WELL-BEING
to be less effective as a person grows older. In short, risk factors can be biological (viruses, aging), chemical or physical agents, and, in many cases, inherited genetic traits that predispose to this disease, especially when they coexist with risk factors. Furthermore, we must keep in mind that cancer is a large group of diseases with a wide combination of causes.
RISKS FACTORS FOR CANCER: Tobacco use, alcohol use, unhealthy diet and physical inactivity are the main cancer risk factors worldwide. Some chronic infections are risk factors for cancer and have major relevance in low- and middle-income countries. Hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) increase the risk for liver and cervical cancer respectively. Infection with HIV substantially increases the risk of cancer such as cervical cancer. HOW CAN THE BURDEN OF CANCER BE REDUCED? Knowledge about the causes of cancer, and interventions to prevent and manage the disease is extensive. Cancer can be reduced and controlled by implementing evidencebased strategies for cancer prevention, early detection of cancer and management of patients with cancer. Many cancers have a high chance of cure if detected early and treated adequately. MODIFYING AND AVOIDING RISK FACTORS: Prevention strategies: • Increase avoidance of the risk factors listed above. • Vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV). • Control occupational hazards. • Reduce exposure to non-ionizing radiation by sunlight (UV). • Reduce exposure to ionizing radiation (occupational or medical diagnostic imaging). EARLY DETECTION: Cancer mortality can be reduced if cases are detected and treated early. There are 2 components of early detection efforts:
1. Early diagnosis: The awareness of early signs and symptoms (for cancer types such as skin, cervical, breast, colorectal and oral) in order to get them diagnosed and treated at early stage. Early diagnosis is particularly relevant when there is no effective screening methods or – as in many low-resource settings – no screening and treatment interventions implemented. In absence of any early detection or screening and treatment intervention, patients are diagnosed at very late stages when curative treatment is no longer an option. 2. Screening: Screening aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for treatment or when feasible for diagnosis and treatment. Screening programmes are especially effective for frequent cancer types for which cost-effective, affordable, acceptable and accessible screening tests are available to the majority of the population at risk.
SOME EXAMPLES ARE: A. Visual inspection with acetic acid (VIA) for cervical cancer in low-resource settings. B. HPV testing for cervical cancer. C. PAP cytology test for cervical cancer in middle- and high-income settings. D. Mammography screening for breast cancer in high-income settings. E. Detection of prostate antigens in men over 50 years in middle- and high- income settings. In short, the earlier the diagnosis of precancerous or cancerous lesions, the higher the chances of cure. Similarly, it is important to control, eliminate or minimize risk factors of cancer diseases, especially in people with a family history of cancer. In 2013, WHO launched the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 that aims to reduce by 25% premature mortality from cancer, cardiovascular diseases, diabetes and chronic respiratory diseases by 2025. Some of the voluntary targets are most relevant for cancer prevention, including the target aimed at reducing the prevalence of tobacco use by 30%. I wish you all good health, unity and harmony l
(*) Internist, Master in Management and Public Policy July 2015 / Impacto evangelistic
17