Revision as of 14:39, 24 September 2017

Estimated incidence and prevalence of cancer cases, state-wise, 2014; Graphic courtesy: The Times of India, Decemebr 8, 2015

Vitamin C: helpful to treat cancer

From the archives of The Times of India: 2008

Vitamin C might be useful to treat cancer after all, according to a US study in which injections of high doses of it greatly reduced the rate of tumor growth in mice. The idea that vitamin C, also known as ascorbic acid, could be used to treat cancer was advanced in the 1970s by American scientist Linus Pauling, who awarded the Nobel Prize in chemistry in 1954. The notion was controversial and subsequent studies failed to show a benefit. But those studies involved vitamin C given orally. The new study involved injections of vitamin C to enable greater concentrations of it to get into the system. The researchers implanted three types of aggressive cancer cells into laboratory mice — ovarian, pancreatic and glioblastoma brain tumors.

Extent and gender divide: 2012

Cancer strikes more Indian women, but kills more men

Malathy Iyer The Times of India Feb 04 2015 Mumbai

Extent and gender divide: 2012

More Indian women than men are diagnosed with cancer every year. It is reflected in insurance statistics that show more women in our cities claim medical insurance for cancer treatment. Blame it on physiology or the stereotypical image of an Indian woman who chooses to ignore her symptoms for long, but fact is the Big C exhibits a clear gender divide.

But when it comes to cancer-related fatalities, the figures turn upside down: more men die of cancer annually than women.

In all, 5.37 lakh Indian women were diagnosed with cancer in 2012 as against 4.77 lakh men, according to the World Cancer Report. The same year, 3.56 lakh men died of the disease in comparison to 3.26 lakh women.

In the past four years, 62-65%of cancer-related insurance claims were for women while the figure for men was only 35-38%, according to data released by private insurance firm ICICI Lombard. The claims were more for cancers of the cervix and breast, which are, according to the Indian cancer registry, the leading cancer types among women.

The main reasons for the gender divide in cancer are hormones and habits. “Physiologically, women’s cells are exposed to more hormones and more hormonal fluctuations, leading to an increased susceptibility of cell dysplasia (abnormality),” said Dr Boman Dhabar, medical oncologist with Wockhardt Hospital in Mumbai Central.

He believes “oppression of Indian women” leads them to neglect their own health. “There are also socio-economic reasons such as lack of hygiene and toilets that lead to an increased incidence of cervical cancer,” said Dr Dhabar.

Dr Surendra Shastri, who heads the preventive oncology department of Tata Memorial Hospital, had another reason. “There is an increase in the incidence of lifestyle-related cancers, for example breast cancer and ovarian cancer. Moreover, better awareness and detection rates have contributed to the increasing numbers of cancer in women in India.” His colleague Dr Rajesh Dikshit, who heads the epidemiology department, pointed out that if incidences of breast and cervical cancers are removed, women have a very low and almost negligible incidence of cancer in comparison to men.

“Claims from men are usually limited to oral cavity and lungs, where the root causes are tobacco and occupational exposure to hazardous material such as asbestos and silica. We find men who suffer from these cancers come from classes that primarily stay away from taking any health insurance,” said Amit Bhandari of ICICI Lombard.

Interestingly, data for 2014 from Metropolis Healthcare, a chain of laboratories, shows how different cancer rates are among men and women (see box). Dr Kirti Chadha from Metropolis India said of the 1,151 samples that tested positive for cancer in Mumbai, 214 were of breast cancer alone. “Breast cancer is the most common or largest cancer in our country.

This is our finding from each of our laboratories across the country,” she added. There is an age difference pattern too in cancer’s gender bias. “If you look at age-wise cancer incidence, the peak period for women is 60 while for men it is 70,”said Dikshit.

A 2006 paper from Duke University in US titled, ‘Difference between male and female cancer incidence rates: How can it be explained?”, said the peak of hormonal imbalance in women is between 45 and 55, when the reproductive system ultimately stops functioning. In males, this peak is shifted to 55 and 65.

