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'One third of most common cancers can be prevented':
Debunk myths on cancer
By Carol Aloysius
Just this week the Health Ministry decided to set up Early Detection
Centres countrywide to control the high incidence of cancer.
 The decision welcomed by health professionals is significant in the
light of a steep upsurge of cancer cases, which continue to rise sharply
year after year. In the past two decades it is reported that the numbers
of cases have nearly tripled from 6,000 to 15,000 while the cost of
treatment is said to be in the region of Rs 400,000 million a year - a
sum our overburdened health budget can hardly bear with other non
communicable diseases on the rise as well.
According to them, the key to both prevention and reducing the burden
of cancer lies in early detection of the disease through screening tests
especially to prevent breast, and cervical cancer in women.
While many of our state hospitals already have these facilities given
free to deserving patients, the takers are still limited largely due to
false beliefs and myths that cause fears and reluctance among the public
as well as the stigma that surrounds the disease.
According to a Cancer Research bulletin, the burden of cancer in
low-and medium-income countries (LMIC) is expected to increase in the
next decades.
The application of current knowledge and results of research in key
areas would contribute to limit the impact of this phenomenon.
Opportunities for research on cancer prevention in LMIC include
investigating specific circumstances of exposure to known carcinogens
and to agents which are not prevalent in other regions, as well as
interactions among carcinogens and between genetic and environmental
factors.
Early detection both by screening and early clinical diagnosis
represents an important component of cancer control in LMIC. Research
has been carried out to identify effective and sustainable approaches
for early detection of cervical cancer through human papilloma virus
testing and visual tests and of oral cancer through visual inspection.
For other important neoplasms such as breast cancer, on the other
hand, no effective low-cost screening methods are currently available.
Down-staging represents a potentially important approach for cancer
control and a priority area for future research.
Studies addressing the efficacy of treatment protocols,
country-specific cost-effectiveness of various interventions and the
clinical utility and cost-effectiveness of innovative health care and
communication technologies represent the priority for clinical cancer
research.
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Cancer in Sri Lanka
Sixty percent of the cancers prevalent in this country are primarily
preventable mainly through ending tobacco usage and prevention of viral
infections. Eg - Oral and lung cancers and carcinoma of cervix uteri.
Other major cancers such as breast cancer and colonic cancers will be
controlled by early detection. The strategies for these are simple and
cost effective while the increased disease burden and the late disease
will need a huge amount of public health sector funds with very low
quality results as the out come. The health education with regard to
prevention of tobacco usage, healthy life styles and diet patterns,
proper hygiene and the regular monitoring of health status with
surveillance of occupational risks will not only result in the control
of cancers but also will give significant benefits in various other
disciplines too. |
“Early detection of cancer is the key to controlling the disease, and
the most cost effective method”, reiterates Community Physician and
Oncologist Cancer Prevention Campaign, Sri Lanka, Dr Suraj Perera. "This
is why, even though World Cancer Prevention Day falls next month, our
campaign has already launched several programs to create awareness among
the public of the real facts about the disease and thereby debunk those
myths”, he says in an interview with the Sunday Observer.
Following are excerpts…
Q. What is the theme for World Cancer Day next month?
A. Building on the success we achieved in our campaign last
year, we shall be again focusing on Target 5 of the World Cancer
Declaration: ‘Reduce Stigma and dispel myths about cancer’. Our tag line
will be ‘Debunk the myths’.
Q. What are these myths and what are the actual facts?
A. Myth 1 is that we don't need to talk about cancer. The
truth is that whilst cancer can be a difficult topic to address,
particularly in some cultures and settings, dealing with the disease
openly can improve outcomes at an individual, community and policy
level.
Q. How?
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Cancer control in Sri Lanka
The WHO developed Cancer Control Programs in various countries
starting 1980 to reduce morbidity and mortality of cancers in the world.
The National Cancer Control Program of Sri Lanka is one such
organisation developed with the support of the WHO by the Ministry of
Health in Sri Lanka. It works under a Director and has a Field staff
including Doctors. One of the main functions is surveillance and
monitoring of the disease burden. It maintains a cancer registry data
base of pathology, epidemiology and public health related data.
Publications are released from these from time to time .
The second aspect of cancer control is primary health care with
health education, tobacco control within the island, and the Advisory
committee on Tobacco control to the MoH monitors these activities and
the director of the National Cancer Control Program is the Secretary of
this committee, EX - Officio. Other health education work is done with
the collaboration of Health Education Bureau, Family Health Bureau,
UNFPA, Ministry of Education, Rotary Club and other non-government
organisations.
