Quest to prevent cancer

Don’t let the word ‘cancer’ scare you. Do all you can to eliminate the risk factors

As women, we multitask every day and our priorities are pretty clear — family, career, finances etc. And most often, our health is at the very bottom of our checklist. And before we know it, we start skipping our health check-ups and ignore certain symptoms as everyday discomfort.

But what if we see the dreaded ‘c’ word looming on the horizon? It is never too late to take precautions and eliminate the risk factors of the deadly disease.

Cancer is a term used to describe diseases in which abnormal cells divide without control and can invade nearby tissues.

As a gynaecologist, some of the questions that I am asked frequently are: what are the common cancers that can affect women? Will my condition turn into cancer? How can I reduce my risk of cancer? If I have cancer will my daughter get it too? Let me address a few of these questions here.

The most common cancers in Indian women are breast, cervical, colorectal, ovarian, lip and oral cancers. Until a few years ago, cervical cancer was the most common cancer in Indian women. However, this has been overtaken by breast cancer especially in the metros.

Breast cancer
This is the most common cancer in Indian women and accounts for 27% of all cancers in women. Around one in 28 women is likely to develop breast cancer during her lifetime. In the urban areas, the incidence is one in 22 as compared to the rural areas where one in 60 women develop breast cancer. The risk of developing the disease increases in the early 30s and peaks at the age of 50 to 64.

The cause of breast cancer is not known. Hence, prevention becomes difficult. Studies have tried to find a link between breast cancer, diet and exercise. Although there are no definite conclusions, there are benefits for women who exercise regularly, maintain a healthy weight, do not smoke and have limited intake of alcohol. Women who breastfeed are also at a lower risk of breast cancer.

Breast cancer cannot be prevented. However, if detected early it is easier to treat. In the past, breast self-examination was advocated to help diagnose cancer early. But breast exams are no longer a part of the screening recommendations because research does not show that they provide a clear benefit. Still, the American Cancer Society says all women should be familiar with how their breasts normally look and feel and report any changes to their doctor immediately. Mammograms are advocated as a screening procedure to pick up early cancer. These can be done from the age of 45 onwards at regular intervals as recommended by your doctor.

Cervical cancer
The incidence of cervical cancer in India is 22.86% making it the second most common cancer in Indian women. The average age of affliction is 38 years with a range of 21-67 years. It is thought to be caused by the Human Papilloma Virus (HPV) through sexual contact. It is not common in women who are not sexually active. It is more common in rural women.

Ways of reducing the risk of cervical cancer include using condoms, not smoking, getting regular pap smears done, being vaccinated against HPV virus and not having multiple partners.
Cervical cancer most often is preceded by a pre-cancerous stage. This stage can be detected with preventive screening tests such as the pap smear and HPV test. If a pre-cancer is found it can be treated. Most invasive cervical cancers are found in women who have not had regular pap tests. The HPV vaccine is now available and is primarily given to adolescent girls. They will, however, have to continue to have regular pap smears once they are sexually active.

Cervical cancer does not have a genetic or familial predisposition and hence will not affect any other female member of the family.

Ovarian cancer
The incidence of ovarian cancer in India is between 0.9 – 8.4/100,000. The risk starts increasing from the age of 35 and reaches a peak between the ages of 55-64. The exact cause of ovarian cancer is unknown.

The risk is increased after the age of 50, it can run in families with a history of ovarian, breast and colorectal cancers, personal history of breast cancer, endometriosis, being overweight and taking fertility pills continuously for more than one year also increase the risk. Factors that reduce the risk include a full-term pregnancy before the age of 26, birth control pills used for three to six months or more and tubal ligation or sterilisation.

There are no specific screening methods for this disease and therefore, unfortunately, it is detected only in the later stages. However, some of the non-specific warning signs are bloating of the abdomen, feeling full quickly after eating, frequent urination, abdominal pain, loss of weight and nausea. So if you have any of these symptoms it is better to consult your gynaecologist.

Lifestyle factors such as smoking, unhealthy eating habits, alcohol consumption, sun exposure, environmental pollutants, infections, stress, obesity, and physical inactivity can cause 90–95% of the cancers.

The evidence indicates that of all cancer-related deaths, almost 25–30% are due to tobacco, as many as 30–35% are linked to diet, about 15–20% are due to infections, and the remaining percentage are due to factors like radiation, stress, physical activity, environmental pollutants etc.

Therefore, to prevent the onset of the life-threatening disorders one has to quit smoking, eat plenty of fruits and vegetables, drink a moderate amount of alcohol, exercise, avoid of direct exposure to sunlight, reduce meat consumption, consume whole grains and go for regular check-ups.

Remember most importantly, that prevention is better than cure and especially in the case of cancers, some of them are curable if caught early in the disease.

(The author is director, Fortis La Femme)