"Global Burden of Cancer"-2013

The Times of India May 29 2015

Sushmi Dey

Deaths in India from the disease have gone up by 60%

Cancer is the 2nd biggest killer

Cancer has emerged as the second-leading cause of death globally after cardiovascular diseases.Proportion of deaths due to cancer around the world increased from 12% in 1990 to 15% in 2013 while the number of new cases almost doubled in India during the period. In India, deaths from the disease have increased by 60%, according to the latest report `Global Burden of Cancer-2013', released worldwide.

“Even if we adjust for the rise in population in India over this period, the new cancer cases have increased by 30% per unit population and deaths have risen by 10%,“ says Lalit Dandona, co-author of the study and Professor at the Public Health Foundation of India and Institute for Health Metrics and Evaluation.

In 2013, there were 14.9 million new cancer cases regis tered globally, whereas 8.2 million people died due to the disease. The report is based on a global study of 28 cancer groups in 188 countries by a consortium of international re searchers from University of Washington and Institute of Health Metrics and Evaluation.

The report suggests that new cases of virtually all types of cancer are rising in countries globally -regardless of income -but the death rates from cancer are falling in many countries primarily due to prevention and treatment. However, it says there is a threat of increasing incidence in developing countries due to ill-equipped health systems.

While incidence of breast cancer is highest in India as well as globally, most number of cancer deaths in India are caused due to stomach cancer, which is globally the second most common reason for death.

Chemical in toiletry items causing breast cancer

[ From the archives of the Times of India]

Found in make-up, toothpastes & also food products

Scientists say they have discovered a chemical, used in daily toiletry products and food products, in tumours of 40 breast cancer patients, but allayed fears by claiming that further probe is needed. A team at the University of Reading claims the chemical compound, called parabens, was spotted in the tissue samples of the 40 women undergoing mastectomies between 2005 and 2008 for first primary breast cancer in the UK. Parabens possess oestrogenic properties. Oestrogen is known to play a central role in the development, growth and progression of breast cancer.

Parabens are found in moisturisers, make-up, shaving foam, tanning lotions and toothpaste, as also used in processed meats such as sausages, pies and pastries along with other savoury snacks. For the study, altogether 160 samples were collected, four from each woman. The scientists found 99% of the tissue samples contained at least one paraben and 60 per cent of the samples had five, the ‘Daily Mail’ reported.

The team found women who didn’t use underarm deodorants still had measurable parabens in their tissue, suggesting they must enter the breast from other sources. Dr Philippa Darbre, who led the team, said: “The fact that parabens were detected in the majority of the breast tissue samples cannot be taken to imply that they actually caused breast cancer in the 40 women studied. However, the fact that parabens were present in so many of the breast tissue samples does justify further investigation.” Added co-author Lester Barr from the University Hospital of South Manchester: “Our study appears to confirm the view that there is no simple cause and effect relationship between parabens in underarm products and breast cancer.” PTI

Lung cancer: Delhi

The Times of India, Feb 04 2016

DurgeshNandan Jha

20% of Delhi's lung cancer patients non-smokers: Docs  In what could be an alarming fallout of air pollution, top oncologists say they have noted a significant rise in lung cancer among non-smokers. Roughly one in every five persons diagnosed with the disease does not smoke.

Delhi Cancer Registry data shows lung cancer cases ta shows lung cancer cases have been increasing among women too -from 4.2 cases per 1,00,000 population in 2008 to 4.6 in 2010. DCR, which compiles data from all big hospitals in Delhi, is yet to release data beyond 2010.

While the data is based on cases in Delhi, doctors said it represents a wider trend because a significant number of cancer patients being treated in hospitals are from outside.

In 2013, the International Agency for Research on Cancer (IARC), the specialised cancer agency of the World Health Organisation (WHO), classified outdoor air pollution as carcinogenic. It issued a statement saying there was sufficient evidence that exposure to outdoor air pollution causes lung cancer and increases risk of bladder cancer.

Particulate Matter (PM), a major component of outdoor air pollution, was evaluated separately and also classified as carcinogenic by IARC the same year. “The predominant sources of outdoor air pollution are transportation, power generation, industrial and agricultural emissions, and residential heating and cooking,“ the IARC stated.

