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Road map for cancer control

HUMAN body is composed of numerous cells. The cells die after a few days and new cells come to replace them. When cell division becomes uncontrolled, a tumour is formed. Cancer occurs when there is a mutation of cell genes. Cancer can affect anyone but it is possible to cure most of the cancer patients if cancer is initially detected.

Cancer prevention, diagnosis and treatment is a big challenge in our country. The rate of death from cancer is very high; but in the past few decades, cancer treatment has improved. Treatment is delayed because of late diagnosis. Then patients go to cancer specialists, they do not have enough time to get standard treatment as cancer spreads rapidly from one organ to another.

According to the International Cancer Research Agency report 2018, there are currently 150 thousand new cancer patients in the country — 83,000 male and 67,000 female. One hundred thousand patients died from cancer in 2018 although the actual number is many times higher because we do not have any established cancer registry. Women mainly suffer from breast, cervix and head-neck cancer. On the other hand, male mostly suffer from lungs, mouth-throat, oesophagus, gastric, and colon cancer.

The cause of cancer cannot be established as yet, but some possible causal associations are known: risk of cancer increases with age; tobacco consumption is responsible for at least 30 per cent of cancer cases; unhealthy food is responsible for 35 per cent of cancer cases. Fruit treated with formalin and other chemicals, food items having non-food-grade colour, fish and livestock reared with feed from tannery wastes increase the risk of cancer because of the inherent toxic chromium; no physical work increases the risk of cancer; infections cause 15 per cent of cancer cases. Hepatitis B and hepatitis C cause liver cancer and human papilloma virus is responsible for head-neck and cervical cancer in women; helicobacter pylori can cause stomach cancer; and alcohol is also a cause of cancer.

Different treatment procedures — surgery, radiotherapy, chemotherapy, hormonal therapy, targeted therapy and immune therapy — are followed to cure cancer patients. Cancer treatment is usually multi-disciplinary. Twenty per cent of the patients require surgical treatment, 60–70 per cent radiotherapy and 25–30 per cent chemotherapy. There are 20 Linac and 10 Cobalt-60 external radiotherapy machines and 17 brachytherapy of internal radiotherapy machines in the government and non-government sector which are inadequate against the demand. Bangladesh now needs at least 300 machines.

There are also only one 300-bed National Cancer Research Hospital, 12 government medical colleges and 7 hospitals in the private sector that have radiotherapy machines.

Along with limited facilities for treatment, there is very limited cancer research in Bangladesh. Statistics show that cancer causes direct and indirect economic damage. The amount of revenue generated from tobacco is lesser than the treatment cost of tobacco-related diseases.

Bangladesh is committed to implementing the national cancer control strategy as a signatory to the World Health Organisation’s cancer prevention and cancer control resolution. Bangladesh took this initiative in 2007 to implement the plan.

The plan provisions for Bangladesh to have a system of cancer control, which will bring down the death rate from cancer. The cancer strategy focuses on primary prevention; effective screening and early detection; disease-specific protocol development and standard treatment; necessary support, rehabilitation and palliative care; effective planning, coordination and consolidation of resources and activities, monitoring and evaluation; establishment of cancer registry activities; research and monitoring; provision for health insurance for cancer patients; research on cancer; formation of a national cancer control fund; provision for anti-cancer drugs at affordable cost; and a 50 per cent reduction in rent in public transport for cancer patients.

The principles of cancer strategy aim at ensuring timely and equitable opportunities for all; providing quality health care; making anti-cancer activities sustainable; using evidence-based methods; and reflecting the patient-centred care treatment.

An early detection of breast, cervix, lungs, head-neck, colon, gastric, stomach and prostate cancer is possible by training general practitioners in signs and symptoms of cancer and physical examination. General practitioners, after detection of the cancer, will refer the patient to cancer specialists centres for appropriate treatment.

Primary steps to prevent cancer can include increasing awareness of harmful aspects of tobacco and its inclusion in school curriculum, the enforcement of anti-tobacco law and doubling tobacco prices; healthy living, adequate intake of fruit, vegetables and regular physical work; public awareness of harmful aspects and the prevention of cancer; time steps for Hepatitis B and HPV vaccine.

The international projection is highly alarming in that by 2030, every family in Bangladesh may have a cancer patient. Are we ready for this disaster? Do we have adequate hospital infrastructure, medical equipment, medicines and specialist doctors, nurses and technologists? We should make a comprehension strategy and work out a road map to attend to the problems.

By: Prof. Syed Md. Akram Hussain, Senior Consultant, Clinical Oncology & Radiotherapy