Battling the Big C

Cancer continues to remain one of the leading causes for morbidity and mortality despite many advances in the recent past by way of detection and treatment. Yet, the surge in cancer patients and caring for them in state hospitals has put a huge economic strain on the State’s limited resources. Thus the shift now is towards preventing cancer and early detection

Spearheading the move towards a cancer free society in Sri Lanka is the National Cancer Control Programme (NCCP) of the Ministry of Health, Nutrition & Indigenous Medicine. Here Sunday Observer speaks to Consultant Community Physician at the NCCP, Dr. Suraj Perera, about cancer prevention and the NCCP goals.

Q: February 4 is World Cancer Day. What is its significance globally and in Sri Lanka?

A: World Cancer Day brings together a wide spectrum of organisations whose goal is to prevent cancer, detect cancer early, uplift the lives of cancer patients and enable them to live out their remaining years comfortably and with dignity.

7 warning signals of cancer

1) A change in bowel or bladder habits
2) A sore that does not heal
3) Unusual bleeding or discharge
4) Thickening or a lump in the breast or elsewhere
5) Indigestion or difficulty in swallowing.
6) Obvious change in a wart or mole
7) Nagging cough or hoarseness

Q: Cancer is still widely prevalent in Sri Lanka, despite the many interventions by the Health Ministry to halt this frightening trend. What are the reasons for this surge in cancer cases?

A: This high incidence of cancer among both men and women on a global scale is largely due to increasing of unhealthy life styles and unhealthy environment. In addition, ageing populations, improvement of screening and diagnostic facilities, and availability of cancer treatment facilities along with increased awareness raising and improved information systems have contributed to the increase incidence of cancers. Delay in obtaining treatment is also a significant issue. Often reasons underlying this reluctance to consult a physician despite obvious signs of cancer symptoms, is linked to fear of undergoing surgery, and anxieties regarding loss of employment, especially when the patient is the sole breadwinner.

A: The NCCP is the national focal point for prevention and control of cancers in the country. It is also responsible for policy, advocacy, monitoring and evaluation of prevention and control of cancers and conducting surveillance of cancers and facilitating research related to cancer. The NCCP coordinates with all cancer treatment centres, national level institutes (E.g. Family Health Bureau, Directorate of Non Communicable Diseases) and Provincial Health Ministries to implement cancer control activities in Sri Lanka.

A: If we consider all cancers in general, one third of them can be prevented through healthy lifestyles and keeping the environment healthy. Therefore national level advocacy programs, awareness programs are conducted in partnership with health and non health sectors including religious dignitaries, Ministry of Education, civil society and organisations. Media campaigns, development of health education material on healthy lifestyles, awareness programmes for religious dignitaries, and training of trainer (TOT) programs for school teachers are some of the activities that were coordinated by NCCP. Leadership of religious dignitaries to promote healthy lifestyles is worthwhile to mention. Additionally, the NCCP collaborates with the Non Communicable Diseases unit of Ministry of Health to promote healthy lifestyles through island wide awareness programs, under the leadership of Regional Director of Health Services (RDHS) at district level, while Medical Officers Non Communicable Diseases (MO/NCD) coordinate activities at health institutional level and (MOH) at area level who conduct healthy lifestyle programs islandwide.

A: The NCCP also conducts a National Cancer Early Detection Clinic at Narahenpita, Colombo 5, which operates from Monday to Friday from 8.30 a.m.to 4.00 p.m. Teaching about self breast examination, conducting clinical breast examination and mammographic evaluation for breast cancer early detection, pap smear examination followed by colposcopic evaluation by a consultant gynaecologist for cervical cancer, oral examination by a dental surgeon for early detection of oral cancer and medical examination for other cancers through actively looking for early warning symptoms and signs are the early detection services available at the clinic. Additionally, services for early detection and diagnosis of cancers are evolving throughout the country through Well Women Clinics, Dental Clinics, Breast Clinics and other facilities at secondary (Base & District General Hospitals) and tertiary care hospitals ( Provincial General & Teaching Hospitals). The Family Health Bureau of Ministry of Health is co-ordinating the Well Woman programme nationally and we have about 983 Well Woman Clinics (WWC) functioning countrywide. Married females above the age of 35 are invited initially to the WWC. Teaching self breast examination and conducting clinical breast examination for breast cancer, Pap smear testing for cervical cancer are the services offered at the WWC. These clinics are conducted at MOH level and additional mobile clinics at community and work place based settings can be arranged through the area MOH office. Special breast clinics are conducted at tertiary care hospitals (National Hospital, National Cancer Institute Maharagama, and Teaching Hospitals, Kandy, and Kurunegala) for females with breast problems.

