Knowing the preventive measures for any disease is the key factor in its control & management. Considering that over 60% of the total population of Pakistan lives in rural areas, the chances of a common man having knowledge about cancer and its risk factors are very bleak. Even if you live in the city, you might not be aware of what causes this disease and preventive measures.

So let’s have a revision about cancer.

What is Cancer?
Cancer as defined by American Cancer Society (ACS) is a group of diseases that occur due to unchecked abnormal growth of body’s cells which spread later making the immune system so weak that it is impossible to fight back.

How Does Cancer Spread?
Every one of us is already aware of the fact that our bodies are made up of cells. Among the cells a check system exists which connects the cells with each other. Via this system, neighboring cells keep an eye on each other’s well being.

In normal circumstances when a cell starts to grow uncontrollably, its neighbor cells detect this suspicious activity and destroy that cell. Cancerous cells first cut off this relationship of harmony among the cells which results in their unchecked growth.

It’s like a strategy of divide and conquer being played on a cellular level.

How Many People Does Cancer Died Every Year?
In the most recent press releases, WHO indicated that over 8.8 million cancer deaths occur every year.

In Pakistan, the number of people diagnosed with cancer each year are increasing. A cancer mortality rate of 100,000 is itself proof of the devastated state of public health facilities. Being from low-middle income country, we don’t have much resources to treat such a huge number of cancer patients.

To establish a national cancer action plan for prevention and control, in 2015 NHSRC launched the national cancer registry programs in major private and public hospitals through Pakistan Medical Research Council (PMRC). The purpose of Cancer registry program was to gather data regarding “all-cancer” types and demographic of the neoplasms so that our health systems can be tailored.

Number of Cancer Hospitals in Pakistan
There are currently 21 Cancer hospitals offering their services in Pakistan. 7 cancer hospitals are working in Punjab, 5 in Sindh, 5 in KPK and 2 each in Balochistan and Gilgit Baltistan. Cancer treatment is expensive and only Shaukat Khanum Memorial Cancer Hospital(SKMCH), Bait-ul-Sukoon Cancer Hospital and Children Cancer Foundation Hospital are providing free and comprehensive treatment plans.

Other hospitals do offer free /subsidized treatment plans through zakat funds or bait-ul-maal but acquiring treatment from these channels is a lengthy and tiresome process as applicants are more than government’s capacity.

What Are The Risk Factors For Cancer?

According to WHO guidelines, below are the risk factors for cancer:

Smoking/Tobacco Use
Physical Inactivity
Poor diet/Diet low in fruits & Vegetables
High stress levels
Environment factors like Pollution
Family history
Hepatitis B& C virus
Papilloma Virus
Too much alcohol consumption

How To Counter These Risk Factors
Signs & Symptoms:
Cancer advocacy plays a vital part in combating this deadly disease. Educating the public about the risk factors and early signs/symptoms of cancer is of prime importance.

As per guidance of WHO, the early diagnosis of cancer decreases the overall treatment cost and early identification means a higher chance of it being cured as well. There needs to be an emphasis on access to basic screening tests and treatment at subsidized rates as unavailability of these facilities at low cost is one of the many reasons people don’t go the doctor in the first place.

Proposed by American Cancer Society (ACS), on the appearance of these early signs & symptoms of cancer one should contact a healthcare provider:

Unexplained Weight Loss
Pain, not responding to general treatment
Changes in skin color: Darkening of the skin, yellowish skin, reddened/itched skin, Excessive hair growth.
Bowel Changes
Unusual bleeding or discharge
Sores/white patched on tongue or in mouth
Lump in breast or in any part of the body especially armpits, groin & neck.
A cough that doesn’t go away or hoarseness
The signs & symptoms of cancer are not limited to the above ones. If any noticeable change within the body takes place and gets worse with time, one should immediately seek medical help.

Healthy Diet:
The role of healthy diet cannot be overlooked in decreasing cancer risk. In many researches, the high intake of fruits and vegetable rich in phytochemicals plays a role in decreasing cancer risk. Phytochemicals are the biologically active chemicals produced by plants which possess anti-oxidant properties. They are also responsible for the color, odor and flavor of plants.

The American Institute of Cancer Research (AICR) categorized phytochemicals further and their occurrence in various fruits & vegetables. Red, orange and green fruits & vegetables like broccoli, carrots, tomatoes, oranges, watermelon, apricots contain carotenoids (beta-carotenes). Apple, citrus fruits, soy products, tea and coffee are rich in flavonoids. Grapes, cherries, berries & green tea are rich in terpenes & polyphenols.

