Growing burden of head, neck cancers

Every year, since 1987, the World Health Organisation (WHO) and global partners have been celebrating World No Tobacco Day (WNTD) on May 31. Given the worldwide tobacco epidemic and the growing cases of preventable diseases and deaths it causes, the annual campaign is a significant step in the right direction. And as the world’s third largest tobacco user, India can no longer afford to be non-committal.

A whopping 35% of the adult population in India consumes tobacco — by way of cigarettes, cigars, hookah, gutkha, bidi, khaini — as per the Global Adult Tobacco Survey (2009-10). This is not counting the substantial number of passive smokers.

Studies show that nearly one million new cancer cases are diagnosed in India every year. Of these, about 50% are linked to tobacco use. As per modest estimates by the WHO, tobacco kills more than one million Indians each year.

HNC factor

While myriad factors play critical roles in the global fight against cancer, in India our challenges are often unique. For instance, most people are surprised to know that head and neck cancers (HNCs), not breast cancer, lung cancer, prostate cancer, or cervical cancer, account for almost 40% of India’s cancer burden. Incidentally, 57% of the world’s HNC cases, studies concur, are found in India.

As practitioners in this field, we know that the real incidence is likely to be much higher as many cases of HNC go undiagnosed or unreported. Because there’s little awareness about the disease.

HNCs are, basically, tumours in and around the throat, larynx, nose, sinuses, or mouth. They include cancers of the oral cavity, which are especially common in India due to the widespread use of tobacco. Unfortunately, most patients come in for treatment at advanced stages, when the chances of survival have dropped drastically. Early detection, as is the case with most cancers, is the key to cure.

The general perception is that India lacks the resources to deal with the cancer challenge. However, that’s not really the case. Today, with diagnostic tests such as biopsy, endoscopy, X-ray, ultrasound, CT scan, MRI, PET-CT and molecular testing, it’s easier, faster, more accurate and affordable to diagnose HNCs. Also, we have treatment modalities – surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy – that are on par with the best in the world.

Yet, it’s disconcerting to see younger patients with HNCs. Men and women, in their 30s and 40s, are ignoring the early symptoms — red or white patches in the mouth, lump in the neck, swelling in the jaw, hoarseness in the voice, difficulty while swallowing, sores on the lips or mouth that do not heal.

The truth of the matter is that we are far from beating cancer as we fail to address the risk factors. Unless we bring down the usage of tobacco (smoking and chewing), things won’t truly change. The simplest, yet most trying, a solution is to curb the widespread social acceptance of tobacco in the country.

The big picture

There’s no denying that preventing the onset and detecting the disease at an early stage are both critical. And for a developing nation like ours that is known for its state-of-the-art healthcare services, the need of the hour is to adopt an organ-site approach to cancer.

Globally, dedicated organ-site focused multidisciplinary teams are providing holistic care in terms of diagnosis, treatment, and post-treatment services for all kinds of cancers.

On this WNTD, let’s make concerted efforts to raise awareness on the deadly effects of tobacco use and second-hand smoke exposure, and to discourage the use of tobacco in any form. It’s time to rise to the challenge.

(The writer is Senior Consultant, Co-founder and Clinical Director, Cytecare Hospitals, Bengaluru)