists to operate them. And we do see that there is a huge variation of the number of people served by radiotherapy across different countries. Countries which have very high burden have very limited treatment coverage. We also know because of these reasons of late pickup and poor treatment, we have varied mortality rates of cancer across different countries. And these vary by national income levels. Those countries which belong to low income levels have much higher rate of mortality for any given level of incidence of cancer, whereas those in high income countries for the same level of incidence have much lower mortality. Therefore the case fatality rates are much lower in the high income countries and this is because of their health systems being much better endowed both for early detection and more effective treatment. And one of the clear-cut inequalities is demonstrated in the use of anti-cancer drugs which frequently are very expensive. And we see that whereas the burden of cancer is mostly in the low and middle income countries, for example in the African, in Asia and Latin America, the actual use of drugs is very limited in those countries. And we find that countries of the United States and Europe and Japan use a very large fraction of the anti-cancer drugs in the world just because they can afford it. At the same time, while we are trying to make anti-cancer drugs more widely available, accessible and affordable to all populations across the world, we must also recognize that those who have advanced to end stage of cancer are now suffering in many developing countries because of denial of appropriate pain relieving therapies. This is where palliative care becomes very important. It is an approach that improves the quality of life of patients and their families when they are faced with life-threatening illness through prevention and relief of suffering by early identification and management of pain and other problems which require physical, psychosocial and spiritual approaches for their management. Indeed cancer becomes one of the largest reasons for requiring palliative care. And because we recognize that 34% of all palliative care needs globally are due to cancer, of course other chronic conditions also require palliative care when they reach an end stage. We have to particularly focus on insuring adequate pain relief and supportive therapy for cancer patients. And unfortunately, our health services which ought to be better organized for providing palliative care to the terminally ill and also providing support to the patients and their families are found wanting in this respect across many health systems. Physical, social, psychological and spiritual support of patients with a life limiting illness has to be delivered by a multidisciplinary team. Not merely doctors but nurses, physiotherapists, psychological counselors, all of them are required and Nutritionists. But unfortunately we do not have in many countries such teams easily available. Indeed many trials of early palliative care have shown that the groups that have received palliative care have done much better both in terms of quantity of life being prolonged and quality of life being much improved. But one of the main areas of palliative care and pain relief is opioid treatment. And unfortunately opioids for pain relief are not widely available in many countries or even permitted by their legal systems to be used. And therefore we see a huge discrepancy in the amount of opioids consumed for pain relief in palliative care between the United States, which consumes a very large amount per case as opposed to people in China, India, Mexico, Uganda or in Haiti. And this again is a huge inequity, if people are condemned to live in pain, this is indeed an injustice. So we really have to gear up our health systems to be much more sensitive to the issue of palliative care and pain relief of the terminally ill, especially the cancer patients who do not have much hope of cure. And therefore we require a public health approach to cancer, in terms of prevention of cancer, because much of cancer is still very much preventable, whether it is the living habits like diet, tobacco, or alcohol and physical inactivity that need to be addressed or elimination of viral infections which cause cancer cervix, or cancer of the liver, which again are very amenable to public health interventions, or early screening for effective detection of early stages of cancer or precancerous conditions so that treatments can be applied in order to cure and prevent them from proceeding to advanced stages, or in advanced stages too, providing the appropriate therapies with adequately equipped health systems and health services. And finally by providing palliative care and pain relief to all those who need it without really denying drugs to people in low and middle income countries, merely because of price related factors. All these become public health priorities and in a global scenario where cancer is becoming an increasing global threat, all of these issues need to be addressed, not merely at the national level, but as a part of a global health response.

Pedro Pereira Leite

Pedro Pereira Leite

Researcher and professor. He had his PhD. on museology in 2011, with the title “Muss-amb-ike Homeland: The commitment on musicological process”, that was published in 2011. In 2012 he finishes a Post-PhD Research on "Biographical Glances: The intersubjectivity poetry on museology, at Lusófona University (Lisbon). Presently he is working in his Post PhD. Research about: “Global Heritages" with the aims to build a network on local cognizance and memory manager has a tool to build the will of action in 3 different communities, linked by past communed heritages.” He works at CES. He participates on different Research network, presented papers in national and international conferences, and had published books on research subjects.

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OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Non-Communicable Diseases VII. Global Heritages. Recuperado em 13 de Novembro de 2025 de https://doi.org/10.58079/p2p0


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