November 17, 2020

Cancer: The Second Killer disease in humans

Cancer is one of the most dreaded diseases in the world. Of the ten million new cases diagnosed every year, more than half are from developing countries. The total world incidence shows the enormous health problem caused by cancer, which is recognized as the second killer disease in humans.World is facing an epidemic of non-communicable diseases and it is believed to get worse at the end of this decade. Non-communicable diseases are responsible for more than three fifths of the deaths globally (36 million), largely contributed by cardiovascular diseases (48% of non-communicable disease deaths), cancers (21% of non-communicable disease deaths), chronic respiratory diseases (4.2 million deaths), and diabetes mellitus (1.3 million deaths). The most common types of cancers with highest rate of mortality are the cancers of lung, stomach, liver, colorectal and esophagus among men and the breast, lung, stomach, colorectal and cervical cancers among women. Cancer is characterized by abnormal or uncontrolled division of cells, dictated by pathological breakdown in the process of cell proliferation. The cells in our body normally grow and divide in a controlled way to keep the body functioning properly. When normal cells grow old or get damaged, they die, and new cells take their place. However, this process may go wrong to generate new cells even when the body doesn’t need them, or the old damaged cells may not die as they should. The buildup of extra cells often forms a mass of tissue called a lump, growth, or tumor. Thus tumor is the outcome of an evolutionary process involving successive generations of cells, which progressively advance towards cancerous growth. The cancerous cells frequently break free from the tumor site and enter the bloodstream, spreading the disease to other organs and this process is called metastasis. Cancer is occurring in every country, though the magnitude of the problem and common sites differ. Accurate statistics on the occurrence of cancer are not available for the developing countries.The high incidence of cancer of the mouth in India is well known and has led to the identification of habit of chewing tobacco with betel nut as a risk factor.Cancer is the second most common disease in India responsible for maximum mortality with about 0.3 million deaths per year. As per the National Cancer Registry Programme (NCRP) report, the incidence of stomach cancer is leading in Bangalore and Chennai in India, and is less common in Bhopal, Mumbai and Delhi. The high incidence of cancer of the mouth in India is well known and has led to the identification of habit of chewing tobacco with betel nut as a risk factor. Similarly, cancer of the gall bladder is the leading cancer in women in Bhopal and Delhi, and is hardly seen in Chennai and Bangalore. The National Cancer Registry Programme (NCRP) of the Indian Council of Medical Research (ICMR), collected data from six different parts of the country, and reported that cancer of the trachea, bronchus and lungs was the most common type of malignancy in males in 1989 from Bombay, Delhi and Bhopal. It was the second most common cancer in Madras (Chennai) and third most in Bangalore, and was most unusual in Barshi, a rural area. In 2012, almost 145 000 Indian women were diagnosed with breast cancer. Social factors, especially inequalities, are major determinants of India’s cancer burden, with poorer people more likely to die from cancer before the age of 70 years than those who are more affluent. A statistically significant increase in age adjusted rate over time (1982–2014) in all the PBCRs namely Bangalore (annual percentage change: 2.84%), Barshi (1.87%), Bhopal (2.00%), Chennai (2.44%), Delhi (1.44%) and Mumbai (1.42%) was observed.
Kashmir valley (India) which is located at an altitude of 1800-2400m from the sea level and borders the low-incidence country and the high-incidence area of Pakistan, is distinct from other areas in terms of its unique geographical locale, intra-community marriages, tradition, culture, food habits and ethnicity. Over the past few years, the valley has witnessed a tremendous increase in the incidence of breast cancer in its unexplored ethnic population. Most Kashmiris take hot tea called “Noon-Chai” (hot beverage boiled in samovar) both in the morning and at supper, and this has been proposed as responsible for the high incidence of this carcinoma in the valley. Besides, hukka smoking may also be a causative factor, and is practiced commonly by both, the males and females in rural Kashmir. Unhealthy foods are widely available in public, contributing to diet-related chronic diseases, such as obesity. This is a concern given that public facilities often provide a significant amount of food for consumption by vul¬nerable groups, including children and seniors. Over all Incidence of cancer in Kashmir showed a distinctly increasing trend over the past decade and the number of cancers diagnosed is expected to double between the period 2012 and 2027. Kashmir has an unprecedented high incidence of gastric cancer possibly due to their special personal habits like smoking of Hukkaand consuming dried and pickled vegetables, smoked fish and mixed spice/cake (Wur). However, during the same period esophagus cancer showed a slightly declining trend and cancer showed significantly increasing trend. Lung cancer was reported as the second most common malignancy in an earlier hospital-based study from the Kashmir Valley of the Indian subcontinent. However, a study by Koulet al. reported that Srinagar, has the highest incidence of lung cancer among males in India. Carcinoma of the skin in the form of “Kangri”(Fire pot) cancer was a common cancer. Nearly 50% of the cancers of skin were of this type. Kangri cancer is a highly aggressive tumor with a propensity for nodal metastasis. This malignancy is virtually non-existent in the rest of world. High incidence of this carcinoma is because of the chronic irritation of the skin due to the use of afire pot (Kangri), by the Kashmiri people during winter season, thus producing a premalignant lesion called erythema-ab-ignae. A study conducted on the analysis of Breast Cancer in Kashmiri women implies that Breast Cancer is the second common cancer in the valley after Oesophageal Cancer. Besides, in India Breast Cancer too is the second common Cancer among women however the first being Cervical Cancer. Breast