In a few days, cancer specialists and caregivers will come together to discuss an important issue that needs immediate attention: closing the gap in this field. The Sunday Observer spoke to Community Physician, National Cancer Control Program Dr Suraj Perera to find out what these gaps were, why it was important to fill them and how they should be filled.
Excerpts of the interview
Q: World Cancer Day is observed on February 4 each year throughout the world. The theme for this year is ‘Close the care gap’. What is its significance to the world in general and to Sri Lankans in particular?
A: The theme highlights that everyone, collectively and individually need to be a partner to close the care gaps in cancer control aiming to minimise the impact of cancer.
Q: Can you elaborate on what exactly these gaps are?
A: Enhancing health promotion initiatives, avoiding known modifiable cancer risk factors, screening and early diagnosing cancers at the early stages, improving access to diagnosis, ensuring access to quality cancer treatment and follow up care, arranging palliative care services for cancer patients and their family members are some the essential care needs to be addressed if optimal level of cancer control is to be achieved.
The World Health Organization (WHO), Union for International Cancer Control (UICC) and other international organisations involved in cancer control activities in global level advocate governments of each country to use this opportunity to motivate all stakeholders in their countries for taking sustainable actions to close the care gap for prevention and control of cancers.
Q: What are the main activities organised in Sri Lanka to commemorate World Cancer Day?
A: Information related to the theme of World Cancer Day is communicated to the health care staff up to the grass root level through a circular and information sheets and request each institute / member to conduct awareness raising activities. Parallely at national level, media programs are conducted through print, electronic and social media to motivate the civil society.
Q: Can you describe the current situation in terms of cancers in Sri Lanka?
A: In 2019, 31, 848 patients (male -14,854, female- 16,994) were diagnosed as having cancers in Sri Lanka, according to the National Cancer Registry giving a crude incidence rate of 146 cancers per 100,000 population. Highest incident cancers among males were lip, tongue and mouth cancers (number of cases – 2,173), lung cancers ( 1,264) and colo-rectal cancers (1,260), while breast cancers ( 4,447), thyroid cancers (2,202) and colo-rectal cancers ( 1,247) were the highest incident cancers among females.
When we simplify the statistics, about 87 new cancer patients are identified per day in Sri Lanka. Of them, about 12 breast cancers are identified among females per day while about six oral cancers are detected per day among males.
Q: How about deaths due to cancers?
A: According to the information from Registrar General Department, the latest cause of death data available is for 2014 and in that year, 13,514 deaths were occurred due to cancers. It was 10.5 percent of total deaths in Sri Lanka. About 37 deaths are occurred per day due to cancers in Sri Lanka
Q: What are the measures available for primary prevention of cancers?
A: Generally, about one-third of cancers can be prevented through healthy life styles (avoiding tobacco smoking, avoiding betel chewing and consuming smokeless tobacco, stopping alcohol intake, physically active, consuming healthy diets, avoiding unsafe sexual practices) and healthy environment. Therefore, regularly public needs to be encouraged to practise and sustain healthy behaviour. Those who want to get rid of unhealthy practices have to be supported.
Over 1,000 healthy lifestyle centres attached to the health care institutions, are functioning throughout the country to promote healthy lifestyles and active interventions. Those of 35 years and above are invited to attend to ‘healthy lifestyle centres’ to obtain these services. ‘Yovun piyasa’ which are established in selected hospitals are alsi providing services related to primary prevention of cancers.
Also through vaccination, occurrence of cervical cancers (HPV vaccine) and Liver cancers (Hepatitis B Vaccine) can be minimised.
Q: Can you describe the facilities for early detection of cancers?
A: Another one-third of cancers can be detected early and with the prompt diagnosis and treatment, those can be successfully cured. Through the Well Women Clinic program, every married women are invited for cervical cancer screening at the age of 35 and 45 years. The aim is detecting possible cervical cancer patients at the precancer stage. If every female attend to cervical cancer screening at specified age, majority of cervical cancers can be prevented. Therefore, one of the key messages is importance of utilising these services since the Ministry of Health is offering free cervical cancer screening throughout the country as close to the home of the females. Most of the developed countries have reduced their cervical cancer through well organised cervical cancer screening program well before the introduction of HPV vaccination programs.
For early detection of breast cancers, Self-Breast Examination (SBE) is taught to every woman requesting them to practise every month from the age of 20. In addition, health care professionals (doctors, nursing sisters or nursing officers) conducts clinical breast examination at the Well Women Clinic and Health Lifetyle Centres established throughout the country. This will facilitate early identification of breast lesions.
