Wed, 17 May 2000

Prevention better than cure in fighting cancer killer

By Rita A. Widiadana

SINGAPORE (JP): The 41-year-old Robby was devastated when he was diagnosed as suffering from advanced lung cancer.

He could not stand to think about the little time he had left with his wife and two teenage children. For him and millions of other patients, lung cancer sounds like a death sentence.

Despite advances in oncological treatment, a diagnosis of cancer invariably fills a patient with dread.

Often the diagnosis is too late for doctors to treat patients with the most advanced medicine and technology.

Speaking at the Gleaneagles Hospital's annual seminar Cancer 2000 in Singapore early this month, University of California oncology professor Judith Luce said cancer was a disease of global epidemic proportions but it was preventable.

In the last 10 years, degenerative diseases including cancer have increased as the main cause of death instead of infections.

According to the World Health Organization, there will be 20 million new cancer patients each year by 2020, the vast majority of whom will live in countries where medical resources are limited.

"This year alone, cancer will affect 10 more million people, and five or six million people will die from it," she said.

The incidence of cancer is rising steadily, mainly because a growing proportion of people in both developed and developing countries are old, reaching the age when their bodies become vulnerable to disease, changes in diet, rapid industrialization and excessive tobacco use.

Luce said lung cancer and other kinds of cancer-related diseases hit millions of people in the United States and worldwide.

"It is very saddening because the disease could be prevented," said Luce, who is also the president of the American Cancer Society in California.

Smoking is reaping more and more cancer victims among women and populations of developing countries, where there is little will or few funds to discourage the habit.

Among developing countries, China is expected to bear the brunt of cancer's advance. The country is the world's biggest producer and consumer of cigarettes, with an annual output of more than 1.8 trillion.

Cancer became the country's main cause of death in 1996, ahead of heart disease, with an explosion in the number of cases of lung, breast, colon and rectal cancer.

Managing director of Parkway Group Healthcare Dr. Lim Cheok Peng said over the last 30 years, cancer and heart disease became the leading causes of death in Singapore. Since l991, cancer has become the leading cause of death.

The top cancer deaths among male citizens are lung cancer (27.2 percent), followed by colorectal cancer at 11.5 percent. For females, colorectal accounted for 15.1 percent, followed closely by breast cancer at 14.9 percent.

In Indonesia, cancer takes 38,000 lives per year, and 190,000 others contract it, with ovarian cancer topping the list of most prevalent cancers followed by breast, lung and skin cancers.

Dr. Peng said cancer treatment, especially for those in advanced stages of the disease, was costly. It affects the financial statements of individuals as well as healthcare systems in every country.


"Public education on cancer, promotion of healthy life styles are the key to primary prevention," said Luce.

Common cancer prevention is divided into two strategies. Primary prevention consists of behavioral changes and clinical interventions that reduce the risk of cancer. Secondary prevention involves screening and early detection to reduce mortality from cancer.

Primary cancer prevention research has been far less successful and conclusive. The strongest study done was the Breast Cancer Prevention Trial, which showed a 50 percent reduction in new breast cancers in high risk women who took tamoxifen for five years.

Lung cancer prevention must consist first and foremost of smoking prevention and smoking cessation. Significant success can be reported from smoking control programs in the United States, particularly in California, the professor said.

For the prevention of breast cancer which affects millions of women throughout the world, women are encouraged to undergo breast cancer screenings like mammography and conduct self- examinations.

Consultant general surgeon at Gleneagles Hospital Dr. Chua Choon Lan advised women to have breast screenings performed by professionals.

Although clinical breast examination is a time-honored method, it is difficult to rely on it as a stand-alone screening technique owing to the varied expertise of the physicians. In addition, it is not easy for doctors to detect early and small lesions, particularly in large-breasted, postmenopausal women.

Breast self-examination is widely promoted because it is a low-cost, low-risk procedure that can be repeated in the convenience of the home. However, its efficacy is uncertain.

Screening by mammography is the only method that has an impact on breast cancer mortality for women aged 50 to 69 years; screening done every one to two years with or without clinical breast examination can decrease mortality by 15 percent to 30 percent.

The seminar also discussed new technology on the screening and treatment of cancers.

An interesting topic addressed by Dr. Kok Lee Peng was how to cope with psychological problems faced by cancer patients, their families and medical caregivers.

"Treatment of cancer patients not only deals with medication and therapy but also people as humans," the doctor said.

Cancer patients often suffer from psychological disorders ranging from adjustment reactions to coming to terms with their own mortality.

The two-day seminar clearly voiced the message of increasing the awareness of people, doctors and the government that cancer is now threatening the lives of many -- young and old -- and something must be done immediately to deal with this killer.