Let Not Your Fear Metastasize: Fight Against Cancer

A woman, often described as second sex with so-called lesser abilities is usually described as a multi-tasker with more neurons supporting her functionalities, and as “care giver”. Right from giving meals timely to her grandparents and in-laws to spoon-feeding healthy syrup to her stubborn child, she struggles to look after everyone well, except her own well-being. Her health is often neglected, either by her (which happens most of the time) or by her family. While taking care of others, she tends to miss out on looking after health concerns, further becoming more susceptible to several health hazards. According to her biological anatomy, her health differs from men in several ways. Going by definition given by WHO, “health”is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". This indicates that a holistic approach is the key, and in fact, essential. However, general health care can still be managed to a certain extent as there is some possibility of reversing the conditions for better. But when it comes to cancer, nothing works perfectly.

Cancer is a slow and silent killer. If it happens to someone, then one will need hard and strong-hearted people to endure the consequences.Nearly every family in the world is touched by cancer, which is now responsible for almost one in six deaths globally. On World Cancer Day (4 February) WHO highlights that cancer no longer needs to be a death sentence, as the capacity exists to reduce its burden and improve the survival and quality of life of people living with the disease.“All countries can do more to prevent and treat cancer,” notes Dr Etienne Krug, WHO Director for the Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention. “We know the main causes. Acting upon them will avoid that many cases occur in the first place. By strengthening the health system response, we can also ensure earlier diagnosis and better access to affordable treatment by qualified personnel, thereby saving millions of lives.” In May 2017, the Member States came together around priority actions to ensure cancer care for all. World Health Assembly resolution WHA A70/A/CONF./9 "Cancer prevention and control in the context of an integrated approach"lays out a clear road map to realize the potential for prevention, early diagnosis, prompt treatment and palliative care for people with cancer.Detecting cancer early also greatly reduces cancer's financial impact: not only is the cost of treatment much less in cancer's early stages, but people can also continue to work and support their families if they can access effective treatment in time.

In 2018, the Indian Council of Medical Research, had projected that India might register more than 17 lakh new cases of cancer and over 8 lakh deaths due to it by 2020. In 2016, about 14 lakh cases of cancer were recorded as an article by care hospital stated. It was found that among these cases, more of women as compared with men are diagnosed with cancer. The common forms of cancer in women being breast, lung and cervical cancer. According to a World Cancer Report, 5.37 lakh Indian women were diagnosed with cancer in 2012, as compared to 4.77 lakh men. On the other hand, death caused by cancer is higher among men, as compared to women. Now the question is: Why more women?

Breast cancer, cervical, ovarian and uterine cancers are certain cancers that hit women. Certain research studies suggest that the known risk factors for breast cancer include high-fat diet, obesity, late marriage, fewer children, inadequate breast feeding.

As Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia has pointed out in one of her articles that the general causes behind cancer in the South-East Asia could be lifestyle issues (apart from unhealthy diet), occupational hazards, tobacco use, and exposure to environmental substances, including ambient air pollution.

Studies by National Institute of Cancer Prevention and Research (NICPR) reveal that for every two women newly diagnosed with breast cancer, one woman dies of it in India. Tobacco (smoked and smokeless) use accounted for 3, 17,928 deaths (approx) in men and women in 2018. Breast cancer is the most common cancer in women in India and accounts for 14% of all cancers in women. It is believed that two-third of cancers are preventable. Some of the cancers like breast, cervical, skin, ovarian, lung, and endometrial cancer are the most common cancers in women. Hence, it is imperative to pay heed to the abnormal changes that occur in a woman’s body.

We spend nearly one-third of our lifetime working in the office, home or somewhere else. Working causes exhaustion and stress. Women, unsurprisingly, are more prone to stress. They utilize their entire energy looking after miniscule of things, and worrying about all. We tried to understand from Ms. Pritika Singh, CEO and Planning and Strategy, Director of Prayag Hospital, about how stress impacts a woman's health. “According to many studies women differ from men not only in their emotional responses to stress, but also in their physical and mental health, particularly their acute and chronic stress may take a greater toll. Women may face many problems due to stress that includes irregular periods, acne breakouts, hair loss, poor digestion, depression, insomnia, weight gain, and many more.” On this line, Dr.Ranjana Sharma, Senior Consultant, Obstetrician & Gynecologist, Indraprastha Apollo Hospitals, New Delhi said, “stress can lead to problem with delivery. When the mother goes into labour, if she is stressed then it is not good for a normal delivery. The labour lasts for hours, if the mother is stressed out, it may interfere with a normal delivery.But there is no evidence to suggest that if the mother is stressed then the baby will be abnormal.”

