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PRACTITIONERS SECTION |
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| Year : 1996 | Volume
: 50
| Issue : 2 | Page : 50-52 |
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Cancer control in the asia pacific region - The next lap
Praful B Desai
,
Correspondence Address:
Praful B Desai
,
PMID: 8979633
How to cite this article:
Desai PB. Cancer control in the asia pacific region - The next lap. Indian J Med Sci 1996;50:50-2 |
| ¤ Summary | |  |
Cancer control in any part of the world has to be a multi-directional effort addressed in a holistic manner. The general impression that cancer control means only collation of epidemiological data and efforts at primary prevention needs to be redefined because preventive and educative oncology, though an important component of cancer control, can achieve long-term goals only after 20 years or more. Along with such long-term objectives, methodology needs to be developed which takes care of immediate and recent needs in early diagnosis, effective treatment, and appropriate basic research for the ultimate control and cure of cancer. A holistic approach to the cancer control effort will, therefore, need the combined skills of many different specialists.
| ¤ Asia Pacific Region | | |
Epidemiological data of this region show many distinctive features, such as a high incidence melanoma in Australia, of stomach cancer in Japan, of cancer of the lung in the westernized populations of Australia, New Zealand, Japan, and Hong Kong, of oral cancer in Singapore Indians, and of nasopharyngeal cancer in China, Singapore, and Hong Kong Chinese. These scientifically collated epidemiological data have been available for some time, yet no significant reduction in cancer incidence or improved treatment has resulted, indicating that we need to address other components of cancer control forcefully, as mentioned earlier. For example, the strong preponderance of nasopharyngeal cancer in the Chinese population-and its infrequent occurrence in other Asia Pacific regions.-indicates a strong genetic link which needs to be researched further. Life styles and habits in South Asia (tobacco chewing and smoking) are responsible for a very high incidence of oral and other head and neck cancers in India, Sri Lanka, and other countries in the region. Preventive education is vital for the 14-20-year age group when these habits become established.
Tobacco usage and its direct and indirect link with cancer is now irrefutable and despite our best tobacco control efforts, the UlCC Fact Sheets on Tobacco paint a depressing picture: while tobacco use has now reached a plateau in the Western world, export of tobacco continues to increase steadily, and the amount spent on advertising has increased from $500 million to $5 billion between 1975 and 1992. Tobacco production in China is rising at 11 a year and global cigarette production has been increasing by 2.2% annually over the last two decades. We obviously need to intensify our efforts in tobacco control in the corridors of power and through education of the urban and rural target populations.
| ¤ Early Diagnosis | | |
Our current medical and scientific technology has provided enough tools to diagnose many cancers very early enabling us not only to control, but also cure, cancers of many sites, including of the uterus, cervix, breast, colon, and oral cavity, to name just a few. Death rates are steadily dropping when cancer is diagnosed early and can be treated effectively.
Appropriate screening of highrisk populations has saved many lives. It is unacceptable today to state that high technology diagnostic procedures like mammography and Pap smear More Detailss should not be carried out in developing countries. Screening, even in poorer countries, is worthwhile and, indeed, cost considerations are secondary when it is a question of saving human life. Of course, such screening programmes have to be applied in a pragmatic manner to well defined "highrisk" populations.
| ¤ The Concept of a Community Cancer Centre | | |
Even in the advanced nations of the world, cancer care does not reach out uniformly to the community. We have to accept that the incidence of cancer, particularly advanced cancer, is inversely proportional to the socio-economic status of a community. The Asia Pacific region, and particularly the South Asia region, is still an economically deprived area where cancer is also a socio-economic problem. Large comprehensive cancer institutes in major metropolitan areas do not adequately meet the needs of the predominantly rural populations. The concept of a "Community Cancer Centre", therefore, needs to be developed further. Experience gained at the Tata Memorial Centre, Bombay, India, in developing such a centre in a rural setting, are encouraging. With minimal budgets and maximal efforts in public and professional education for early diagnosis, down- staging of cervival and oral cancers has been achieved. Starting from a tiny out-patient department nearly 12 years ago, the Community Cancer Centre now has departments of radiotherapy, surgery, and medical oncology. A major effort was made to select, the right professionals to staff the centre. The objectiv e of screening people for cancer in their own environment has been. adequately fulfilled. With the right infrastructure, community cancer centres can appropriately manage and treat 80%, of all cancers. Interaction between community and comprehensive cancer centres needs to be established in a mutually supportive fashion for the ultimate good of the community. Much medical capability exists beyond formal institutes of learning, and the contributions of the primary health-care workers or paramedics need to be acknowledged for community efforts to be successful.
| ¤ Cancer Research | | |
Today's science is tomorrow's medicine, and the final answer to the cancer problem and its control-if and when it comes will come from basic research in cancer. "Cancer research is like looking under the rocks", says Sir Lewis Thomas, an outstanding cell biologist of our time. Research is such a widely encompassing field that there are too many leads and avenues to follow, making it difficult to decipher which is the best direction. Cancer genetics, the mechanism of metastastic processes, molecular biology, research in epidemiology, and preventive and educative oncology are all important areas o research-leading towards the ultimate goal of cancer control.
No discussion of cancer control can be complete without mentioning the importance of rehabilitation and support systems for the cancer patients and their families. Pain relief and terminal care will be needed by nearly 50% of all cancer patients, and inadequate attention to these human needs is unacceptable in today's holistic effort towards a total cancer control. Only the best doctors and humanists are capable of providing a state-of-the-art rehabilitation and support systems to a cancer patient.
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