A: All out patient dental clinics throughout the country are offering the services for early detection of oral cancers at the pre cancerous level called Oral Potentially Malignant Disorders (OPMD).

Therefore those who chew betel or areca nut packets (e.g. babul, beeda), smoke or consume alcohol should go to a dental clinic for proper oral examination.

Burden of cancers in Sri Lanka

* The number of cancer patients since 2008 has zoomed according to the Cancer Registry. From 11,163 newly diagnosed patients in 2008, there were 13,890 new patients last year (2015).

*In Sri Lanka the overall crude incidence rate of cancer was 82.6 per 100,000 population in 2009 according to the National Cancer Registry published by the NCCP. .

Oral cancer is the leading cancer among males. All leading male cancers can be prevented through healthy life style practices. The five leading cancer types among males are oral, lung, oesophagus, colon and lymphoma.

* Breast Cancer is the leading cancer among women. The five leading cancer sites among women were breast, uterine cervix, thyroid gland, ovary and oesophagus.

* Number of cancer deaths in 2009- 11,286 with crude annual cancer death rate per 100,000 population being 55.2%

A: Yes. If they come to any of our government health facilities for advice on prevention (Healthy Life Style Clinics), early detection (Well Women Clinics and Dental Clinics throughout the country, Breast Clinics at main hospitals & Cancer Early Detection Centre at Narahenpita) and treatment (National Cancer Institute Maharagama, and provincial cancer centres) our services are free of charge.

Q: Are you funded entirely by the Sri Lankan Government or do you have foreign donors?

A: Major funding source is the annual Ministry of Health budgetary allocation. In addition NCCP activities are supported by the World Health Organisation (WHO) Country Office Biennium. Some activities are supported through World Bank funds. In addition, International Agency for Research on Cancer (IARC) of WHO also provides technical support.

The NCCP is further supported by the joint programme of WHO, International Atomic Energy Authority (IAEA) called Programme of Action for Cancer Therapy (PACT) for improving facilities for cancer care and capacity building.

Also the Cancer Early Detection Centre is a joint project of Rotary Club of Colombo and other partners.

We can, I can

The World Cancer Day theme, ‘We Can, I Can’ highlights the importance of collective and individual actions to reduce the global burden of cancer. This theme will continue for three years emphasising the importance of community, family and individual interventions for all aspects of cancer control including primary prevention, early detection, prompt treatment, palliative and supportive care.

A: On December 29, 2015, Minister of Health, Nutrition & Indigenous Medicine (www.nccp.health.lk), launched the National Policy & Strategic Framework on Cancer Prevention & Control Its vision - ‘A country with a low incidence of preventable cancers and high survival rates with good quality of life and minimal disabilities & suffering from effects of cancers.

A: The Health Ministry has already initiated several strategies to combat cancer by involving as many organisations in the central and provincial health sectors as well as civil society and the community. Currently we are carrying out national level awareness programmes coordinated by provincial and district ministries of health .Awareness programmes are conducted for health staff, civil society organisations, volunteers, school teachers, staff in government and private sector including garment factories as well as the estate sector.

We also have education programmes on primary prevention of cancer and early detection at routine clinics in hospitals and MOH clinics.

We are also strengthening activities relating to early detection of cancer at our Well Woman Clinics and other health facilities. The Ministry is also working through community groups to raise more awareness on cancer, and overcome prejudice and superstitions that surround the disease.

A: Currently NCCP is situated at Narahenpita, Colombo 5. Administrative units, Technical units are located at the ground floor of the Public Health Complex. A Central Cancer Early Detection Centre is located at a separate private building, which is rented by the Rotary Club of Colombo at Narahenpita.

For further enquiry: contact National Cancer Control Programme. Contact Number: 0112 368627