February 2014

Cancer of the lung and cervix: A bird’s eye view

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ehealthIn India, approximately 950,000 cases of cancer were reported in 2008, of which the top five were cancers of cervix uteri, breast, oral cavity, ehealthlung and esophagus; which accounted for a total of about 46% of the overall reported cancer cases in India

By Dr Firoz Ahmad  & Dr B R Das

Statistics describing the spread of cancer paint a disheartening picture. Globally an estimated 12 million cases of cancer were reported in 2008, of which the top five most commonly reported cancers were cancers of the lung, breast, colorectal, stomach and prostate which accounted for a total of about 50% of the reported cancer cases world wide. As per statistics put forth by the Globocan 2012 report, cancer of the cervix has been reported as the most common cancer among Indian women accounting for about 22.85% of all cancers and 20.69% of nationwide cancer related deaths. On the other hand, cancer of the lung is the most common cancer among Indian males accounting for about 11.25% of all cancers and 13.65% of all cancer related deaths. On the occasion of World Cancer Day (4th February), it is apt to provide to our readers, a bird’s eye view of two of the most common cancers in India, namely, cancer of the lung and cervix. Lung cancer is associated with a high death rate and individuals above the age of 60 years are highly vulnerable to the disease as compared to their younger counterparts.

• The average 5-year survival for lung cancer is among the poorest of all cancers (16.8%)ehealth
• The existing guidelines recommend no annual screening for cervical cancer either by Cytology test or HPV DNA test (Advanced test which detects the DNA of the causative HPV) before the age of 21 years
• The importance of regular cervical cancer screening needs to be reiterated among women in the age group of 30-55 years

The average 5-year survival for lung cancer is among the poorest of all cancers (16.8%), as the large majority of patients with lung cancer are diagnosed at late stage. Chronic exposure to tobacco smoke remains as one of the major risk factor for causing lung cancer, accounting for 90% of all lung cancers. Radon gas, pollution, toxins, and other factors contribute to the remaining 10%. Clinical studies have demonstrated that smoking cessation notably reduces the risk of lung cancer. Interestingly, death rates from lung cancer have been declining among men since 1984 and among women since 2003. This trend can be attributed to international awareness campaigns regarding the health hazards of tobacco use. The diagnosis of lung cancer can be elusive as symptoms appear only at late stages of the disease. The most common symptoms includes chronic cough, shortness of breath, chest pain, wheezing, weight loss, bone pain etc. Several researchers and cancer organizations recommend people with an increased risk of lung cancer consider annual computerized tomography (CT) scan screening to monitor for the presence of lung cancer. If you’re 55 or older and smoke or used to smoke, talk with your doctor about the benefits lung cancer screening. However, for confirmatory diagnosis, a clinician can order a number of tests (CT scans, repeated X rays for monitoring, lab analysis of the patient’s sputum, checking cells from the patient’s body to detect the disease [cytology], or removing a small piece/bit of the suspected tissue from the patients body to check it under a microscope [tissue biopsy]) to look for cancerous cells and to rule out other conditions. Treatment options typically include one or more treatments, including surgery, chemotherapy, and radiation therapy. In addition, the concept of targeted therapy in lung cancer has gained tremendous attention in recent times– popularly known as personalized medicine- “the right treatment to the right patients at the right time”. Cervical cancer reveals an equally sordid tale. An estimated 132,000 new cases diagnosed and 74,000 deaths annually in India, accounting to nearly 1/3rd of the global cervical cancer deaths. Cervical cancer occurs early and strikes at the productive period of a woman’s life. The incidence rises during 30–34 years of age and peaks at 55–65 years, with a median age of 38 years (age 21–67 years). The human papillomavirus (HPV), a sexually transmitted infection, plays a key role in causing most cases of cervical cancer The adverse effect of HPV infection on a woman’s body is influenced by other factors like individual genetic makeup, environmental exposure, sexual activity; smoking and lifestyle choices. Effective cancer screening has successfully decreased cervical cancer incidence and mortality in various countries. The existing guidelines recommend no annual screening for cervical cancer either by Cytology test or HPV DNA test (Advanced test which detects the DNA of the causative HPV) before the age of 21 years. For women aged 21 to 29 years, screening with cytology alone every 3 years is recommended. Similarly, women aged between 30 to 65 years should be screened with cytology and HPV testing (“cotesting”) every 5 years (preferred) or cytology alone every 3 years (acceptable). In addition to screening, vaccination is also recommended for disease prevention. Currently, two vaccines licensed globally are available in India; Gardasil ™ marketed by Merck) Cervarix ™ marketed by Glaxo Smith Kline. The Indian Academy of Pediatrics Committee on Immunisation (IAPCOI) currently recommends routine vaccination of females aged 11– 12 years with three doses of the HPV vaccine. Vaccination can be given to females as young as 9 years as well as to those aged 13–26 years; who have not previously completed vaccination. Pap testing (simply taking a swab sample from the woman’s cervix and analyzing it in the lab for presence of cancer-like cells) and screening for HPV DNA or HPV antibody before vaccination is not needed. Increased awareness among the common masses regarding the medical hazards of tobacco can play a pivotal role in further curbing the occurrence of lung cancer. Mass media campaigns being aired on national television and in cinema halls issuing warnings against tobacco consumption are great initiatives which have proven instrumental. Similar mass scale campaigns need to be designed and executed at a ground level, for creating cervical cancer awareness too. The importance of regular cervical cancer screening needs to be reiterated among women in the age group of 30-55 years. Pap testing and cytological screening of women in the productive age group can be promoted at a national level as part of a mass surveillance programme. This World Cancer Day, we re-affirm our resolve to continue spreading awareness among the common masses about preventable diseases like lung and cervical cancer. The bottom-line is in tune with the age old maxim of medicine “prevention is always better than cure.”

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