Why there seems to be cancer everywhere

There are few diseases that can evoke fear in us than cancer. Perhaps not just because of its creeping nature, but because it connotes doom.

In the developed world, the number one killer disease is still ischemic heart disease. In the developing world, it is lower respiratory infections (mainly in children). Though, in the developing world, they are now eating what the developed world eat, and living a more sedentary lifestyle, heart related diseases and such other non-communicable diseases mainly found in the developed world are now finding their way into the developing world. Nonetheless, in many parts of the world cancer wants to be second to none.

Though the fact that cancer wants to be number one sounds disturbing, perhaps it is not proper to start comparing cancer to other diseases. As George Johnson, editor and author of 'The Cancer Chronicles,' argued "Cancer is, by far, the harder problem—a condition deeply ingrained in the nature of evolution and multicellular life. Given that obstacle, cancer researchers are fighting and even winning smaller battles: reducing the death toll from childhood cancers and preventing—and sometimes curing—cancers that strike people in their prime. But when it comes to diseases of the elderly, there can be no decisive victory. This is, in the end, a zero-sum game."

It is believed that with enough money and the will, science might reduce cancer mortality to a significant minimum. "But what, then, would we die from?" asks, Johnson. Heart disease and cancer are mainly diseases associated with old age. If we have less people dying from one of them it means more people will live long enough to die of the other.

There is a general increase in life expectancy in most parts of the world. If you get to age 67 you are very much likely to get past 80. The median age for people to die of cancer is 72. But we now live long enough for cancer to get us.

What used to be major killer diseases, like tuberculosis, smallpox, influenza, bubonic plague were easier to handle. For each of these diseases there was a single infectious agent, an identified cause that could be faced.

Nevertheless, death from heart disease is being reduced, or perhaps delayed with diet, exercise and drugs which help control blood pressure and cholesterol. Even major heart problems seen as mechanical, like worn-out valves, clogged piping, may have temporary solutions.

With these interventions, people between 55 and 84 are now more likely to die from cancer than from heart disease. But for those who live beyond that age, heart disease overtakes cancer. And as Johnson puts it "year by year, as more failing hearts can be repaired or replaced, cancer has been slowly closing the gap."

Cancer remains the most intractable. This is because it is more of a phenomenon, than a disease, the result of a basic evolutionary arrangement. As our body lives and grows, its cells are constantly dividing, and copying their DNA, and giving it to the daughter cells. It is a large genetic library. The daughter cells then pass it to their own progeny: copies after copies after copies. Somehow, along the way, inevitably errors occur. Some of these errors are caused by carcinogens, but most of them are due to random misprints.

However, cells have complex mechanisms which recognise and correct many of the errors. But sadly, this mechanism is not foolproof, and it can't ever be. Mutations are what bring about evolution. Without mutations humans would not have evolved. A certain combination will give a cell too much power. It starts to evolve on its own apart from the rest of the body. Just like new species trying to live in an ecosystem, it grows to become a cancerous tumour. And that cannot be easily repaired.

As Johnson elucidates further, "These microscopic rebellions have been happening for at least half a billion years, since the advent of complex multicellular life—collectives of cells that must work together, holding back, as best each can, the natural tendency to proliferate. Those that do not—the cancer cells—are doing, in a Darwinian sense, what they are supposed to do: mutating, evolving and increasing in fitness compared with their neighbours, the better behaved cells of the body. And these are left at a competitive disadvantage, shackled by a compulsion to obey the rules."

As people become old their cells gather more potentially cancerous mutations. If given a long enough life, you will eventually succumb to cancer, unless something else kills you. That would still happen even with the best medical technology and even if the world is free of carcinogens.

Still, the best we can do is to prevent cancer. And places where you hear better news about cancer is where they have better preventive measures. Worldwide, about 15 to 20 percent of cancers are thought to be caused by infectious agents. Improved refrigeration and public sanitation, have significantly reduced stomach cancer, which is linked to Helicobacter pylori bacteria. Vaccines against human papilloma virus can potentially eliminate cervical cancer. Where you have successful antismoking campaigns lung cancer, which accounts for almost 30 percent of cancer deaths in the United States, is reducing gradually. We can make more progress with improvements in screening and by reducing the incidence of obesity (A 2012 study in the Lancet linked cancer to high body-mass index), which along with diabetes, gives cancer a strong foothold.

Amazingly, only a small percentage of cancers have been traced to the many synthetic chemicals that industries have added to the environment. As regulations become stricter, cancer rates are being reduced a little more.

Again, most of the progress made on cancer has been in advanced countries. With enough political will the same effort can be taken to less developed countries.

More progress will be made in the sciences. New immune system therapies that bolster the body's own defences have shown promise for certain cancers. There are nano robots which repair and reverse cellular damage. There is also genomic scans that can tell a cancer’s precise genetic signature.

