This year’s World Cancer Day (Feb 4) offers us a message of hope, courage and optimism with its tagline, “Cancer – Not Beyond Us”.
It is also a message of partnership and working together. It tells us simply that if we join forces in the fight against cancer and support the cause in our own individual ways, we can overcome the challenges in beating this disease.
It doesn’t matter how big or small our individual contribution. What matters is our individual commitment and support in conquering this disease.
Historically, the emphasis of cancer control was on how best we could treat or control symptoms. Today, there is a growing trend towards the prevention of cancer. More people are beginning to realise that a large percentage of all cancers are caused by environmental factors that can be controlled, including leading healthy lifestyles, avoiding smoking, regular exercise and eating right.
In many countries, including Malaysia, negative public perceptions and stigma associated with cancer stifle public discussion and perpetuate misconceptions about this disease.
This slows down efforts to raise awareness about cancer prevention, healthy behaviours and seeking early diagnosis for signs and symptoms.
The good news, however, is that we know that at least a third of the most common cancers can be prevented through the reduction of alcohol consumption, healthier diets and improved physical activity levels.
Of the numerous lifestyle factors that cause cancer, tobacco use is the single largest preventable cause of cancer in the world today, according to the World Health Organisation. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries.
Comprehensive strategies, including bans on tobacco advertising and sponsorship, tax increases on tobacco products and smoking cessation programmes, can reduce tobacco consumption.
These initiatives have been shown to effectively decrease the number of cancer deaths, but not all countries have implemented or rigorously enforced these important interventions.
In disadvantaged areas, cancer prevention programmes must go beyond addressing behavioural change, and look to addressing cancer-causing infections.
Several of the most common cancers, such as liver and cervical cancers, are associated with the hepatitis B virus and human papillomavirus (HPV) respectively.
Access to affordable, quality and timely cancer services across all levels of cancer care, is important. The adoption of healthy behaviours early in life reduces the risk of cancer. In this regard, concerted action across all sections of society and at all levels is needed to facilitate prevention policies and programmes that empower individuals to make healthy choices.
To this end, the implementation of a National Cancer Control Plan is vital. An integrated, as well as partnership, approach between the Government and the private sector is essential in developing and implementing evidence-based advocacy policies and preventions, laws and programmes that reduce the level of exposure to risk factors for cancer and make it easier for individuals to adopt healthy lifestyle choices.
Legal and regulatory measures have shown to be effective approaches in reducing exposure to tobacco, alcohol and unhealthy foods, as well as environmental factors.
For instance, tobacco taxation has been identified as the single most important population-wide measure that governments can take to reduce major risk factors for non-communicable diseases (NCDs).
And action must go beyond the health sector to include education, sports, urban planning and agriculture. For example, schools can foster a health-promotion culture by providing healthy meals, facilities for recreation, and include nutrition and physical activity in their respective curricula.
Workplaces and offices can provide a smoke-free environment, healthy food options and smoking cessation tools.
The annual global cost of cancer is US$2.5tril (RM9tril) in 2010. Investing in the prevention of cancer is cheaper than dealing with the consequences. It is estimated that by implementing resource-appropriate strategies for prevention, early detection and treatment, between 2.4 and 2.7 million lives could be saved each year, 80% of them in low- and middle-income countries.
In Malaysia, the Government and the private sector have been investing in health systems that support healthy lives. Looking forward, we need to sustain or increase such investments to make further progress in our fight against cancer.
Awareness is recognised as the first step to early detection and improving cancer outcomes, because with few exceptions, early stage cancers are less lethal and more treatable than late stage cancers.
Recognition of the early warning signs of some cancers is particularly relevant in the context of primary care in non-urban areas – it is cost-effective, and in some cases, does not require any specialist technologies, as is the case with check-ups for oral cancers and clinical breast examinations for breast cancer.
For childhood cancers, equipping primary healthcare workers with the knowledge and tools to recognise the warning signs and symptoms of paediatric cancer is essential to reduce the likelihood of misdiagnosis and ensure prompt referral to specialist medical care.
Ensuring the availability of, and access to, early detection programmes for cancer can significantly reduce the cancer burden in Malaysia.
Early signs and symptoms are not known for all cancers, but for many, including breast, cervical, colorectal, skin, oral and some childhood cancers, the benefits of implementing planned approaches to early detection and care are clear.
Despite the evidence, for many populations, particularly in disadvantaged areas, the value of early detection and the importance of seeking care when symptoms are present are often poorly understood, even among health professionals.
Many communities outside of urban areas face a critical shortage of trained health professionals, which is a key barrier to the delivery of effective quality diagnosis for early detection.
In Malaysia, early detection programmes should aim to improve knowledge of cancer among communities, health professionals and policy makers, and increase awareness around the options for early detection.
Whilst understanding and responding to cultural beliefs and practises are essential, it is equally vital to understand and respond to diagnosis and treatment as well.
Stigma associated with cancer, as well as gender and social inequities, can lead individuals to delay care or to avoid seeking help altogether.
This is where the fight is. The perception of cancer needs to change for there to be action taken.
“Cancer – Not Beyond Us” is not only a rallying cry to governments, but to every individual and community to make the effort to understand and change their perceptions on cancer.
Cancer can be prevented. Cancer can be detected early. Cancer can be treated. You can survive cancer. It is NOT BEYOND US to make that change.
Dr Saunthari Somasundaram is the medical director and president of the National Cancer Society of Malaysia.