Stress also leads to an imbalance in one’s lifestyle, especially for women who always try to strike a balance between their family and work life. This, apparently, results in unhealthy eating habits, including eating at odd times and starving, further making them more susceptible to cancers, and colon cancer is one of them. Colon cancer usually happen to people with a personal or family history of this cancer, or to those who have polyps in their colon or rectum, or those with inflammatory bowel disease are more prone to colon cancer. Also, being overweight; eating a high-fat diet; smoking, and being inactive can make a person more likely to have this cancer. Screening with a stool-based test or with an exam that looks at the colon and rectum (a visual exam) should be carried out periodically.

Did you know? A WHO study reveals that 1000women die every day because of the consequences of pregnancy and childbirth. There are circumstances prevailing in different parts of the world, where girls are forced into early marriage, pregnancy and harmful practices like female genital mutilation, etc., which pose serious health risks. To avoid gynecologic problems and infections Dr. Sharma shared that women must follow proper hygiene. “One must also know the medical history of one’s sexual partners, whether they have had a history of infection. Use of condom is a very good idea. To avoid infection in urine, which can occur due to sexual activity- passing urine before and after sexual intercourse, can help in avoiding UTIs? The HPV vaccine can prevent cervix cancer. One must vaccinate against viruses against which vaccines are available, for example Hepatitis B.”

Another critical issue among women in India is poor menstrual hygiene. Unhygienic practices can lead to fungal infections, reproductive tract infection and urinary tract infection, thereby causing cervical cancer. Cervical cancer is the second most common cancer in India in women, accounting for 22.86% of all cancer cases in women and 12% of all cancer cases in both men and women. It occurs in the median age of 38 years (age 21–67 years). This indicates at the age when maximum people are in their working stage. Rural women are at higher risk of developing cervical cancer as compared to their urban counterparts. The survival chance of a person becomes better if the cervical cancer is detected and treated at earlier stages. Therefore, it is important to avail of cervical cancer screening. This type of cancer mostly impacts sexually active women and occurs in women who have had the human papillomavirus (HPV), which is passed during sex. It is also common in women who smoke, have HIV or AIDS, poor nutrition and who do not get regular Pap tests. No symptoms are found in early stage. But as cancer grows, certain symptoms like: abnormal vaginal bleeding (between periods, during sex or after menopause); pain during sex; and vaginal discharge may occur.

Hygiene and sanitation plays a significant role in women’s health. Taking this discussion forward, we asked Dr. Rita Bakshi, Senior Gynaecologist and Founder, International Fertility Centre about the disadvantages of the use of unhygienic clothes, as a lot of women also don’t use sanitary napkins during their menstruation days. “Most women in rural areas spend most of the money in buying sarees and bangles, but still think that buying a sanitary napkin is something which is not really required. Women in rural areas, in today’s times also use soil and ash during their days of menstruation which is even more agonizing and dreadful. It is very important for them to understand that deviations for sanitary napkins like cloth and ash can easily bog down and are unhealthy for the vagina. It is important to realize that there are number of germs and infections that these alternatives carry, which can be tumorous and cancerous.”

Dr. GeetaBaruahNath, HOD Obs&Gyne Department, Artemis Health Institute, Gurgaon, expressed, “Maintaining Hygiene and Sanitation is extremely important for a woman to remain healthy. Good habit of washing and drying, to use cotton undergarments and lowers so that skin can breathe to prevent infection need to be inculcated from childhood. Unhygienic habits and unsafe sex can lead to bacterial, fungal, mixed infection, which in turn can cause tubal block and infertility along with other health hazards even reproductive tract cancer.”

We also stumbled with an amazing product, “toilet seat sanitizer” by PeeSafe, India's leading personal hygiene brand that facilitates all to use public toilets in a healthy way, without getting vulnerable to infections. Its founder, VikasBagaria, expressed, “Poor sanitation practices are depriving women to use public toilets for the chances of getting infections, vaginal burns and UTI. It can be even worse, however, PeeSafe aims at giving women a comfortable and safe experience while they use the toilets - with the help of toilet seat sanitizer spray that protects users from the deadly germs and bacteria while using the toilet.” Amazing solution indeed! But we were curious to know if it is safe for pregnant women and children, to which he answered, “It is a unisex spray which is completely safe and can be used by pregnant women as well as children above five years of age.”

