Prevention and Screening of cancer.

We are all familiar with the concept, “prevention is better than cure”. However, when the inevitable happens, there are certain steps that are necessary to be taken. For a noncommunicable but hereditary disease such as cancer, the main risks are of two types—lifestyle-based, and genetics-based.

In India, we see development of cancer primarily due to an unhealthy lifestyle. This can be linked to the age old practice of chewing tobacco; or the fairly recent trend of new instant foods flooding the market, heavy in heavy metals such as lead. The problem is, the majority of the Indian population remains oblivious to these changes until it is too late, and the cancer has metastasised and is in the late stage.

That is where screening comes in.

Screening is the process of screening or checking the body all over for any types of cancer. It is usually done when there is even the slightest doubt of a tumor being cancerous. So when the person is screened for cancer, the tumor is discovered to be cancerous (or not) and can be removed at the earliest; saving the person the pain of chemotherapy, immunotherapy and even palliative care, which is said to be emotionally draining.

We shall delve into these topics one at a time.

Before that, we must consider that the most common types of cancer in India are breast cancer, cervical cancer, and oral cancer.

Prevention

• Vaccinations - The vaccine for HPV has been proven to be effective for curbing the risk of cervical cancer, especially for teenagers below the age of 15. Hepatitis B vaccine helps to prevent liver cancer. Other vaccines like BCG for bladder cancer and Sipuleucel-T for prostate cancer can be used for treatment.
• Lifestyle changes - The leading cause of oral cancer in India is tobacco. Liver cancer and cirrhosis of liver are primarily caused by agents of alcohol. Lung cancer is mainly caused by air pollution and cigarettes. As the general public we need to come to a consensus that a few moments of dopamine influx is not worth putting your life at stake.

It is without a doubt that in case of addiction, you must seek help without fail. Try swapping chewing gum for cigarettes; fruit juice for alcohol; running for tobacco. The steps initially are very small—but they accumulate and become increasingly impactful over the years.

The Hepatitis B vaccine has been proven to prevent the risk of liver cancer. On the other hand vaccines like BCG are used for treatment of bladder cancer and Sipuleucel-T for prostate cancer.

• Lifestyle changes - The main causation of oral cancer and lung cancer in India is tobacco and cigarettes respectively. Cirrhosis of liver is caused by excessive drinking.

The general public has to come to the realisation that a few moments’ worth of dopamine release isn't worth putting your entire life at stake. If you have addiction problems, you should seek help immediately without fail. Try switching to chewing gum instead of cigarettes. Fruit juices instead of alcoholic beverages. Go on runs instead of tobacco. Take small steps, but you will only prevent cancer by changing your lifestyle choices.

• Proper nutrition — Fresh fruits and vegetables, lean meat, rich mineral and vitamin sources boost your immunity. Even in the dire case that you do get cancer, an already well developed immunity will help you to fight against it to the fullest extent.
• Urging the government for transparent company policies— Even if we do have a higher quality of life overall, making the right choices—it will be worthless if the very good we put into our bodies is laced with poison. A very famous instant noodle brand in India was banned for having lead—yes, lead, the same thing your pencil nibs are made of— in alarming amounts in their tastemaker. Not just that, this particular brand of noodles is known to have sodium content and being overall unhealthy. We must put pressure on the FSSAI to prevent such brands from profiting off of the well being of Indians.

This, though not excusable, is not unexpectable from a private company. What is inexcusable though, is, our own government is failing us at the heart of the country, in our capital. Aggravatingly high levels of pollution in NCR is a high risk of lung cancer. And the government is not doing anything visible to tackle this. It is time we demand answers and put pressure—for our personal and collective well-being as a society.

• Daily medical checkups (once every 3 months) is almost a sure way to eliminate cancer if present in the early stages.

Screening

Screening is done usually by government departments such as the NPCDCS, or non profit organisation such as the Indian Cancer Society (ICS).It is the process of checking the body for cancers before the development of late stage cancer, so it can be treated at the earliest and any risk can be taken care of. It is essential for an individual to research nearby cancer screenings if any symptoms are doubted at the earliest.

