The Brunei Cancer Centre, Pantai Jerudong Specialist Centre
World Cancer Day is celebrated every February 4, and the hashtag from 2019 to 2021 is ‘#I am and I will’.
It is an empowering call to action urging personal commitment. It urges the individual to inspire change and mobilise action.
For example, if you are a student, what can you do? Yes, even a student has a part to play. You can stop smoking, eat healthy, do more exercises and learn more about cancer. Spread the word, join the action, show up for an event, volunteer to help. Help a friend who is ill or convince a friend to give up smoking. As a parent, you can change and choose healthy foods to cook and buy. Set an example for your children by choosing healthy foods, living a healthy lifestyle and lead a less sedentary lives.
Who should be involved in this fight? You could be a cancer survivor, a co-worker, a friend, a parent, a leader, a healthcare worker, or a teacher or student. You have the power to act. Many of us are touched by cancer and have experiences to share. This will make a difference.
This year is the 20th anniversary of World Cancer Day. It is an initiative of UICC (Union for International Cancer Control), which is an NGO and is the largest and oldest international cancer organisation, founded in 1933 at Geneva, Switzerland to fight cancer. It has 1,150 member organisations, in 173 countries, including Brunei Darussalam as a member country.
Its aims include: to save millions of preventable cancer deaths each year; to raise awareness and education about cancer; and to press individuals and governments to take action.
The theme ‘#I am and I will’, wants the individual and policymakers to choose healthy lifestyles, emphasises early detection, achieve quality treatment for all and maximise quality of life.
In Brunei Darussalam, cancer has been the number one killer for the past few years. Every year about 800 cancer cases are diagnosed. The most common cancers here are colorectal, breast, lung, stomach, gynaecological (cervix, uterine, ovarian), prostate, lymphomas, nasopharngeal, thyroid, skin and oral cancers.
Colorectal and breast cancers form over 25 per cent of the cancers. But unfortunately, over 30 per cent of the cases are in the more advanced stages – Stage 3 and 4 – and more difficult to cure, in spite of the most modern drugs and modalities of treatment. We are also seeing younger patients affected.
The key messages are: one third of cancers are preventable; another one third of cancers cancer can be cured with early detection – Stage 1 cancers have greater than 95 per cent chance of cure; getting good quality of treatment is important, which includes proper surgery, and if need be additional chemotherapy or radiotherapy, or targetted drugs; do not be carried away by misleading promises of “cure”, by some media, websites offering alternative treatments.
There are a number of cancer risk factors. One is smoking. Tobacco use causes at least 15 different types of cancers, including lung, oral cancers, bowel, stomach, liver and leukemias. Seventy-one per cent of lung cancers are caused by smoking. By stopping this single risk factor, you can prevent nearly one third of cancers. Quitting at any age still makes a difference.
Another risk factor is alcohol, which is also linked to several cancers including mouth, pharynx, liver and pancreas.
Other cancer risk factors include: work place hazards – dyes, asbestos, pollution; UV irradiation – related to skin cancers; certain viral and bacterial infections – getting vaccinated against Hepatitis B and HPV can help reduce liver cancers and cervical cancers; environmental pollution; diet – processed food and increased red meat intake increases cancer risk, and one needs to increase dietary fibre, vegetables and fruit intake; obesity – increases the risk of a few cancers; and regular exercise helps to reduce cancer risk.
There are many myths and misconceptions that need to be dispelled. The stigma associated with cancer need to be lifted.
One of the common myths or fears about cancer are that it is a “death sentence” and there is no cure. This is false. Many cancers detected early are cured. Even in advanced Stage 4 cancers, many patients lead a good quality of life for over five years and some 10 years.
Other common myth or fears about cancer are: that it is a “curse” put on you, and that one should seek alternative treatment – many of these may delay potential early treatment; that you should not talk about it and that it is a taboo subject – this is not true, and seeking help early can cure you; cancer is contagious – not true; that many cancer treatments make your disease worse and kill you – many treatments including chemotherapy and radiotherapy do have side effects, but with it you reduce the chance of disease relapse and in some cancers chemotherapy can cure your disease.
What can we do? As an individual, learn more about cancer and the risk factors – take steps to reduce risk factors. Health professionals need to understand the disease better, to aim for early screening and appropriate referrals for early diagnosis. Policymakers – increase public education of risk factors and instill importance of early detection; ensure quality healthcare for all; and instil healthy work place environments.
In Brunei Darussalam, under the Government of His Majesty Sultan Haji Hassanal Bolkiah Mu’izzaddin Waddaulah ibni Al-Marhum Sultan Haji Omar ‘Ali Saifuddien Sa’adul Khairi Waddien, Sultan and Yang Di-Pertuan of Brunei Darussalam, healthcare has been provided for the residents. Steps taken by the Ministry of Health, and Health Promotion Centre include: tobacco control, to reduce smoking; Health Promotion programmes to raise awareness of cancers and other non-communicable diseases (NCDs); early detection – the launching of National Breast Cancer and Colorectal screening programmes recently, and the launching of the Early Detection and Cancer Prevention Unit at Pantai Jerudong Specialist Centre (PJSC), as well as the availability of Pap smears for early detection of cervix cancer; advising lifestyle changes to reduce obesity and diet advices; vaccinations like Hepatitis B and HPV to prevent liver and cervix cancers respectively; reduce availability of alcohol; and treatment facilities easily available, with surgical, radiology and diagnostic pathology services at the main hospitals, and oncological and radiotherapy services, nuclear imaging at PJSC.
PJSC is made up of three centres of excellence – The Brunei Cancer Centre (TBCC), the Brunei Neuroscience Stroke and Rehabilitation Centre (BNSRC), and Maxillofacial, Facial Plastic and Reconstructive Surgery Centre (MFPRSC), all working together to fight cancer.
The Brunei Cancer Centre is made up of Medical Oncology and Palliative units, Radiotherapy Unit, Nuclear Medicine Unit, Cancer Detection and Cancer Prevention Services. The Medical Oncology Unit sees about 450 new referral of cancer cases a year and the outpatient clinic sees over 11,000 patients a year. Daily, over 35 patients undergo chemotherapy at the Day Care Cancer Unit under the care of specialised staff. The radiotherapy unit also gets over 400 cases a year referred for radiotherapy.
The Nuclear Medicine Unit since its inception has also seen an increase of bone scans, thyroid scans and PET-CT scans over the past two years.
The Early Detection and Cancer Prevention Unit since its launch last year will be seeing an increase of referrals.
The important message is that the individual needs to take the first step towards reducing cancer risk factors, and to seek early detection. The next step will be to seek appropriate treatment and not be misguided by false claims.
The individual also needs to educate himself more about cancer and its risk factors. Cancer deaths can be reduced by 75 per cent in coming decades with improving public education and making available proper diagnostic and treatment facilities available for all.