Every now and then government and non-government agencies in India suddenly wake up to the threat of cancer. There are appeals to hold free cancer detection camps at various medical facilities and people are exhorted to go to them. Children with cancer are herded into groups in hospitals and are asked to paint pictures. These will later be made into greeting cards and sold. Twenty-four hours later it is back to business as usual. What is the current situation and what are the factors holding us back from implementing a meaningful all India cancer control programme? The cancer statistics for major metropolitan cities in India suggest that breast cancer is fast becoming the number one cancer among women, who account for more than half the new cases of cancer reported each year. Does this, therefore, mean that every woman needs to do a breast self-examination, as is being suggested in some quarters? The answer is, no. Not only is this unnecessary, it can in fact be detrimental. Recent years have seen great discussion on this subject in Britain where doctors began to be deluged by patients who felt that they had discovered lumps in their breasts. In the process, women who in fact had lumps that were malignant did not get the attention they deserved and went unnoticed. The recommendations now are that those who have a significant family history of cancer, or are at high risk, need to be screened more regularly and that examination is best left to a trained professional. Here again, it is not a mammogram that is necessarily going to catch that malignant tumour once it starts, as is being widely touted. Most women, prior to menopause have dense breast tissue that prevents tumours from being detected by mammography. When you consider that in India, if you are to believe cancer specialists, women are being struck with breast cancer almost 10 years before their counterparts in the West the utility of this detection technique, besides the obvious expense, becomes doubtful. It is the humble ultrasound that can pick up these tumours and yet it is hardly ever considered for this purpose. Which seems to suggest that it is also about money and commercial interests. You can, and need to, charge much more for a mammogram than for an ultrasound. After all, the mammogram is a very expensive machine — no matter that in the process you expose women to radiation that can increase their risk of cancer while the ultrasound does not carry this risk. In fact, so-called cancer detection camps and programmes have become happy hunting grounds and sources of funds for organisations that regularly hold them. Rarely is a case of full-blown cancer ever detected. There are references to pre-cancerous lesions but it is a moot point as to whether they would have become cancerous had they been left unattended. What is worse, people go away feeling reassured that they do not have cancer. What needs to be explained to them, and is not done, is that they are only being screened for a few of the most common cancers. This does not mean that they do not have a cancer growing elsewhere in their body. When it comes to cancer today, you are at the mercy of unfettered human greed. Cancer therapies are being offered at prohibitive costs by self-proclaimed cancer specialists operating private commercial establishments. What is distressing is that a great many patients who will go to these private ‘‘shops’’ will be given palliative chemotherapy and radiotherapy and not the treatment they deserve. These people will fight an unequal fight with the odds further weighted against them and will also suffer unnecessarily. This sorry state of affairs does not restrict itself to conventional medicine either. I can still see before me the face of an irate father whose son had lost precious time because they had been lured by a homeopath whose advertisements proclaiming a cure for cancer regularly appear in the national dailies. He had only one question for me, ‘‘Can’t you do something to make it a crime for such people to advertise in respectable newspapers?’’ Apparently under the current law, as long as practitioners of alternative therapies do not advertise a particular product they are free to make all kinds of tall claims. Surely it is time for the various medical bodies to take cognizance of these facts and do something about them? At present, commercial interests are dictating priorities in cancer and not the needs of the patients. Even the cancer awareness literature prepared and distributed by most organisations, barring a few, reflects little understanding of ground realities. To give an illustration, women are being told to come in for regular Pap smear tests so that the incidence of cancer of the cervix can be brought down. This is like putting the cart before the horse. If you read the history of cancer of the cervix in the so-called developed world, where it is practically non-existent today, you will realise that the fall in its incidence had a great deal to do with improvements in hygiene and in the living conditions of ordinary people as well as with late marriage. Going in for a regular Pap test without paying attention to these predisposing factors will remain at best a fire-fighting measure. But if you are copying awareness literature from the West, as most organisations do, you will recommend measures more suited to their conditions now than to ours and of little relevance to women living in inhuman conditions in India’s villages and urban slums. Isn’t it time for all concerned parties to come together and sort out the mess that prevails in the name of preventing, detecting and treating cancer? Only then I believe will we have earned the right to talk about fighting it in the first place. (The writer is a cancer survivor who started the first emotional support group for cancer in India. She currently heads CanSupport)
