”I am and I will”

Scientifically, cancer is defined as the uncontrollable growth of abnormal cells, spreading beyond their usual boundaries and sometimes invading into adjoining parts and organs of the body – a process known as metastasis. Socially, cancer is a disease more often defined by fear and stigma. This is understandable given the frightening statistics on cancer incidence, the agonizing treatments, and the soaring mortality rate of this disease; however, social misconceptions about cancer are a barrier to effective cancer control.

The goals of World Cancer Day (WCD), celebrated annually on February 4, are to establish better access to cancer diagnosis and treatment for all patients, and to provide supportive and palliative care, and rehabilitation services to patients and cancer survivors. Untrained personnel are a fundamental obstacle in the less developed parts of the world – where approximately 70% of cancer deaths occur1– while diagnostic delays and poor access to treatment are global challenges. WCD aims to dissolve all social myths surrounding cancer – by promoting awareness about risk factors, preventive measures and early detections, showing support and raising our personal and collective voices. Thus, cancer incidence and mortality rates can be significantly reduced.

Globally, 1 in 5 men and 1 in 6 women develop cancer during their lifetime, with 1 in 8 men and 1 in 11 women dying from the disease2. According to recent World Health Organization data, there were 9.6 million deaths attributable to cancer in 20182. By 2030, cancer deaths per year are projected to rise to 13 million3. These numbers could be dramatically smaller, given how one third of all cancers are preventable, and numerous cancers could be cured if diagnosed early1,3.  Making a conscious effort to limit risk factors contributing to cancer and knowing the warning signs of cancer is vital for efficient prevention and favorable treatment.

Tobacco plays a pivotal role in cancer, as it’s responsible for 22% of all cancer deaths4. Amongst others, tobacco is linked with cancers of the lung, esophagus, larynx, pancreas, stomach and kidney. Second-hand smoke can also cause lung cancer. Physical inactivity, unhealthy diet and obesity raise the risk of esophagus, breast, colorectal, endometrium and kidney cancers, whereas a healthy, balanced diet can have protective effects. Moreover, high alcohol consumption is an important risk factor for cancers of the oral cavity, liver, esophagus, colorectal and breast. In 2010, there were over 300,000 alcohol-attributable cancer deaths5. Viruses, such as HPV, Hep B and Hep C are also responsible for a high number of cancers. Two-thirds of infection-attributable cancers – amounting to nearly 1.4 million people – occur in less-developed countries5. Vaccination against infectious agents can significantly reduce the risk of liver and cervical cancers, resulting in over 1 million less deaths6. Additionally, environmental pollution, occupational carcinogens and inappropriate radiation use can increase cancer risk. Reducing air pollution, and simple acts like applying sunscreen and avoiding excessive sun exposure can reduce chances of developing cancers of the lung and bladder, mesothelioma and leukemia. By avoiding or limiting these risk factors, cancer incidence can fall by 30-50%5.

Detecting cancer signs and symptoms promptly is important to avoid diagnostic delays. If a cancer is detected early – when it’s still small and hasn’t metastasized to other organs yet – chances of successful treatment are better. Some of the signs include unexpected weight loss, fatigue, pain and skin changes, with different cancers having more specific symptoms. Reliable screening programs, that can detect the disease early – ideally before the onset of symptoms – could play an integral part in early detection, improved treatment, and survival rates. Common screening tests are the PAP test for cervical cancer, mammogram for breast cancer, and colonoscopy for colorectal cancer. Unfortunately, most screening tests don’t have high sensitivity. Moreover, certain cancers like liver, stomach or pancreas currently do not have screening tests. Consequently, tissue biopsies – which are invasive, expensive and painful – are currently the main detection method of cancers.

Hence, an area of particular excitement in the cancer field is the liquid biopsy test – a blood test that can tell you whether there is a raised risk of cancer in the body along with the location of the cancerous site. Circulating tumor DNA (ctDNA) is released into the bloodstream from cancerous cells and tumors. This ctDNA varies from ‘normal’ DNA as it has acquired genetic mutations (alterations) due to the tumor. Importantly, ctDNA levels vary depending on tumor type, location and cancer stage. Therefore, it is possible to detect the presence of ctDNA in the bloodstream, check whether the cancer has metastasized and guide tumor-specific treatment according to the properties of each cancer. Another benefit of this advancement is that because it is a simple, painless blood test, it can be performed at various stages during treatment to evaluate the effectiveness of therapy depending on the ctDNA amount and monitor the patient’s remission.

Today, we know more about cancer than ever before. We know that by raising awareness and support, and by investing in research and innovation, extraordinary breakthroughs can occur. Breakthroughs that improve cancer prevention and diagnosis rates, increase the progress of care and treatment and empower all of us – cancer survivors, family and friends – to stand up to cancer.

References:

  1. World Health Organization (2018). ‘Key Facts’, https://www.who.int/news-room/fact-sheets/detail/cancer
  2. World Health Organization Press Release (2018). ‘Latest global cancer data: Cancer burden rises to 18.1 million new cases and 9.6 million cancer deaths in 2008’. International Agency for Research on Cancer.
  3. World Health Organization (2019) ‘Key Statistics’, https://www.who.int/cancer/resources/keyfacts/en/
  4. GBD 2015 Risk Factors Collaborators. (2016) ‘Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study’. Lancet. Oct; 388 (10053):1659-1724.
  5. World Health Organization (2019). ‘Cancer Prevention’. https://www.who.int/cancer/prevention/en/
  6. Plummer M et al. (2016) ‘Global burden of cancers attributable to infections in 2012: a synthetic analysis’. The Lancet Global Health. Sep;4(9):e609-16. doi: 10.1016/S2214-109X(16)30143-7