On the other hand, it is also observed that cancer screenings are also very risk based. For example, one of the most common cancers in India is cervical cancer—which only occurs in those who are born with a cervix. So the demographic is primarily cisgender women 35-60+.

For cisgendered men, it is prostate cancer that is most at risk. This typically occurs for above 45+ men. So the screenings are mostly eligible for men above 45+.

Another notable point is that screenings are mostly widely done for the most common cancer types such as cervical, oral and breast cancer. For rarer cancers such as small cell carcinoma, the screenings are rarer.

Here's a peek into the screenings of different cancer types:

• Cervical Cancer: Pap Smear (detects abnormal cells) and HPV DNA tests (detects cancer-causing viruses). In terms of visual imaging, we also have acetic acid tests for the cervix.
• Breast Cancer: Clinical Breast Exam (such as checking for lumps), Mammography (X-ray), and sometimes Breast MRI, especially for high-risk individuals, such as women above 30, or women with a hereditary risk of breast cancers.
• Ovarian Cancer: CA-125 blood test, often for postmenopausal women as they do tend to have complications after menopause. It is also often done for women with PCOS/PCOD. It is also necessary to note that for women who have had tubectomy done, there is a risk of infection and possibly cancer and or/sepsis if the surgery isn't done properly.
• Prostate cancer: PSA (Prostate-Specific Antigen) blood test and Digital Rectal Exam (DRE) for men above the age of 45.
• Oral cancers: The primary method of Screening for this is, well, a visual and physical check of the buccal cavity. Any kinds of sores and lumps are looked around for physically. If they are found, in that case, a bit of the tissue is taken and sent to the lab for testing.
• Colorectal cancers: The medium for checking is again physical. The rectum is physically checked for any lumps, or bumps, and the tissue is again sent for testing. Stool tests are also done to check for any blood in stool, as that is also a sign of colorectal cancer. A colonoscopy is also done.
• Oropharyngeal/ head and neck cancers: As the most common agent for this is the same as the one for oral cancer (tobacco), the methods of testing are also quite similar. Here are a few variations in testing. (Source: https://www.cancer.gov/types/head-and-neck/patient/oral-screening-pdq)

Toluidine blue stain: A procedure in which lesions in the mouth are coated with a blue dye. Areas that stain darker are more likely to be cancer or become cancer.

Fluorescence staining: A procedure in which lesions in the mouth are viewed using a special light. After the patient uses a fluorescent mouth rinse, normal tissue looks different from abnormal tissue when seen under the light.

Exfoliative cytology: A procedure to collect cells from the oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, or mouth. The cells are viewed under a microscope to find out if they are abnormal.

Brush biopsy: The removal of cells using a brush that is designed to collect cells from all layers of a lesion. The cells are viewed under a microscope to find out if they are abnormal.

• Blood related cancers (such as Leukemia): The most common type of Screening for this is Complete Blood Count (CBC).

Q) Even if I do get screening done, how can I understand the results?

• Negative —you don't have cancer of the type you got screening done. Symptoms are also normal; you're healthy.
• Positive— you do have a symptoms of the cancer you got Screening done for. This, though abnormal, requires follow up tests and second opinion.
• Inconclusive— Requires retesting

Q) What is the government doing?

• The National Cancer Registry Programme (NCRP) tracks trends, while the National Institute of Cancer Prevention & Research (NICPR) guides policy and press releases/ mass information availability for cancer resources.
• India's National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) under the National Health Mission (NHM) drives prevention and control of deadly cancers.
• Training frontline health workers (ASHAs, CHOs, etc.) to conduct screenings and provide awareness at the grassroots level, starting from villages itself; since cancer is a leading cause of death amongst rural poor.
• Apart from this, there have been infrastructural development for helping the public to beat cancer as well. 770 District NCD Clinics, 233 Cardiac Care Units, 372 District Day Care Centres, 6410 Community Health Centre NCD Clinics have been set up both in suburban areas and metropolitan areas alike.
• For more information on government resources for cancer prevention and screening around you, a visit to (https://www.mohfw.gov.in/?q=/press-info/8378) will prove helpful.