The dark age of Cancer

The last 50 or 60 years have seen humans make unprecedented progress in science and technology. Progress that has seen applications in all areas of human life. Travel, agriculture, healthcare, entertainment, food production, communication, have all benefitted from the giant strides made by humankind in this time.

A consequence or corollary of this tremendous progress has been the adverse effects on our planet and environment, affecting all life on Earth. Rampant construction, all kinds of pollution, depleting green layers worldwide, global warming, drastically changing climatic conditions. All of these have been largely ignored at the altar of progress.

The cost to human life and health has also been dramatic and, yet again, ignored because no one wants to hinder progress. One of the most significant effects, affecting humans everywhere, has been the rise of Cancer (yes, with a big C). A factor that does not, yet, invoke the same kind of fear in humans today as some of the other fears we spoke about earlier. Should we be afraid of Cancer though?

Cancer has probably been around for ages. But we are increasingly creating more conditions for Cancer to flourish. Environmental pollution, lifestyle habits, processed food, chemically treated plants, genetically modified foods, air and water pollution, have all been increasing at unprecedented levels too. And with this increase comes rising incidences of Cancer being reported all around the world.

Do we know all the factors that cause Cancer? Are there multiple causes? If it is hereditary why do some who have no history in the family get it? Is Cancer curable? These, and many more such anxious doubts, have troubled healthcare workers, researchers and families for decades.

Global data and even the sparse data available in India throws up some interesting facts.

• Cancer is among the leading causes of death worldwide. In 2012, there were 14.1 million new cases and 8.2 million Cancer-related deaths worldwide.
• 57% of new Cancer cases in 2012 occurred in less developed regions of the world that include Central America and parts of Africa and Asia; 65% of Cancer deaths also occurred in these regions.
• The number of new Cancer cases per year is expected to rise to 23.6 million by 2030.

The number of Cancer cases in India is increasing every year. According to WHO’s Cancer Report, in India, lung, oral, lip, throat and neck cancers are the most common among men while women suffer more from cervix, breast and ovarian cancers. In the elderly, the most commonly occurring cancers are kidney, intestine and prostate cancer.

Regional variations in Cancer incidence and mortality are driven by multiple factors. Other than internal factors like genetic, hormonal and poor immune conditions, external or environmental factors like food habits, industrialisation, pollution and lifestyle can also cause Cancer.

This is why data on geographic pathology can give some indication of the proportion of cancers that could be prevented by modifying specific harmful lifestyle or environmental factors.

The various types of Cancer in India and the predominant environmental causes across various parts of India are as follows:

1. North East: Oesophagus Cancer, caused primarily by consumption of tobacco and household burning of wood fire
2. West Bengal: Bladder Cancer due to air and water pollution.
3. South & coastal India: Stomach Cancer attributed to a diet rich in spice and salt
4. Goa: Colon Cancer, because of a diet rich in red meat and alcohol and tobacco consumption
5. Gujarat & Rajasthan: Head and neck Cancer, caused by tobacco consumption, mostly in pan masala
6. Punjab: Kidney, urinary bladder, and breast Cancer due to pollution and pesticides and toxins in food
7. Gangetic Plain (UP, Bihar): Gall bladder, head and neck Cancer, caused by polluted water, mostly due to river sediments and a diet rich in meat and fish
8. Madhya Pradesh: Oral Cancer, caused by tobacco consumption

Across India, Cancer cases and mortality are escalating among women, primarily due to low awareness and late detection. India accounts for the third highest number of cancer cases among women after China and the US, a number growing annually at 4.5-5 percent, according to new data.

According to the ‘Call for Action: Expanding Cancer care for women in India, 2017’ report from FICCI and E&Y, Cancer incidences among women in India last year was estimated at 0.7 million. However, this number may well be just the tip of the iceberg, referring as they do to only registered cases. There will be multiple cases where the woman is not diagnosed. Reports estimate between 1 and 1.4 million cases may go undiagnosed or unreported. More than 50 percent of the cases in India are diagnosed in stage 3 or 4, which decreases the patients’ chances of survival. Reports say India has highest mortality-to-incidence ratio in the whole world.

The World Cancer Report, produced by the WHO’s specialised Cancer agency, and released on World Cancer Day, predicts that new Cancer cases will rise from an estimated 14 million annually in 2012 to 22 million within two decades. Over the same period, Cancer deaths are predicted to rise from 8.2 million a year to 13 million.

Data collection and incidence reporting In India have been always found wanting. One of the foremost medical journals ‘THE LANCET Oncology’ makes a significant point about data collection. It says the fallout from the Cambridge Analytica–Facebook scandal marks a significant inflection point in the public’s trust concerning Big Data. The health-science community must use this crisis-in-confidence to redouble its commitment to talk openly and transparently about benefits and risks and to act decisively to deliver robust effective governance frameworks, under which personal health data can be responsibly used.

An organization in EU called BD4BO (Big Data for Better Outcomes) has a comprehensive European research programme aimed at developing key enablers to support health care system transformation through the use of big data. The initiative will develop platforms for integrating and analysing diverse data sets, focusing on outcomes that matter to patients and generating meaningful insights that will help improve health care.

At the end of the day, data will only help in analysing trends, patterns, behaviors and identify any factors that appear significant. The issue of preventing or curing the disease will not be answered by this alone.

Another interesting data point, this time collected by medical professionals, points to the ‘Bad Luck’ factor in humans.

What is this ‘Bad Luck’ factor? The National Centre for Biotechnology Information (NCBI) houses a series of data bases relevant to biomedicine. A well-studied contributor to cancer is inherited genetic variation. Data shows only 5 to 10% of cancers have a heritable component, and even when hereditary factors in predisposed individuals can be identified, the way in which these factors contribute to differences in cancer incidences among different organs is obscure. A theory that the number of cells in a tissue and their cumulative number of divisions may be related to cancer risk, making them more vulnerable to carcinogenic factors has been proposed. The concept underlying the current work is that many genomic changes occur simply by chance during DNA replication rather than as a result of carcinogenic factors. In formal terms, NCBI’s analyses show that there is some stochastic factor (i.e. a random sequence) related to stem cell division that seems to play a major role in cancer risk.

In the meantime ongoing research by Dr. Vincent J lynch, University of Chicago, on the basis for human morphological traits, particularly defining the developmental genetic mechanisms, studied elephants. The results were an eye opener! An animal weighing 8 tons should have a lot of cells to make up the whole Elephant. All of those cells rose from a single fertilised egg, and each time a cell divides, there is a chance that it will gain a mutation – one that may lead to Cancer. But, he found that, elephants are less prone to cancer compared to other animals and much less than humans! It seems elephants aggressively kill off cells whose DNA has been damaged; they protect themselves with a unique gene, which has been called ‘Zombie DNA’. It seems humans have only one copy of this gene while elephants have 20 copies.

In conclusion we should be aware of our environment, not smoke or chew tobacco, exercise regularly and guard against obesity and of course do regular screening and checks for cancer markers. And maybe, we should also choose our parents carefully.