Hair loss

Jyoti Shelar, Jan 19, 2017: The Hindu

Scalp cooler and its functions in brief; Jyoti Shelar, Jan 19, 2017: The Hindu

Tata Memorial begins clinical trials to beat chemotherapy hair loss

The Tata Memorial Hospital (TMH), Parel has started a clinical trial using technology to minimise hair loss due to chemotherapy. The initiative, the first such in India, is expected to address the loss of self-esteem and confidence that many cancer patients, especially women, face and reduce cancer-related trauma.

The trial, which involves four breast cancer patients initially, uses a scalp cooling technique to restrict chemotherapy medication from reaching the scalp, thus reducing hair fall. The machine has two scalp coolers, which are essentially specialised inner silicon caps containing coolants at temperatures of up to minus four degrees centigrade. The technique is widely used in the U.K. and the machine hase been brought to India free of cost.

The machine circulates the coolant in the caps, reducing its temperature and consequently blood supply to the scalp. As chemotherapy medication is given intravenously and circulated through the blood, the scalp gets less blood and thus less of the medication.

The trial is being headed by Dr. Jyoti Bajpai, associate professor, Department of Medical Oncology, TMH. She says chemotherapy medication works best on fast-dividing cells. Since cancer cells divide rapidly, the medicines attack those cells, but other cells like those in the blood, mucosal lining and hair follicles also come under attack.

“This is why patients suffer from reduced blood count, mouth ulcers and hair loss during chemotherapy. But of all the side-effects, hair loss has the worst impact on women. The fear of cancer becomes secondary and the fact that they will lose hair during treatment takes centrestage,” adds Dr. Bajpai.

Doctors grade chemotherapy-induced alopecia, or baldness, in three stages: Grade 0 for no hair fall, Grade 1 for less than 50 per cent hair fall and Grade 2 for more than 50 per cent hair fall (patients need a wig or head scarf). While hair loss starts soon after the first cycle of chemotherapy, there is none in a few cases.

“Through the trial, we are aiming at 50 to 70 per cent hair preservation. In Grade 1, women still feel confident as they are able to mask their scalp with the hair. We want to avoid the Grade 2 stage,” says Dr. Bajpai. The most common side-effects of using scalp coolers are headache and cold, but so far, none of the participants have reported these to be unbearable. The participants feel hair loss is a continuous reminder of the cancer and puts them in focus in a crowd.

Women participating in the trial will begin using the scalp cooler 30 minutes before starting chemotherapy and continue for an hour to 90 minutes after it has been completed. Doctors are maintaining pictorial records to evaluate the scalp cooler’s effect during every cycle. Trial subjects are asked to wash their hair well and not use hair oil on chemotherapy day, and their hair is covered with conditioner before the cap is put on.

The randomised trial, to be conducted over a year, has two arms: one with 34 patients who will be put on scalp coolers, and the other with 17 patients who will not be using the machine. All participants will start the trial from the first chemotherapy cycle. “We are taking non-metastatic patients in whom the cancer hasn’t spread. Also, to maintain uniformity, we have taken patients who are on Taxane- and Anthracycline-based chemotherapy,” Dr. Bajpai says. She adds that usually, patients are administered chemotherapy in two phases: four cycles of Anthracycline-based treatment before surgery and four three-weekly cycles or 12 weekly cycles of Taxane-based medication after surgery.

Dr. Bajpai cites the example of a 35-year-old woman who delayed cancer treatment as she did not want to suffer hair loss. “Another woman from Uttar Pradesh in her fifties was thrown out of her house by her husband and in-laws because of her baldness. Her teenaged daughters were also asked to leave with her. The family considered her disease and baldness to be an outcome of past sins,” she said, adding misconceptions and stigma attached to hair loss are worrying. “Women associate their femininity with hair. It becomes difficult to explain that the hair loss is temporary. Hopefully, such women will be benefited if our trial shows promise.”

2016

Childhood cancer campaign

The Times of India, Sep 23, 2016

Aditya Dev

Cancer awareness programme held at Taj on September 25-27

In a unique initiative, "CanKids..Kidscan", a national society for change for childhood cancer in India, has joined hands with the Archaeological Survey of India (ASI) and UP government to hold an exhibition at the Taj Mahal from September 25 to 27. The exhibition is a part of the NGO's 'Go Gold India - Taj Goes Gold and UP Goes Gold campaign', aimed at spreading awareness about childhood cancer.

