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Toppling the Emperor

The Telegraph April 4, 2013

In 1713, Bernardino Ramazzini published the second edition of his book, De Morbis Artificum Diatriba, about the diseases of workers unique to each different trade and observed how an inordinately high number of celibate Roman Catholic nuns in the monasteries around Padua suffered not from uterine cervical cancer but from breast cancer. “Find a convent that does not harbour this accursed pest,” he said, making the first connection between a specific lifestyle and cancer. Six decades later, Sir Percivall Pott wrote about young chimney sweepers crowding London hospitals, all of whom suffered a “singularly hard” fate of agonizing death resulting from scrotal cancer suspected to be caused by the daily exposure to soot. The medical point about cancer being caused by external irritants was squarely made when cases of scrotal cancer vanished from London hospitals after the practice of thrusting naked young boys up the chimneys was stopped by law. Biologists since then have ardently studied the genesis of cancer and can now put their fingers on the causal agents or ‘risk factors’ that trigger off the cancerous process. Much of that knowledge is in the public domain. People know that there are risk factors for cancer in one’s diet, habits and surroundings but often remain unmindful of the underlying message that removing those factors can prevent cancer. About one third of the cases of cancer in countries like ours are preventable. But that can be realized only by putting knowledge into daily practice.

Cancer cooks up many myths, evokes many emotions, but typically, in most societies, it is associated with the fourth horseman of the apocalypse, death. True, cancer is the emperor of all maladies. But the emperor is not monolithic and invincible on all sides. Nor is it an indecipherable miasma. Rather, it has many measurable forms, with varying degrees of caprice and maliciousness. While some cancers gnaw like marauding wolves, many others are slow nibblers, containable by modern medicine like any other chronic disease.

Therefore, the theme — “Dispel damaging myths and misconceptions about cancer” — selected for the World Cancer Day this year (observed on February 4). This is listed as being the fifth of the 11 targets to be achieved by 2020 by the World Cancer Declaration. The Union for International Cancer Control has selected four specific myths to be busted. The first of these — ‘cancer is just a health issue’ — is busted by the story of the chimney sweepers itself. Pott described it in 1775 but it took many decades to bring in the appropriate legislation for want of political will. The whole of society stands to trial if cancer affects an individual. Economically, it impoverishes families by curtailing access to occupation, education and effective healthcare, thus pushing them into a vicious cycle of poverty and illness. The burden of cancer erodes national wealth. A total of 979,786 new cancer patients in India in 2010 caused an economic loss of $270.06 million.
The second myth, ‘cancer is a disease of the wealthy, elderly and of developed countries’, needs to be analysed. Cancer is a disease of the aged, but that age is not chronological but physiological. People from developing countries like India age prematurely and develop cancer earlier in life than in the West. The consequence is the invalidation of a larger number of bread-earners and home makers, leading to a greater fall in wealth generation. Given current lifestyle trends and the demographic characteristics of a large population with poor nutrition, infections, lowered immunity, substance abuse, lack of awareness and early detection facilities, an 81 per cent increase in the cancer burden is projected for developing countries.

The third myth in the list could be the most difficult to be busted. It is ‘cancer is a death sentence’. The truth is that a great majority of early-stage common cancers, if treated properly, can be cured and many others can be contained with long-term treatment. Sustained campaigns for early detection and structured treatment have already lowered the cancer mortality rate in advanced countries.

The fourth myth is ‘cancer is my fate’ — implying helplessness, when cancer is seen as an inheritance of mutated genes. But genetic susceptibility is not reason enough unless the human body’s own protective mechanisms are ‘silenced’ by extraneous forces and the rebel cells are provided with a micro environment conducive to growth. White-skinned people are susceptible to skin cancer but that also requires a good deal of roasting in the sun. A genetic mutation leading to lung cancer is caused by smoking. All these lend credence to the proposition — and there is now demographic data to support this — that preventive measures help avoid cancer. A few specifics need to be underlined though. As people live longer, they become more prone to cancer, which is why we see more people affected with cancer around us now. But a particular individual is more prone to develop a particular type of cancer depending on his or her family history, lifestyle, dietary habits, health abuse, history of past illnesses, occupational exposures and environment. Periodical check-ups should be made routine.

Ramazzini asked his patients a question that Hippocrates did not ask — “what is your occupation?” In this age, when cancer has become a fact of life, everyone needs to ask, “What is my risk?” and live by his advice. Moderation is the best safeguard against the malady, for men and women alike. The maxim, “Nothing in excess”, is one of which I excessively approve.