As at today, with genetic information colon, ovarian, and breast cancer can be prevented in many patients. Perhaps, as a consolation for those who live in less developed countries like Nigeria, Theodora Ross, an oncologist advises that "most people should focus less on the high-tech future of genetic testing and more on the low-tech history of their family trees. Those who don’t know their own family histories, because of adoption, secrecy, loss or estrangement, should take comfort in the fact that we are one big family."

Perhaps, in time to come some of us will give Methuselah a good run for his money. But except for medicine for immortality, a body will get to a point where it has outfoxed every danger life has thrown at it. And for each added period of life, there will be more mutations, which also means more accumulations. "If the heart holds out, then waiting at the end will be cancer," Johnson forewarns.

Dr Cosmas Odoemena

THE SCOURGE OF DIABETES

The number of people worldwide suffering from diabetes is a “staggering” 366 million, according to The International Diabetes Federation. This was made known by officials during a recent meeting in Lisbon, Portugal. They estimate that 4.6 million people die annually from the disease and it cost governments about $465 billion every year to fight the disease.

In the same vein, Centers for Disease Control and Prevention (CDC) report estimates that about 26 million Americans have diabetes. It also says about 79 million Americans have prediabetes. According to the National Diabetes Fact Sheet for 2011 diabetes affects 8.3% of Americans of all ages and 11.3% of adults 20 years and older. Here, 6 million Nigerians live with diabetes, according to Diabetes Association of Nigeria (DAN). One out of every five adult Nigerians die before their 50th birthday, and three out of five with childhood diabetes die before 20th birthday. In Africa at least 80% of people with diabetes are undiagnosed. Diabetes is the leading cause of nontraumatic lower limb amputations. It also increases the risk for coronary heart disease 2-4 times more than in nondiabetic. Approximately two thirds of people with diabetes die of heart disease or stroke. There is also the risk of Diabetic Ketoacidosis (DKA), a very life-threatening complication, this especially in type I diabetes also known as Insulin Dependent Diabetes Mellitus. It used to be thought that type II diabetes also known as Non-Insulin Dependent Diabetes Mellitus was less common in non-Western countries, but now as people in those countries adopt Western diet and lifestyles it is now also seen more. Other complications of diabetes are kidney failure, blindness, infertility, miscarriages, stillbirths, sudden death, and reduced life expectancy.

The diabetes challenge is tripartite - and threefold. To the individual it is about knowing that you have a disease that is debilitating and lifelong. There is no cure but it can be managed. The individual has to learn to control their diet, reduce their weight and change their lifestyle. In other words a hedonic learns to become anhedonic, couch potatoes learn to break sweat. For older people a leopard would have to learn how to change its spots. They may need to change friends to stay alive. The individual will keep regular appointments with the doctor, to monitor compliance and to detect complications early, but more than anything every appointment helps make it fresh and gives them zeal to carry on. Those who stay away from appointments are more likely to die from complications of diabetes.

It is important to know that the so called diabetic diets are actually the ideal diet for any one above the age of 25, that is, for all of us. Telling the patient to cut down calories is not enough. There should be objectivity. I always say for carbohydrates a fixed-size portion is enough. This is one case where one-size-fits-all works. The ideal size is the size of the person’s fist. Whether full or not, the patient gets up, they won’t die. One thing is sure: those who take fewer calories live longer. Science has proven it. It is more “satisfying” to eat with bowls instead of dishes. That way your brain will not tell you that you are missing something. Food is like sex, it is pleasurable. So it can be abstained from and quantity taken controlled with discipline. It is still amazing that patients find it easy to take vitamins, but difficult for them to take their blood sugar lowering drugs. But patients should see these drugs for what they are – life-prolonging drugs.

For governments, especially with the global recession, there will be other things crying for attention. Health budgets may be cut. But whatever happens there must be money for treatment and research. And the political will for positive and purposeful research, through the road less travelled, apologies to Morgan Scott Peck. The next paragraph sheds more light on this.

But perhaps the greatest challenge is for medical scientists. For long the world has been presented with this disease among others where patients have to pop pills or injections all their lives to stay alive. It is almost always the same reaction from patients when as a doctor I break the bad news: “you mean I have to take these drugs everyday?” Some push their luck: “doctor, you mean maybe for a while.” Some go philosophical, “It is not my portion!” I feel compassion for them. My answer: “In this wicked world, there is no absolute health.” But research should strive to move from the frontier of “management” to “cure”. And perhaps the hope lies in stem cells. This part of medical research has been over politicized and there is a need for conservatives, especially religious bodies, to look far ahead to see the big picture.

November 14 of every year is Word Diabetes Day. For one day diabetes stays in our consciousness. For non-diabetics and non-stakeholders, after that day, it is forgotten. Diabetes and all its problems need to stay longer in the consciousness of all the players, and indeed all of us.

Dr Cosmas Odoemena