The mere mention of “ cancer” puts many people at unease. This is perfectly normal from a very basic notion of self-preservation. But it is also this response that sabotages millions of people around the world from trying to make practical sense of cancer. The first response commonly elicits denial and “ fight or flight” responses ( scolding the messenger or running away) which hamper the understanding of how to approach cancer and how to do effective screening. Many feel that they are helpless to prevent cancer.
The number of people being diagnosed with cancer is increasing over the years. From 11,441 in 2010, it has increased each year ( 11,743, 12,312, 12,785) to 13,241 in 2014.
The truth is that an integrated approach to cancer works better. This is based on information of cancer incidence, cancer deaths, and risk factors for cancer and effective screening tools.
Cancer Incidence
A third of us will contract some form of cancer in our lifetime. 30% occurs before retirement – 70% occurs after 65 years of age.
Top 10 Cancers for Men by Incidence | (%) | Top 10 Cancers for Women by Incidence | (%) |
Colorectal | 17.1 | Breast | 29.2 |
Lung | 15.1 | Colorectal | 13.3 |
Prostate | 12.4 | Lung | 7.6 |
Liver | 7.6 | Uterine | 6.6 |
Lymphoma | 6.8 | Ovarian | 5.5 |
Skin, including Melanoma | 5.8 | Lymphoid | 4.5 |
Stomach | 4.8 | Skin | 4.3 |
Naspharynx | 3.7 | Thyroid | 3.7 |
Kidneys and Urinary System | 3.6 | Stomach | 3.5 |
Myeloid (Bone Marrow) | 3.2 | Cervical | 3.1 |
*Cancers in bold have an effective screening tool to PREVENT cancer. Cancers in underlined italics have an accepted test to enable early detection
Cancer Deaths
Top 10 Cancers deaths for Men | (%) | Top 10 Cancers deaths for Women | (%) |
Lung | 27.1 | Breast | 17.6 |
Colon | 13.8 | Lung | 16.5 |
Liver | 12.6 | Colon | 15.2 |
Stomach | 6.3 | Liver | 6.4 |
Pancreas | 5.3 | Stomach | 5.9 |
Prostate | 5.3 | Pancreas | 5.8 |
Naspharynx | 4.1 | Ovary | 5.2 |
Lymphomas | 3.2 | Cervix | 3.1 |
Kidney and other Urinary | 2.9 | Lymphoma | 2.5 |
Leukaemias | 2.7 | Leukaemias | 2.5 |
Cancer deaths paint a more “ outcome” based picture which reflects how aggressive a cancer is, and the strengths of our healthcare system.
For example, prostate cancer for men and uterine cancer for women are within the top four in incidence, but are farther down the list in terms of cancer death. More people die “ with”, or “ ever had” prostate and uterine cancer, than “ of “ the cancer itself.
We also know that certain cancers are more lethal than others.
Here are the 5 year age-adjusted survival rates ASR (2008-2012) of the common cancers arranged from most lethal to the least: the top 4 common cancers are highlighted.
Male | | Female | |
Pancreas | 5.4 | Pancreas | 7.0 |
Lung | 11.0 | Lung | 16.2 |
Liver | 21.1 | Liver | 21.2 |
Stomach | 26.8 | Stomach | 25.6 |
Leukaemia | 47.5 | Ovary | 41.9 |
Lymphoma | 49.6 - 54.3 | Skin | 42.8 |
Skin | 56.8 | Leukaemia | 43.2 |
Rectum | 57.1 | Kidney and Bladder | 57.2 - 61.6 |
Nasopharynx | 58.5 | Lymphoma | 58.6 - 59.1 |
Larynx | 58.9 | Colon | 59.2 |
Colon | 60.3 | Nose | 60.4 |
Kidney | 61.0 | Cervix | 60.7 |
Bladder | 67.6 | Rectum | 63.6 |
Testis | 74.4 | Uterus | 72.4 |
Prostate | 88.5 | Breast | 79.5 |
You can see that the more lethal cancers are still Lung and Liver, whereas Colon, Prostate and Breast have good 5 year survivals.
Where prostate and breast cancer patients have good survival rates (most patients would not die of prostate cancer), patients with breast cancer have good survival beyond 5-10 years, but in reality most would still have a recurrence 20 plus years later. This explains why breast cancer is still the top major cause of cancer death.
When detected early and treated well, cancers of the breast, prostate and colon become more like a chronic disease that needs regular surveillance.
Risk Factors For Cancer
Smoking and obesity account for the top 2 causes of early death. They affect lifespan not only by causing early heart attacks and strokes but also a higher incidence of many common and lethal cancers. This explains why at every yearly screening, our emphasis is on avoiding weight gain and trying to quit smoking.
Lack of exercise further contributes to another 14 cancers. Regular exercise ( every 3 days) is still the best supplement that you can take, much better than a multivitamin.
Effective Screening Tools
Cancer is a good candidate for screening because of its severity. The cancer must be common enough ( see Table A), and treatment in the early stages must be more effective than treatment in the later stages.
Screening for Pancreas, Lung and Liver is not effective for the general population. Liver cancer screening is effective only for carriers of hepatitis B and C as the lifetime incidence in this population is above 70%.
What is effective for the general population will be:
For Men: Colonoscopy from 50 ( colon), yearly Prostate Specific Antigen from 55 ( prostate).
For Women: Colonoscopy from 50 ( colon) , mammograms 2 yearly from 45 ( breast), Pap smear 3 yearly ( cervical cancer).
For those with a family history of cancer, appropriate screening for yourself ( if any) should take place 10 years before the age of diagnosis in the immediate family member.
For Chinese or Indians with previous history of gastritis, it is important not to delay an oesophagogastroscopy (OGD) if symptoms of dyspepsia continue as it can also mean early stomach cancer.
What about the rest of the cancers? Beyond colon, prostate and breast cancer, many of the cancers are low incidence, highly lethal ( lifespan less than 6 months), or have no screening tool. By sticking to the above screening recommendations, you have prepared and done as best as you could. Every other cancer then becomes a lottery.
Even with the above information, the best course of action when we do contract cancer is to speak to a trusted health professional who can give you another perspective. And you must remember that although doctors can lay out a course of action for you, they are not the ones living through the cancer. You can and may still choose what you deem best.
Case in point, I still remember my university professor who taught about liver cancer – when he contracted liver cancer himself, he opted for neither surgery nor chemotherapy, resigned from office, embraced palliative care early and went quietly 3 months later surrounded by loved ones.
For decades, the private health industry has depended on excessive fear-mongering to generate hospital visits. Select cancers are chosen and awareness drives are done for certain periods of the year. I sincerely hope that at the end of the article I have helped some to be less anxious about cancer, or at the very least, be more open to discussion and not be led on a wild-goose chase in future.
