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Erasing Cancer Fears
16 November 2004
The Malaysian Oncological Society’s continuing educational efforts aims to change the public’s perceptions about cancer and encourage a more pro-active approach towards the disease.
WHEN something threatens our health, our ability to think rationally flies in the face of fear.
There is no better example than cancer. Despite the efforts of doctors to reassure us that cancer can be managed with proper treatment, we still cling tightly to our suspicions and misconceptions.
As a result, we may deny ourselves treatment that could otherwise improve our condition and allow us to enjoy good quality of life.
The truth is, cancer does not have the same implications today that it did years ago. Thanks to modern science, there are now ways to detect cancer early and treat it without causing bad side-effects.
Although many people find this hard to believe, the Malaysian Oncological Society hopes that continuing educational efforts will change their perceptions and encourage a more pro-active approach towards cancer.
Cancer on the rise
“It is estimated that cancer incidence in Malaysia is rising and is expected to continue to rise. The 2002 National Cancer Registry (Malaysia’s first national cancer registry) reported over 26,000 new cancer cases in Peninsula Malaysia,” says Dr Gurcharan Singh Khera, consultant clinical oncologist and president of the Malaysian Oncological Society. The much-awaited 2003 cancer registry report will be published in December this year.
Breast cancer was the most common cancer reported in females, followed by cervical cancer. In males, lung cancer ranked number one, followed by nasopharyngeal cancer. Colorectal cancer is on the rise in both sexes.
“One of the reasons (for the rising incidence) is that most cancers are more common in the older age group. As longevity increases in our country, so will the incidence of cancer,” explains Dr Gurcharan.
He also attributes the rise to increasingly unhealthy lifestyle habits. “Our level of physical activity is minimal and unsatisfactory. Our diet contains more red meat, but less vegetables and fibre. Obesity is increasing. The number of smokers is not reducing,” he laments.
Other factors that increase our risk of cancer include environmental pollution. The evidence is clear – the incidence of lung cancer is higher in urban areas, compared to rural areas.
Cancer is on the rise; however, it does not mean we have to sit back and let it claim our lives.
Early diagnosis, better outcome
Cancer is not a death sentence, especially if it is detected early.
“If cancer is picked up at stage one, the patient will do much better than a stage four cancer patient. Ideally, you want to pick up at stage zero, where there are no symptoms or signs yet,” says Dr Gurcharan.
This is possible with certain cancers, where affordable and simple screening tests may be able to detect abnormalities that may be signs of cancer.
Dr Gurcharan cautions that blood tumour markers should not be used for routine screening. “Only PSA (prostate specific antigen, for prostate cancer) can be considered for routine screening. (Otherwise), tumour markers are used for monitoring patients during and after treatment.”
Proper screening methods include pap smears and mammograms, which may detect early cervical and breast cancer, respectively.
Other screening tests include digital rectal examinations for older men, and periodic liver ultrasound and alpha-fetoprotein tests for hepatitis B carriers.
It is important to go for these screening tests regularly. “Early diagnosis of cancer can bring good results,” says Dr Gurcharan.
Perception of treatment
When it comes to cancer, most patients are more afraid of its treatment than the disease itself. This negative perception towards cancer therapy can be damaging because it leads patients to go without treatment or seek other, unproven therapies.
“The core non-surgical treatment for cancer – radiotherapy and chemotherapy – are perceived by 80% of people to be either useless or harmful,” says Dr Gurcharan.
This is a wrong perception, he says. “Radiotherapy has been shown to be extremely useful for palliative treatment. It is excellent in relieving symptoms such as in cases where a tumour causes bone pain, bleeding or obstruction to swallowing and breathing. There is no doubt to its effectiveness.”
As for palliative chemotherapy, he says that the newer drugs have fewer side-effects and are more effective than older drugs in providing symptom relief for good quality of life.
Some acute side effects are inevitable with curative treatments – there is no medical treatment for any disease that is absolutely devoid of side effects. Even so, there are medications to minimise or prevent these side effects, such as anti-emetic drugs to prevent chemotherapy-induced delayed nausea and vomiting, and growth factors to minimise fall in blood counts.
Extremely nasty side effects will only occur in a small percentage of cases, and only with the use of certain drugs.
Dr Gurcharan stresses that the majority of the side effects are temporary and transient.
“Do not deny treatment to a lung cancer patient who is coughing up blood, just because of perceived side effects.”
He says only a minority of patients give up or stop halfway through treatment. The real hurdle is in getting patients to start treatment in the first place.
Alternative treatment
The cancer patients who do not pursue mainstream treatment favour alternative or complementary treatments instead, be it from their bomoh, sinseh or herbalist.
This behaviour baffles oncologists, who continue to stress that none of the current alternative or complementary therapies are evidence-based.
“The Malaysian Oncological Society stresses evidence-based medicine. Whether it is mainstream or non-mainstream, it must be evidence-based,” says Dr Gurcharan.
Evidence-based medicine means that the treatment has been subjected to rigorous scientific testing in laboratories, and on animals and humans. This is medicine that has been proven to work.
“We believe that there is a place for complementary (not alternative) approaches to cancer treatment. By that, we do not mean alternative or complementary medicine, but holistic approaches like tai chi, qi gong, aromatherapy or diet,” he elaborates.
Alternative medicine cannot be accepted, because there have been no randomised, controlled, blinded studies done to prove their efficacy or safety.
“We cannot take anecdotal reports to highlight the benefits of a treatment. Currently, only mainstream medicine is evidence-based.”
Educating ourselves
Dr Gurcharan believes that education will eventually help the public overcome their fears and misconceptions of cancer.
In line with this, the Malaysian Oncological Society (MOS), an academic society made up of oncologists, physicians and surgeons, focuses a lot of its energies on public education.
“One of our biggest public education activities is our website (www.malaysiaoncology.org). We have articles on all the common cancers in Malaysia, what kind of treatments are available, common cancer misconceptions and where to find treatment facilities,” he says.
The website also features a question-and-answer section where members of the public can email the society if they have general questions on cancer. This section is not intended to replace medical consultation.
The MOS also promotes education among medical professionals, including oncologists, other specialists involved in cancer care, general physicians and pharmacists.
The society organises national, regional and international scientific meetings, Continuing Medical Education (CME) activities, and is involved in committees for clinical practice guidelines and the National Cancer Registry. All these activities are aimed at enhancing and updating members on current issues related to cancer care, and providing a forum for discussion and collaboration with other specialists treating cancer.
In the future, the MOS will subscribe to medical journals through their website for their members and participate in research activities, in collaboration with universities and teaching hospitals.
Says Dr Gurcharan: “We want to promote an evidence-based approach to cancer, whether it is in prevention, detection, diagnosis or treatment.”
He urges people to read as much as possible about cancer, from brochures or websites produced by professional organisations. He also suggests other resources, such as the Merck Manual of Medical Information, an independent publication for laypeople.
“This manual covers many specialities, not just oncology. Readers will be getting reliable information. Similar resources should be encouraged,” he says.
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By Sunday November 14, 2004, The Star
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