In green leafy vegetables like spinach, cabbage, kale and brussels sprouts, glucosinolates and indoles are present in abundance.

All these phytochemicals act as an anti-oxidant. Oxidation is a chemical process which produces free radicals in our body. These free radicals play the role of carcinogens by creating the faults in cell growth pathways which leads to the birth of cancer.

Anti-Oxidants work against oxidation resulting is less free radicals in our body. These anti-oxidants act as an immunity booster. In general, they detoxify carcinogens, inhibit cancer cell growth, downgrade inflammation and tumor size and limit production of cancer-related hormones.

Exercise & Stress Management:
ACS guidelines on cancer prevention strongly suggest that adults involve themselves in 150 minutes of moderate intensity physical activities each week and for children /teenagers it is 1 hour of exercise each day.

Avoid Cancer Causing Agents:
Apart from smoking and inactivity, cancer triggering eatables are the major cause of cancer. They are in our daily diet and we don’t even realize it. American Cancer Society identified 9 categories of cancer causing food which have become an integral part of our busy and fast moving lives.

Hydrogenated oils: These trans-fats contain margarine and ghee. According to FDA, trans-fats aren’t safe regardless of their quality. They are considered the worst type of fat. Keeping in mind how common oil and ghee are in Pakistan, it would be wise to consider replacing them with olive oil, palm oil, coconut oil, desi ghee, or homemade butter.

Browning Carbohydrates: British food scientists have warned about heating carbohydrates higher than a certain temperature. The carbohydrates which are heated for increase amount of time contains higher levels of acrylamide, a chemical compound which is a carcinogen. Fast foods like French fries, popcorn, grilled bread come under this category. We also need to know that acrylamide is found in cigarettes in very high quantities.

Processed Meat: Processed meat like hot dogs, sausages, and other processed meats like ready to fry items all contain high amount of Sodium Nitrite which is a cancer-causing ingredient. If processed meat is a part of your daily diet than you have 67% more chance of getting cancer than non-eater of processed meat.

Red Meat: Consumption of red meat on daily basis puts you at greater risk of having cancer specifically breast cancer. A new study published in San Diego Union Tribune confirmed that red meat contains a sugar molecule NeuSGc that becomes a part of your own cells and it triggers process of inflammation as your body recognizes it as foreign element.

Farmed Fishes & Chicken: By avoiding processed and red meat you will find yourself eating more white meat. Fish is an excellent choice to pursue for protein needs but you should opt for wild fish as the ones bred in farms contain pesticides, antibiotics, PCBs which all are cancer causing contaminants. Farmed chicken on the other hand also has cancer-causing contaminants as the feed given to them has these chemicals so look for Desi ones.
Sugary Drinks: Carbonated drinks have a dangerously high amount of carbohydrates and high amount of sugar, which affects your body adversely. A report in 2014 by Consumer Reports revealed that some soft drinks include known carcinogens.

Refined Sugar/Refined Flour: Anything refined from its natural form is not good for health. Use brown sugar and whole wheat flour.

Artificial Sweeteners: Avoid using products including artificial sweeteners. Artificial sweeteners like sorbitol apart from a cancer-causing agent increase blood pressure as well.

Genetically modified Organisms: Due to GMOs, days of the seasonal fruits and vegetables are gone. Now crops are grown using genetic mutations so that they can adapt to any harsh seasonal conditions and can be grown throughout the year. That’s why you will find all the vegetable and fruits in the market all the time of the year. By growing vegetables in your garden, you can at least lessen exposure to these GMOs vegetables. For fruits, you can handpick them from orchids and farms.

Exercise itself lowers stress levels by producing endorphins which are known as happy hormones. Physical activity curtails obesity and harvests a sense of wellbeing cutting the risk of cancer.

Take Away Message
From 1990 to 2021, the cancer mortality rate in Pakistan actually increased. As a UN member, Pakistan has agreed to reduce premature deaths from cancer by 33% by 2013 as part of the sustainable development goals (SDG).

This kind of target seems a bit unrealistic to achieve considering present facts & figures. To achieve it, we need strong engagement from everyone from healthcare professionals to common men.

We as a nation need to be more vigilant and proactive about non-communicable diseases (NCDs) like cancer rather than declaring them an act of God and leaving it to faith. Change begins with yourself.