Cancer is a leading cause of death globally, and accounted for nearly 10 million deaths in 2020 alone – that is one in six deaths. According to the World Health Organisation (WHO), the most common cancers are breast, lung, colorectal (involving the colon and rectum), and prostate cancers.
Given how prevalent cancer is in the world today, it comes as no surprise that several commemorative days are held to raise awareness and encourage people to get tested and access treatment.
August is Appendix Cancer Awareness Month, as well as Immunisation Awareness Month in the US. World Lung Cancer Day was marked on 1 August, and World Head and Neck Cancer Day was marked on 27 July, while World Cancer Day falls on 4 February each year.
The National Cancer Control Programme (NCCP) in Sri Lanka carries out several events to mark these days, one of the most recent being World Head and Neck Cancer Day. During a press briefing held at the Health Promotion Bureau, NCCP Director Dr. Eshani Fernando spoke about the prevalence of oral cancer in Sri Lanka.
In Sri Lanka, the most common type of cancer is breast cancer, which mainly affects women. In 2019, among men, lip, tongue, and mouth cancer accounted for 20.6% of cases, lung cancer accounted for 12% of cases, and colorectal cancer accounted for 11.9% of cases. In 2019, 39.5% of cancers among women were cases of breast cancer, while 19.6% were thyroid cancer, and 11.1% were colorectal cancer.
Dr. Fernando explained that it is held that one-third of cancers are preventable and one-third of cancers can be treated through early detection, while the remaining third require long-term care for patient comfort.
“Mouth cancer is a preventable cancer, but Sri Lanka is at such a low level in terms of prevention that one of the most preventable cancers is one of the most common in our country. It is also a treatable cancer if detected early. We must thus make a massive effort to reduce mouth cancer in Sri Lanka,” Dr. Fernando stressed.
In Sri Lanka, the reason oral cancer is so prevalent is the common use of tobacco and betel. “Oral cancer is most seen among plantation communities, construction workers, bus drivers and conductors, and fishing communities. The common factors between all these people are firstly, chewing betel or smoking, and secondly, alcohol consumption. Due to this, a special programme is being carried out targeting high-risk groups these days,” Dr. Fernando said.
She added that the NCCP has also implemented a surveillance system, where data on mouth cancer is gathered and used to determine which groups require more focus. Unfortunately, 80% of patients who access medical care and treatment are in the third or fourth stage of cancer, which are the latter stages.
Cancer surveillance is a key function of the National Cancer Control Programme’s Strategic Information Management (SIM) unit. Prior to 2020, the unit was known as the cancer registry unit or the cancer surveillance unit.
The data gathered by the SIM unit shows 35,668 new patient registrations in 2021. Of this, 11,686 were from the National Cancer Institute in Maharagama, 3,619 were from the National Hospital in Kandy, and 2,372 were from the Teaching Hospital in Karapitiya. The previous year, 35,863 new patients were registered, while 35,107 new patients were registered in 2019. Since 2009, over 20,000 new cancer patients have been registered every year in Sri Lanka.
Global situation
According to the WHO, 10 million deaths in 2020 were due to cancer; of these, 1.80 million were due to lung cancer, 916,000 deaths were due to colon and rectum cancer, and 830,000 deaths were due to liver cancer.
In terms of cases, breast cancer accounted for 2.26 million cases, lung cancer accounted for 2.21 million cases, colon and rectum cancer accounted for 1.93 million cases, and prostate cancer accounted for 1.41 million cases. Other common types of cancers are skin (non-melanoma) with 1.20 million cases in 2020 and stomach, with 1.09 million cases.
The WHO added that each year, approximately 400,000 children develop cancer.
Causes and risk factors
Cancer is caused when normal cells transform into tumour cells in a multi-stage process, which generally progresses from a pre-cancerous lesion to a malignant tumour. These changes are a result of the interaction between a person’s genetic factors and three categories of external agents, including physical carcinogens, chemical carcinogens, and biological carcinogens.
Tobacco use, alcohol consumption, unhealthy diet, physical inactivity, and air pollution are risk factors not only for cancer, but other non-communicable diseases as well.
The WHO added that some chronic infections act as risk factors as well, and this is a particular issue in low- and middle-income countries. For instance, in 2018, approximately 13% of cancers diagnosed globally were attributed to carcinogenic infections, including Helicobacter pylori, human papillomavirus (HPV), hepatitis B virus, hepatitis C virus, and Epstein-Barr virus.
Reducing the cancer burden
According to the WHO, 30-50% of cancers can be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies, and it noted: “The cancer burden can also be reduced through early detection of cancer and appropriate treatment and care of patients who develop cancer.”
In terms of prevention, the cancer risk can be reduced by not using tobacco, maintaining a healthy body weight, eating a healthy diet, including fruit and vegetables, and doing physical activity on a regular basis. Other preventive measures include:
- Avoiding or reducing consumption of alcohol
- Getting vaccinated against human papillomavirus (HPV) and hepatitis B if you belong to a group for which vaccination is recommended
- Avoiding ultraviolet radiation exposure (which primarily results from exposure to the sun and artificial tanning devices) and/or using sun protection measures
- Ensuring safe and appropriate use of radiation in healthcare (for diagnostic and therapeutic purposes)
- Minimising occupational exposure to ionising radiation
- Reducing exposure to outdoor and indoor air pollution
Early detection
According to the WHO, early diagnosis consists of three components: Being aware of the symptoms of different forms of cancer and of the importance of seeking medical advice when abnormal findings are observed; having access to clinical evaluation and diagnostic services; and timely referral to treatment services.
In the local context, the NCCP stated that one in three cancers can be prevented and that early detection saves lives. The NCCP added that the Cancer Early Detection Centre (CEDC) provides early detection services for breast, cervical, and oral cavity cancers. Their services include clinical-breast examination, mammography, ultrasound scanning, and pap and HPV DNA testing. The walk-in clinic makes early detection services accessible and available to the public.
According to the NCCP’s Annual Report 2021, around 30 clients receive services per day at the CEDC, with approximately 50 mammography tests and 80 ultrasound scans conducted at the CEDC every month. The CEDC provides services to 2,500 people each year.
In 2021, the CEDC had 1,572 client visits and 123 sessions, of which 92% of the clients were female and 8% were male.
Given how early detection can save lives, it is thus important that we not only pay more attention to our bodies and any symptoms we may display, but also access services that have been made available to us through the NCCP to ensure our wellbeing.