Earlier the organizers had requested the ASI to lit up the Taj "gold" for this event on the lines of several monuments and installations in many parts of the world turned gold in September 2015 to express their solidarity with childhood cancer awareness, but there being a Supreme Court order against holding any such activity within the Taj's premises, ASI collaborated with them to hold an exhibition at the monument instead.

ASI superintending archaeologist Bhuvan Vikrama said, "The exhibition will be held near the Royal gate of the monument. Our team will also be there and spread awareness about the cause." A spokesperson of the NGO told TOI that it would be the first time that such a cause related exhibition held at the Taj Mahal.

During the three-day exhibition, Taj Mahal replicas decorated by children with cancer at 35 participating cancer centers. In addition to that 'I Deserve' competition posters, where children have expressed their demands, and wished for better treatment and care, right to education, clean environment, play school in the hospital ward, no restriction on their movement and most importantly their childhood will be displayed. As many as 10 best pledge books (in which 2,50,000 signatures from across India, to make childhood cancer a health priority) will also be on display.

The spokesperson of the NGO said, "The aim of the exhibition will be to raise awareness about childhood cancer and gold as the colour of childhood cancer. We will also raise funds for children with cancer, survivors and their families and seek Central and state governments support for childhood cancer to be distinct part of cancer control plans, policy and programs and a child health priority in India."

Women- related cancers

2017

Sushmi Dey, India has 3rd highest no. of cancer cases among women, September 24, 2017: The Times of India

Cancer cases as well as mortality are increasing rapidly among Indian women, primarily because of low awareness and late detection. India accounts for the third highest number of cancer cases among women after China and the US, gro wing annually at 4.5-5%, new data shows.

According to a report `Call for Action: Expanding cancer care for women in India, 2017', cancer among women in India is estimated at 0.7 million. However, the real incidence is much more -between 1 and 1.4 million per year as many cases go undi agnosed or unreported.

India also ranks among the top two countries globally on mortality for key women-specific cancers. Data shows cervical and breast cancer mortality rates in India are 1.6 to 1.7 times higher than maternal mortality. It highlightes the significantly adverse mortality rates for women-specific cancers in the country . India topped the list for mortality for breast and cervical cancers and reported the second highest incidence for ovarian cancer globally .

According to the report, released by E&Y in association with Ficci Flo, in 2015, cancers of the breast (19%), cervix uteri (14%) and ovary (7%) contributed to 40% of all cancer incidence among women with states such as Kerala, Tamil Nadu and Delhi having the highest incidence for these cancers.

“It is alarming that awareness levels of womenrelated cancers is low among the general population and even medical professionals. Despite the established benefits of screening, coverage in India is low for women,“ the report said. India-based studies have confirmed that screening improves early detection of cancers by 1.5-2.5 times. For instance, cancers such as breast and cervical can be cured if detected early and treated adequately .

According to the report, of the 2,000 new women diagnosed with cancer every day , 1,200 are detected in late stages. This reduces fiveyear survival rate by 3 to 17 times for breast and cervical cancer. Late detection also adds to the cost of treatment.Estimates show treatment cost for late-stage cancers is 1.5 to 2 times higher than the cost for early-stage cancers.

In fact, the mortality to incidence ratio, which is a key indicator for measuring effectiveness of national cancer control programmes, is the worst in India for key womenspecific cancers when compared to global peers. Experts say it is imperative to address the menace of growing incidence of cancer among women with urgency and in a holistic manner with due emphasis on prevention, timely diagnosis, effective treatment and palliative care.

The report estimates the economic burden of cancer care treatment to be the high est compared to all other dis eases, with the cost of a sin gle hospitalisation exceed ing the average annual per capita expenditure of more than 60% of the population.

It also projects cancer incidence among women in India to increase from 110 per 1 lakh population to 190-260 per 1lakh population by 2025, which will mirror incidence rates of China and other upper middle income countries such as Brazil and Thailand.

India witnessing further deterioration of key risk factors that contribute to cancer incidence. For instance, while obesity is considered a major contributing factor for cancer, the proportion of overweight women in India grew at twice the global average growth between 2004 and 2014, the report says.