Oral cancer is the second most common cancer in India amongst women (10.4 % of all cancers). According to Globocan 2018 data, Total number of deaths in men and women together is 72,616. Around 80-90% of oral cancers are directly attributable to tobacco use. Many women in rural India still have the habit of chewing of tobacco and paan, so much that it has turned into their addiction and an inevitable part of their lifestyle.

Stress is one of the major causes of heart risks, especially in women. It leads to incorporating deadly habits in one’s lifestyle like smoking. Dr Gaurav Thukral, COO, HealthCare atHome, remarked, “It depends from region to region and varies from one individual to others. However, most common addictions are chewing tobacco and smoking cigarettes. Both have the same consequences and adverse effect on health which leads to multiple problems including lung cancer, bronchitis, anxiety and irritability, constricted blood vessels, heart disease and cervical cancer etc.”

Further, Ms Shamantha K- Counseling Psychologist-Fortis Hospitals, Bangalore, explained how smoking and stress are related to a woman. The reason why one feels calm after smoking is because nicotine is a mood-altering drug, in other terms dopamine is released. Fact is it increases the levels of stress in one’s body by increasing the blood pressure, heart rate, constrict blood vessels, decrease the flow of oxygen to the brain and restrict healthy coping skills to the individual.” In fact, “the chemicals in the tobacco enter our bloodstream and expose the whole body to risk of several diseases like lung cancer, colon cancer, mouth cancer, throat cancer, hypertension, risk of heart diseases, chronic obstructive pulmonary disease, asthma, reduced fertility and the list goes on”, says Dr. Walia Murshida Huda, Senior Medical Officer, Healthians - a health test at home service provider.

Dr. Thukral, added another dimension that "Second hand smoking" impacts a woman's health. She enlightened that smoking causes coronary heart disease, cancer, and stroke—the first, second, and fourth leading causes of death for women in the United States.

In fact, stress and work load has also resulted in late marriages with women marry at the age of 30 or during their early thirties. However, they fall in the zone of red alert for ovarian cancer. Those women who have unexplained infertility; who have never had children; or who had their first child after age 30 may be at increased risk for this cancer.

We’re not done here there are other reasons for cancers even. Did you know that climate change has negative and grave impacts on women’s health? UN figures reveal that 80% of people displaced by climate change are women. The climatic changes have increased the risk of various cancers and chronic diseases. Women are more concerned about the health of their families and the rise in the incidence rate due to climatic changes exposes everyone to health challenges. Here, Dr. Kaur added that health symptoms shouldn’t be ignored by women and cited these: “General weakness is the most common symptom we encounter. It could mean anything from a nutritional deficiency to chronic infections, anaemia, cardiac disease, malignancy to even psychological disorders like depression, prolonged fever, menstrual irregularities, post-menopausal or post coital bleeding, new onset headaches, any swelling or lumps on the body, etc.”

Breast cancer can occur at any age, though, but the risk soars as a woman gets older. The best defense is to find breast cancer early, especially, when it has not spread. In fact, women between 40 to 44 age bandwidth should start annual breast cancer screening with mammograms if they wish to, but those between 45 to 54 age bands should get mammograms every year. While women aged 55 and older should switch to mammograms every 2 years; they can also continue yearly screening. But the screening should be done periodically.

Endometrial cancer also known as the cancer of the uterus lining occurs most often in women age 55 and older. Intake of estrogen without progesterone and taking tamoxifen for breast cancer treatment or to lower breast cancer risk can increase a woman’s chance for this cancer. In fact, having an early onset of menstrual periods, late menopause, a history of infertility, or not having children can increase the risk, too. Women with a personal or family history of hereditary non-polyposis colon cancer (HNPCC) or polycystic ovary syndrome (PCOS), or those who are obese are also more likely to have endometrial cancer.

Coming to skin cancer, those who spend time in the sun getting exposed to harmful UV rays can get skin cancer. Did you know that people with fair skin are more likely to get skin cancer than people with darker skin tone? People who have had a close family member with melanoma and those who had bad sunburns as children are also more likely to get skin cancer. However, it can be prevented by limiting one’s exposure to ultraviolet (UV) rays from the sun. Be alert about any sudden moles or spots on your skin. Ladies, get your sunscreen lotion handy as summer is approaching.

In a nutshell, the only way forward to fight against cancer in women is by spreading awareness about it and also getting regular health check ups – the sooner, the better.