‘Two-thirds of all cancers can be treated’

As the second leading cause of global mortality, cancer is often equated with death. This World Cancer Day, Dr. Hari Menon urges us to look at this much-dreaded and oft-misunderstood healthcare challenge through a more hopeful and scientific lens. 

In 2000, the Union for International Cancer Control (UICC), a non-governmental organisation, conceptualised a day – 4^th February – to raise awareness about cancer and to encourage its prevention, detection, and treatment. This year, as we continue to battle the Covid-19 pandemic, with the global spotlight on healthcare, World Cancer Day presents a significant opportunity to tackle the cancer burden.

“Cancer is not something that has been recently diagnosed. If you look at the mummies from the Egyptian pyramids, even they had cancer! But today, we have more cancers that can be cured with effective treatment,” says Dr. Hari Menon, Senior Consultant and Director of Haemato Oncology at Cytecare Cancer Hospitals in Bengaluru.

“Cancer treatment has significantly improved in the last decade, and this is particularly true with targeted therapies and surgical techniques as well as supportive care that has come into play to improve the survival of patients,” explains the oncologist who has worked with one of India’s premier institutes in cancer treatment, education, and research, Tata Memorial Hospital in Mumbai, for a substantial part of his career spanning over two decades.

Edited excerpts from a video interview with the medical oncologist on the possibility of a cancer vaccine, chances of cure, limitations of screening, access to quality care, and more:

What exactly is cancer?

Cancer develops at the cellular level. The cells in the human body are constantly dividing and this is a very tightly regulated process. However, sometimes, these divisions can go rogue because of certain abnormalities like mutations due to environmental stimulus or genetic predisposition.

When the cells start proliferating or dividing uncontrollably, without being checked by the various checkpoints that exist in the body, which includes the immune system, they tend to outgrow many of the normal cells. They start bulldozing their way and sometimes leave their site of occurrence and move to other parts. The spread of cancer interferes with the normal functioning of the body at the cellular level because of which the human body tends to break apart and eventually, culminates in mortality.

We see more cancers as the patient grows older. Across the world, we see increasing cases of cancers because life expectancy has improved considerably. Earlier, the primary cause of death used to be an infection. Today, cancer is second only to cardiovascular diseases in causing human mortality.

Can cancer be cured?

Cancer is curable. It is just like any other disease that the human body develops during the course of its lifetime, and it needs to be dealt with accordingly. There are about 1/3 of cancers that can be well treated and cured completely. And there are about 1/3 of cancers that are well controlled. You can live with the disease, like how you live with diabetes, hypertension, and other lifestyle disorders. And then, there are 1/3 cancers, which are probably not curable, but we can help improve the quality of life for the patient. In a nutshell, about two-thirds of all cancers can be well treated.

Is early detection the only way to prevent cancer?

Not all cancers are amenable to screening. There are several studies showing the benefit of screening in breast cancer and cervical cancer, but there is no screening strategy to identify leukemias.

One of the failures of screening can be seen in prostatic cancer. There are numerous reasons why you may have prostate-specific antigen (PSA) elevation. So to use that as a screening tool may not actually translate into early detection of prostate cancer.

It’s important to apply screening strategies in the relevant areas. At Tata Memorial Hospital, there was a study that showed we could decrease cervical cancer mortality by almost 35% by just simple techniques of screening patients in the general population for cervical cancer.

Similarly, in a country like India with a significant number of tobacco users, screening for head and neck cancers is a viable option. We need to implement these screenings not only at cancer centres, but at the primary health centres.

Besides, the incidence of certain cancers could be regional. For example, Kerala has a high incidence of thyroid cancers (attributed to background radiation from the beaches), while gallbladder cancers are more common in North India, particularly in the Punjab belt. Similarly, the highest incidence of gastric cancers in India is in Karnataka.

Incidentally, gastric cancer is prevalent in Japan too. The country has designed methodologies for early detection and achieved good cure rates. So you have to look regionally as to what is the kind of cancers that are more prevalent in that particular area and tailor your screening strategies accordingly.

Are hopes for a cancer vaccine too far-fetched?

The concept of vaccination for cancer is not new. It has been in the works since the ‘70s. The principle of vaccination is basically to generate a robust immune response in terms of antibodies against an organism.

And there have been attempts at doing it for cancer vaccine, especially with dendritic cell therapy, which present the antigens to the T-cells to elicit a response that will actually result in immune-mediated destruction of the cancer cells.

Theoretically, it’s good, but over the past three decades, we have only made subtle inroads into this concept to control cancer. Also, it may not be applicable for the management of all cancers. So while it is still being actively looked into, a cancer vaccine as a preventive strategy might be something very optimistic.

The cervical vaccine story, though, is a success story. Cervical cancers in women are probably in decline because more women are vaccinated against the human papillomavirus (HPV), one of the causative organisms for cancer. It is part of the standard protocol in the western population and is now being implemented in India too.

How can we address the gaps in cancer care and democratise access to quality care?

It’s true that there is a shortage of oncologists, but the situation has significantly improved in the last decade. When I started my career in oncology in 1998, there were only a handful of centres offering comprehensive oncology care. Now, many of the hospitals have oncology units.

Strengthening medical colleges and institutes where undergraduate training and postgraduate training is provided would be the way to address the shortage of oncologists. We need to inspire aspiring doctors to join oncology.

While we do have excellent super specialty medical centres and confident doctors, we need to strengthen our primary healthcare. Almost 60% of the patients come to us with advanced-stage cancers. There’s a need for a better understanding of cancer, even among the medical fraternity.

What is the impact of smoking, alcohol consumption, and lifestyle factors on cancer?

The number one risk factor is smoking. Smoking causes cancer. Almost 38 different carcinogens can independently cause different forms of cancers – lung cancer, gastric cancers, cancer in the urinary bladder. Even after you quit smoking, your risk of developing cancer remains higher as compared to a non-smoker.

Alcohol can induce cancers as well, but the causal connect is not as robust as for smoking. However, chronic alcoholism is one of the primary causes of a depressed immune system and any depression in the immune system can make you prone to developing cancer.

Many people who consume alcohol are also smokers and that is a deadly combination. The chances of developing oropharyngeal cancers and gastric cancers are several-fold higher in patients who smoke as well as consume alcohol.

Lifestyle is an important factor too. There is definitely an increased incidence of breast cancer with obesity. The kind of nutrition and food habits you have also play a vital role in the increased incidence of colorectal cancer. Having a healthy lifestyle goes a long way in preventing cancer.

Are Covid-19 vaccines safe for cancer patients? Should cancer survivors get vaccinated?

I’ll answer the second question first. Cancer survivors are just like any other person in the community. So they should be taking the vaccination, without having any doubt.

To answer the first question, my concern is not about the safety of the vaccine, but whether the cancer patient who receives the vaccine can mount a response that will allow him to be protected. Because cancer is a sort of immunocompromised state as is the effect of chemotherapy or any anti-cancer therapy.

The general acceptance is that if about three to four months have elapsed after the completion of your cancer therapy, it is okay to go ahead and take the vaccination.