Secondary prevention of early detection and screening is carried out
for most common malignancies and mobile clinics, local health personnel
training, development of health care volunteers and management of
project based screening campaigns are carried out with the Plantation
Health Trust, UNFPA and with other NGOO. Tertiary care management and
palliative care planning are done through the advisory committee for
cancer control where the Secretary is the Director, National Cancer
Control Program.
Rehabilitation work and hospice care is promoted through various
NGOO. Research and development activities also are
promoted by the NCCP. The following project proposal for the next six
years will be mainly centred around the guidelines by the WHO to
increase the monitoring and surveillance of cancer burden in the country
by developing the databases in pathological diagnosis, initial
registration at treatment, monitoring of follow up of cases and
mortality due to cancer.
Health education program will be local area based with the
development of local resource personnel and volunteers. Early detection
programs will centre on development of a central referral screening
laboratory and clinics centre. Mobile clinics will be conducted and
peripheral cancer control units will be developed to promote screening
facilities. |
A. Talking about cancer challenges negative beliefs, attitudes
and behaviours that perpetuate myths about cancer, cause fear and stigma
and prevent people from seeking early detection and treatment.
Q. Who should be involved in shattering these myths?
A. Governments, communities, employers and media all have a
role to play to challenge perceptions about cancer to create a culture
where people are empowered to access quality cancer prevention and care.
Q. Why?
A. Because investing in prevention and early detection of
cancer is cheaper than dealing with the consequences
Q. What is Myth number 2
A. Myth 2: is that there are no signs or symptoms of cancer.
Q. And the truth is…?
A. The truth is that for many cancers, there are warning signs
and symptoms and the benefits of early detection are thus indisputable.
So it is important for individuals, communities, health professionals
and policy makers to be aware of, and educated in recognising the signs
and symptoms for cancer (where possible).
Q. How does one evaluate the success of an early detection
program?
A. The success of early detection programs, can be measured by
a reduction in the stage of the cancer at diagnosis with earlier
diagnosis associated with a reduction in the risk of dying from cancer.
Q. What is the 3rd
A. Myth 3, is that there is nothing one can do about cancer.
Whereas the truth is that there is a lot that can be done at an
individual, community and policy level, and with the right strategies, a
third of the most common cancers can be prevented.
Hence the implementation of policies and programs that support a
life-course approach to prevention, and strengthen the capacity of
individuals to adopt healthy lifestyles choices can bring about
behavioural change, which can help prevent cancer, must be encouraged.
Q. According to the WHO prevention is also the most cost
effective way to reduce the cancer burden.
A. Prevention is the most cost-effective and sustainable way
of reducing the global cancer burden in the long-term. Effective cancer
prevention at the national level begins with a National Cancer Control
Plan (NCCP) that responds to a country’s cancer burden and cancer risk
factor prevalence. NCCPs should include evidence- based
resource-appropriate policies and programs, that reduce the level of
exposure to risk factors for cancer and strengthen the capacity of
individuals to adopt lifestyle choices that promote good health for
life.
Q. What are the other myths?
A. Myth 4 is that some cancer patients believe they don't have
the right to cancer care. The truth however is that all people have the
right to access proven and effective cancer treatments and services on
equal terms, and without suffering hardship as a consequence.
The Universal Declaration of Human Rights has clearly stated that,
“Access to cancer care is a matter of social justice. The enjoyment of
the highest attainable standard of health is one of the fundamental
rights of every human being”.
Q. How does the Health Ministry ensure that right?
A. We maintain that cost-effective interventions must be made
available in an equitable manner through access to information and
education about cancer at the primary health care level, as well as
early detection programs and affordable, quality medicines, vaccines and
technologies, delivered as part of national cancer control plans.
Social protection measures, including universal health coverage, are
essential to ensure that all individuals and families have full access
to healthcare and opportunities to prevent and control cancer.
The body can use its own defences to attack pancreatic cancer
A possible new method for treating pancreatic cancer which enables
the body's immune system to attack and kill cancer cells has been
developed by researchers.
The method uses a drug which breaks down the protective barrier
surrounding pancreatic cancer tumours, enabling cancer-attacking T cells
to get through.
The drug is used in combination with an antibody that blocks a second
target, which improves the activity of these T cells.
 Initial tests of the combined treatment, carried out by researchers
at the University's Cancer Research UK Cambridge Institute, resulted in
almost complete elimination of cancer cells in one week. The findings,
reported in PNAS , mark the first time this has been achieved in any
pancreatic cancer model. In addition to pancreatic cancer, the approach
could potentially be used in other types of solid tumour cancers.