In addition, breast clinics are established with the leadership of onco-surgeons or general surgeons in secondary care or tertiary care hospitals including Apeksha Hospital, National Hospital Colombo, National Hospital Kandy, Teaching Hospital Anuradhapura and Teaching Hospital Karapitiya. Any woman having a concern on symptoms related to breast cancer can walk into a breast clinic.
Q: Early detection of oral cancers?
A: Lip, tongue and mouth cancers (oral cancers) are the commonest cancers among males in Sri Lanka. Even oral cancer is among 10 leading cancers in women too. Therefore, it is important to know early symptoms and signs of oral cancer since there is a pre-cancerous stage too.
Any unhealed mouth ulcers, any whitish lesion which cannot be removed, any reddish lesion, difficulty to open mouth and unusual sensation oral cavity need to be assessed clinically by a trained dental surgeon. All dental surgeons working at the government or private health care institutions are available for clinical mouth examination. In addition, instructions were given by the Ministry of Health to arrange clinical oral examination by a dental surgeon or a medical officer at the healthy life style centres.
Q: Can we prevent oral cancers?
A: Descriptive epidemiological studies have revealed that commonest causative factor for occurrence of oral cancer is betel chewing. Both smokeless tobacco and arecanut are carcinogenic. In addition, tobacco smoking and alcohol contribute for occurrence of oral cancer.
The main approach for oral cancer prevention is avoiding betel chewing, tobacco smoking and alcohol intake. Currently betel chewing and any form of smokeless tobacco usage is banned in health care institutions and government institutions. Smoking is banned in all public places. While these administrative measures are being taken to minimise use of these substances, continuous empowerment of vulnerable groups including drivers, manual labourers, construction workers, plantation workers, farmers and fishermen are important to minimise consumption of betel.
Q: What about early detection of other common cancers?
A: It is important that every person need to be aware what is normal for him or her especially with the advancing of age. It has been shown that reporting of cancers is increased with advancing of age. If there is persistence of any abnormal symptoms, you need to get medical advice. Since there is a free health service extending to the grass roots level in Sri Lanka, anybody can access this health service. The important message is if there are suspicious symptoms, contact the medical professional.
Those abnormal symptoms may be lump in the breast or axilla, change of skin of the breast or abnormal breast pain (breast cancer), persistent difficulty in swallowing for more that two weeks (Oesophageal cancer), alteration of bowel habits or per rectal bleeding (Colo-rectal cancer), persistence of cough or coughing with blood (Lung cancer), persistence hoarseness of voice (Laryngeal cancer), post menopausal bleeding (Uterine cancer), Change of urinary habits and frequency among males (Prostate cancer).
Q: What are the facilities for confirm diagnosis and treatment?
A: Over the years availability of human resources and physical facilities was expanded throughout the country. Therefore, diagnostic facilities are improved to certain extent to diagnose cancers as close to the patients’ homes. It may be histopathology, haematology diagnostic services, and mammography or endoscopy services. It is important to utilise these services to confirm the diagnosis.
Q: What about availability of treatment services?
A: Over the years availability of oncology units are expanded throughout the country. Now at least one oncologist is available at the District General Hospital in each district in addition to the main 9 cancer treatment centres situated at Apeksha Hospital - Maharagama, National Hospital Kandy, Teaching Hospital – Karapitiya, Teaching Hospital – Anuradhapura, Teaching Hospital Ratnapura, Teaching Hospital Batticaloa, Teaching Hospital Kurunegala, Provincial General Hospital – Badulla and Base Hospital – Tellipalai (Jaffna). Therefore, without fearing of side effects, it is important every cancer patient is sought the treatment from these centres without seeking alternative treatment since most of the cancers can be successfully treated if detected at early stages.
Q: Palliative care is a new approach. What are the palliative care services for cancer patients?
A: It is important that palliative care services are available for cancer patients according to the need especially for those who are in advanced stages.
The holistic care for cancer patients is arranged in most cancer centres and also dedicated palliative care services are provided in most cancer centres with the availability of inter-disciplinary teams comprising consultants, palliative care trained medical officers and nursing officers and social service officers. The National Cancer Control Program is strengthening primary health care teams for arranging and delivery of community based palliative care services for the needy cancer patients.
Q: If any person need additional information on cancer in Sri Lanka, from where those information need to be obtained?
A: All information related to cancers is uploaded into the website of National Cancer Control Program www.nccp.health.gov.lk
Data visualisation platform on cancer incidence data is available on https://dashboard.nccp.health.gov.lk/