| Danial Norjidi |
WORLD Cancer Day 2019 takes place tomorrow and will highlight the need for urgent action to increase early stage cancer detection, screening, and diagnosis to significantly improve cancer patients’ chances of survival.
According to a press release by the Pantai Jerudong Specialist Centre (PJSC), World Cancer Day led by the Union for International Cancer Control (UICC) will take place under the theme of ‘I Am and I Will’, and aims to inspire action from individuals, the health community and governments to improve public awareness and access to early detection, screening, and diagnosis.
It was shared that 2018 saw more than 18 million new cases of cancer worldwide, of which nearly five million cases of breast, cervical, colorectal, and oral cancers could have been detected sooner and treated more effectively, improving patient survival rates and quality of life.
Majority of cancers are amenable to early detection. When a cancer is detected at an early stage – and when coupled with appropriate treatment – the chance of survival beyond five years is dramatically higher than when detected at a later stage when the tumour has spread, and the disease is more advanced.
In the US, the five-year survival rate for women diagnosed with cervical cancer at the advanced stage is just 15 per cent, compared to 93 per cent if diagnosed when the cancer has not spread. It was shared that this pattern holds even in lower income settings. In India, a study among rural women with cervical cancer found the five-year survival rate to be nine per cent when diagnosed at Stage IV, which soars to 78 per cent when diagnosed at Stage I.
Early diagnosis can also reduce the cost of treatment. It was shared that studies in high-income countries show that treatment costs for early-diagnosed cancer patients are two to four times less expensive than treating those diagnosed with advanced-stage cancer. A US study estimates the national cost savings from early diagnosis at USD26 billion per year. A study of Sub-Saharan Africa and Southeast Asia found early intervention initiatives such as cervical cancer smear tests, colonoscopy screenings, and mammography screenings (combined with treatment) to be “highly cost effective”.
Despite this, millions of cancer cases are found late, leading to expensive and complex treatment options, diminished quality of life, and avoidable deaths. Globally prevalent barriers exist at the individual, health system, and government level, which prevent millions of people all over the world from receiving an early diagnosis and better treatment.
Chief Executive Officer of the UICC Dr Cary Adams said, “This World Cancer Day, we want people to know that many cancers can be managed and even cured, especially if they’re detected and treated as early as possible. By detecting cancer at its earliest stage, we seize the greatest opportunity to prevent millions of avoidable deaths worldwide.”
Another to comment was Medical Director at PJSC cum Director of The Brunei Cancer Centre Dato Seri Laila Jasa Dr Babu Sukumaran. “In Brunei Darussalam, cancer is our number one killer, over the past few years. In line with the UICC message, we would like to spread the message that cancer is potentially a treatable disease, if detected early.”
“In Stage I cancer there can be cure rates of more than 95 per cent in most cancers. Unfortunately, most of our cancers are detected in Stage II and Stage III, and more than 20 per cent are in Stage IV. Disease and cure rates drop to less than 10 per cent in Stage IV. There has been generally a reluctance to come forward for early treatment, due to fear of surgery and chemotherapy, and in some cases patients tend to go for alternative therapy. Some are ill-advised by friends and relatives and these patients later come with advanced disease, and become less fit for surgery, chemotherapy or radiotherapy.”
“In Brunei Darussalam, more than 600 new cases of cancer are diagnosed early and the incidence is increasing. The theme ‘I am and I will’ will inspire all of us into action,” he added.
There are a number of individual-level factors that can affect early detection and screening attendance. Age can largely influence someone’s ability to understand and communicate their early symptoms of cancer, making children particularly vulnerable. However, childhood cancers are generally some of the most highly treatable forms of cancers – 80 per cent of childhood cancers are curable if prompt diagnosis and treatment is given.
It was also shared that masculine gender norms, combined with a broader lack of men’s health promotion, can prevent help-seeking behaviour even when men might suspect cancer early on. The strongest factor associated with men’s help-seeking behaviour has been shown to be the encouragement and support of spouses and family members.
Socioeconomic status can also present barriers to early help seeking. A Danish study found a strong association between a lower level of education and fear of what a doctor might find. Meanwhile, individuals with a higher socioeconomic status (higher education, employed, and with a higher income) anticipated being too busy to seek medical help.
Feelings of shame and fear, combined with poor health awareness and cultural beliefs, can also keep an individual from utilising medical care or screening programmes.
UICC President and mother of a cancer survivor Her Royal Highness Princess Dina Mired said, “Cancer thrives on late presentation of the disease. The delay allows it to spread and cause damage totally unchallenged. That is why, on this World Cancer Day, I urge you all to educate yourselves with the signs and symptoms of cancer and to not be afraid to seek help immediately. Equally, I urge governments to prioritise and systemise early detection and screening programmes to allow for better access and to give all a fighting chance to beat cancer.”
The opportunity to increase awareness among doctors, nurses, and other general and community health practitioners to detect cancer early is there, especially at the primary care level. A study in the UK found that most people present cancer signs or symptoms at the primary care level in the year before their formal cancer diagnosis. However, even when cancer is suspected, weak systems can prevent patients from being referred efficiently for testing and diagnosis, leading to needless delays in treatment.
When suspected cancer patients do get referred for diagnostic testing, limited access to pathology services and diagnostic technologies can hold back health services from delivering early diagnoses and treatment of cancer. This is especially true in low-income countries where there are a large number of late stage diagnoses – 35 per cent of low-income countries reported that pathology services were generally available compared to more than 95 per cent of high-income countries, it was shared.
As part of its flagship Treatment for All initiative, UICC and its over 1,100 member organisations across more than 170 countries are calling on governments to translate their commitments to reduce the cancer burden into national action. It was highlighted that implementing resource-appropriate strategies on prevention, early detection, and treatment, can save up to 3.7 million lives every year.
Also shared were a number of UICC recommendations for governments towards improving early detection, screening and diagnosis, in line with the guidelines set out by the World Health Organization. These recommendations are: implement measures to reduce stigma and improve public awareness of the signs and symptoms of cancer; implement cost-effective population-based screenings and early detection programmes; strengthen national health systems’ referral mechanisms for suspected cancers to facilities providing diagnostic and treatment services; and increase investment in diagnostic capacities.