Pancreatic cancer is the fifth most common cause of cancer-related
death in the UK and the eighth most common worldwide. It affects men and
women equally, and is more common in people over the age of 60.
As it has very few symptoms in its early stages, pancreatic cancer is
usually only diagnosed once it is relatively advanced, and prognosis is
poor: for all stages combined, the one and five-year survival rates are
25 percent and 26 percent respectively. Tumour removal is the most
effective treatment, but it is suitable for just one in five patients.
Immunotherapy - stimulating the immune system to attack cancer cells
- is a promising therapy for several types of solid tumours, but
patients with pancreatic cancer have not responded to this approach,
perhaps because the human form of the cancer, as in animal models, also
creates a protective barrier around itself.
The research, led by Prof Douglas Fearon, determined that this
barrier is created by a chemokine protein, CXCL12, which is produced by
a specialised kind of connective tissue cell, called a
carcinoma-associated fibroblast, or CAF.
The CXCL12 protein then coats the cancer cells where it acts as a
biological shield that keeps T cells away. The effect of the shield was
overcome by using a drug that specifically prevents the T cells from
interacting with CXCL12.
“We observed that T cells were absent from the part of the tumour
containing the cancer cells that were coated with chemokine, and the
principal source of the chemokine was the CAFs,” said Prof Fearon.
“Interestingly, depleting the CAFs from the pancreatic cancer had a
similar effect of allowing immune control of the tumour growth.”
The drug used by the researchers was AMD3100, also known as
Plerixafor, which blocks CXCR4, the receptor on the T cells for CXCL12,
enabling T cells to reach and kill the cancer cells in pancreatic cancer
models.
When used in combination with anti-PD-L1, an immunotherapeutic
antibody which enhances the activation of the T cells, the number of
cancer cells and the volume of the tumour were greatly diminished.
Following combined treatment for one week, the residual tumour was
composed only of pre-malignant cells and inflammatory cells.
“By enabling the body to use its own defences to attack cancer, this
approach has the potential to greatly improve treatment of solid
tumours,” said Prof Fearon.
- medicalxpress
X-ray laser maps become important drug target
Researchers have used one of the brightest X-ray sources on the
planet to map the 3-D structure of an important cellular gatekeeper
known as a G protein-coupled receptor, or GPCR, in a more natural state
than possible before.
The new technique is a major advance in exploring GPCRs, a vast,
hard-to-study family of proteins that plays a key role in human health
and is targeted by an estimated 40 percent of modern medicines.
 The research is also a leap forward for structural biology
experiments at LCLS, which has opened up many new avenues for exploring
the molecular world since its launch in 2009.
“For the first time we have a room-temperature, high-resolution
structure of one of the most difficult to study but medically important
families of membrane proteins,” said Vadim Cherezov, a pioneer in GPCR
research at The Scripps Research Institute who led the experiment.
“And we have validated this new method so that it can be confidently
used for solving new structures.”
In the experiment, researchers examined the human serotonin receptor,
which plays a role in learning, mood and sleep and is the target of
drugs that combat obesity, depression and migraines.
The scientists prepared crystallised samples of the receptor in a
fatty gel that mimics its environment in the cell.
With a newly designed injection system, they streamed the gel into
the path of the LCLS X-ray pulses, which hit the crystals and produced
patterns used to reconstruct a high-resolution, 3-D model of the
receptor.
This illustration shows a man suffering from a migraine, overlain
with a rendering of the human serotonin receptor bound to ergotamine, an
anti-migraine drug. Also shown is a rendering of a neuron network.
Scientists used SLAC's Linac Coherent Light Source X-ray laser to
explore crystallised samples of the serotonin receptor, which is a type
of G protein-coupled receptor.
GPCRs regulate many important functions in human physiology;
serotonin, for example, is a neurotransmitter that regulates mood,
appetite and sleep. The method eliminates one of the biggest hurdles in
the study of GPCRs: They are notoriously difficult to crystallise in the
large sizes needed for conventional X-ray studies at synchrotrons.
Because LCLS is millions of times brighter than the most powerful
synchrotrons and produces ultrafast snapshots, it allows researchers to
use tiny crystals and collect data in the instant before any damage sets
in.
As a bonus, the samples do not have to be frozen to protect them from
X-ray damage, and can be examined in a more natural state.
“This is one of the niches that LCLS is perfect for,” said SLAC Staff
Scientist Sébastien Boutet, a co-author of the report. “With really
challenging proteins like this you often need years to develop crystals
that are large enough to study at synchrotron X-ray facilities.”
- MNT
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