Cancer occurs with the highest incidence within the age group 30-50 and is approximately three times higher in urban areas as compared to rural areas. Besides, lack of awareness, a number of specific reasons are said to be responsible for the increased risk of Breast Cancer. “Women who have had more monthly cycles because they started their cycles at an early age (before 12) and/or went through menopause at a later age (after 55) have a slightly higher risk of Breast Cancer. Another reason can be the genetic factor. A woman’s risk of developing breast cancer is higher if her mother, sister, or daughter had the same problem of breast cancer,” said DrNaqshbandi. Analysis revealed that 90.04% (389 out of 432) patients with brain cancer were orchard farm workers, orchard residents and orchard playing children exposed to the high levels of multiple types of neurotoxic and carcinogenic (chlorpyriphos, dimethoate, mancozeband captan) chemicals for more than 10 years. There was a significant difference in the sex ratio in the gastro-esophageal junction cancers, and the male to female ratio was 5.54:1, which was significantly different from those observed for the esophageal, stomach and colorectal cancers. Salted tea is the most popular and common drink of Muslims. The method ofpreparation is typical and practised exclusively in this region. Green tea leaves (not grown in Kashmir) are brewed in sodium bicarbonate until a thick red brown coloured extract is obtained. The extract is then diluted with water and salt and milk are added. The tea is repeatedly boiled in a samawar and drunk while boiling hot. The daily consumption per head is quite large (approximately up to 10 cups a day). Special green tea (kehwa), prepared by boiling green tea in cardamom, cinnamon, and saffron is consumed in moderation (approximately two to four cups a day) by Hindus.The staple diet of all communities is boiled rice, Oryza sativa(batta) and boiled cruciferous leafy vegetable of the Brassica olerecea locally known as haak. Almost all the population is meat eating and consumes sufficient lamb. Other special food items consumed by the people are: dried and pickled vegetables, sun dried and smoked fish, mixed spice cake (wur), and vegetable food colourants (Celosia argenteamawal; saffron – zafran). In addition to the food items described, there is a large consumption of locally grown vegetables, red chillies, and lotus stem. There is an increasing incidence of cancer mortality with considerable variation in mortality for different types of cancers in different areas with different physical, socioeconomic & cultural environments in Srinagar city. Situation is changing as far as the deadly disease cancer is concerned. The diseases are alarmingly on surge. There are patients hailing from ever part of city which are diagnosed with such a terminal disease. Lung cancer, which only few years back was not witnessed in that alarming number, has surpassed the GIT cancers across city. Tobacco use is the leading cancer risk factor at the global level causing 71 per cent of lung cancer death. In Srinagar city, the situation is very grim with the highest number of lung cancer cases, which is increasing alarmingly. The cancer mortality rate among Kashmiris have increased due to some leading behavioral and dietary risks, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and lack of regular check-up. The changing life style and food habits among the people had caused surge in all the cancers especially in Lung, GIT and Blood cancers. The rise in cancer cases is also due to intake of spicy food, changing dietary habits and consumption of bulk of contaminated food items available in the market. There is massive adulteration in mass consumption food items which kills people slowly. There are increasing number of patients complaining of food poisoning, gastric troubles and other problems. Any delay in detection of the cancer can prove fatal. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer.
• The study reveals that esophagus is the leading site of cancer in both sexes, followed by lung, brain, head and neck in males and breast and rectum in females. The incidence of cervical cancer in females and prostate cancer in males is lower in Kashmir as compared to Indian registries.
• The study reveals that stomach cancer is the leading one with an average frequency of 19.2% followed by esophagus and lung as 16.5% and 14.6% respectively. Stomach (23%) and lung (21%) are the leading cancer sites among men while esophagus cancer (18.3%) tops among women followed by breast cancer (16.6%). Kashmir is a very high risk area of most commonly occurring cancers particularly cancers of gastrointestinal tract.
• The study shows that cancer of esophagus, stomach and lungs have a high incidence both in men and women in Kashmir. The study reveals that overall incidence of cancer in Kashmir shows an increasing trend and number of cancer diagnosed is expected to double between the periods of 2012 to 2027.
• The study reveals that cancer of esophagus was the most frequent type in both sexes, accounting for 42.9% of all types of cancers in the valley. The preponderance of esophagus cancer was attributable to the local practice of drinking hot salt tea.
• The study shows that esophageal cancer is a multifactorial disease and no single agent has been identified so far as the sole cause of cancer. High incidence in Kashmir have been associated with the consumption of hot salted tea, sun-dried, smoked food, tobacco in the form of hukkah and various genetic factors.
• The study reveals that gastric cancer has been reported to be highly prevalent malignancy in Kashmir. Particular life style habits like consumption of salted tea and tobacco smoking by hukkah as well as Helicobacter pylori infection are main risk factors.
In today’s life people are not foremost concerned with one’s health and well being as they are busy with other priorities. They develop bad eating habits, making poor lifestyle choices and neglecting different aspects of health. In turn, these habits affect their body and overall health of the people. The special day of Cancer awareness is observed in every year to stress upon the early detection and cure of cancer. To avoid cancer, eat healthy diet, don’t use tobacco, maintain healthy weight, avoid risky behaviors and get regular medical care.
(Views of the author’s are their own)

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