COVER

STORY
i.
i
CANCE,R
-
COTII{TRY
Indians
ignore
warning
signs
at
their
own
peiif as
t"ne Oisease
becomes
a top
killer
By Damayanti
Datta
THE OEII{I STATE
CANCER
INSTTTUIE
-:::--"
-.-- .
solitary ngtlrlr {,alks do
rn
the beach in
Goa. adogathcr hccls, her
(iropped
hair a
iangl0 in thc Janua!'ywind. Chemotherapy
has takon away hcr onco-fhmous tresses-
,\ lilb iDtcrl'uptcd by thc shadow of(anccr
aljust
:12.
But shc has beeD luck]'. l)cclarcd hcc of
(iar(cr
aftcr a
]'car
ofintensive trc atmcnt, shc is now
bouncing back to life.
"l'm
notjust a sun'ivor I'm a
(:rusadcr
tbr carrcer-" says N{anisha Koira]a. onc
(]1
Boll].i,vood's n]ost-lo,red heroines of the'90s.
hdia ulgentlv needs crusadels. ,A. caircer spectre
haunts the naii r. The iconic disease of our time
comcs withoui warl]ing. atlffks those who abuse
thcir bod\' rurd ilrose wh{) doII 1, those who have can-
ccr in the fanily and those \4'ho don t. -And lhe num-
bels are rising. "Cancer
is going up in I.*o-" *"o.'"!'"
Prime Minister Manmohan Singh sent out the wam-
ing at two
public
lectues ihis m.rnth, he gave voice Lo
\,vhat countless doclors belie,ve but don't
publi{iy
sa}'.
lndia has alwaJ,s fell good
about its canccr stalisti(:s,
compaxed to ihe West. Not anynore. Death rates are
ta]ling in the lvest. while "70 per
cent ofcan ccr dcaths
are reported in the developirrgworld." as lhc PNI said,
with a fiith coming from India. Paris of the countr,a,
have the world'.s highest cancer rates. Bu[it's notjust
the nunlers. New studics indicate alarming ne\a,
paF
tems ihal foretell a coming cancer tsunami. Are rle
losing |he ivar on canccr?
I1.s not a
qucstioD
with an easy answer: Ilasn't
Koirala fouglrt hcr way back 1r) recovery? Diddt \",e
Fhobgdphby CHANDRADEEP KUIMAR
I
rntness Yu{Taj Singh, 32. powering
back to cricket after beating back
germ
cell cancer? Hasn t actor Lisa Ray, 41,
bormced ba.ck io a winning career aner
her ag$essive bone marrowmyeloma?
Didn't scientists
just
celebrate land-
mark cancer medicines like Gleevec.
Herceptin and Avastin? Despit those
happy milestones on the eve ofworld
Cancer Day, February 4, hope seems to
mask some very real issues ihat make
thjs relendess enemy even harder to de-
feat. carcer has doubled iis gdp over
the world in the last 20 years and struck
deep roots in India, from 800.000 lives
in 2001 io 3.3 million now, says the
World Hea.lth oryaiization {wHol.
India
is far ftom wfiming the war
DANGER SIGNS
Check out the sigls that spell dangen
r Ca.ncer is now one ofthe top causes of
deaih in India, aner heart attack, up
from seventh
position in 2000.
r India has some of ihe world's highest
incidences of cancer: cervical,
gal
bladder, oral and
phar]'nx, which are
also the most common.
. 70 per cent lives are sNfied out in ahe
first year in Inaha, due to late detecton.
r 80 per cent
patrents consult doctom at
a stage when recovery is rarc.
. 71
per
cent ofdeatbs occ(u in the
pm-
ductive age bard of 30-69 in India; 50
per
cent deaths arc a.bove 70 in US.
-
r 15 per
ceni
patients axe childretr and
young addts in Irdia, compared to the
global
average of 0.5 per cent.
r 50
per cent ofcancels now cau-sed by
lifesiyl choices. obesityto tobacco use-
MISSED CUES
one moment she was on top ofher life
and the nen she was fighting for it.
Koimla3 or y synptom was her ex-
pardingwaistline. Try as she might. she
just
couldnt
get
dd ofit. She hit the
g/In,
did Pilates, but her stomach remained
stubbonly bloatrd. She wondered ifold
age was catching up
prematrely. But
ihai, as ittumed out, was the bigrd flag
for ovarian carcex The
prognosis was
hard to believe on Noveniler 21, 2012.
when she fainted at a
public eveDt in
Katbmardu, Nepal. Ovaxian cancer is so
notoriously stealthy ihat thee ir four
women miss the siSns mtil it3 too late-
Celebrity caicer
paiients are busy
,16
NohroDAY. F.BRuARYro.ro
Z Gangtic
plain (UP, Bihar, West Bengal)
Whai Gall bladder, head and neck cancer
wlry Polluted water, sediments in the river,
diei rich inanimalprotein orfish
& Madlry" Pradesh
What oral cancers h8hest
Why Tobacco and
pan masala
North-east
What Highest cancer rate,
especially of oesoPhagus
Why Tobaccq household
burning of firewood
2. West Bengal
What[ung,orinarybladdercancr
lYhy Ah and water
pollution
3. South and coastal India
Uhat Leads in stomach cancer
Wry Diet fich in spicq salt
World's highest rates of cervical,
gall
oral,
pharynx
cancers are in lndia
Causes ar unknown for
20O different cancers like
leukemia,
pancreatiq
eyebll, bone
@
GEOGRAPHY
OF CANCER
6. Pllnjab, t alwa belt
What All cancers higher
than avragq espcially
kidney, urinary bladder.
5, Guiarat and
Rajasthan
What Head and
lNhyTobacco and
pan
masala
4 Goa
wlry Polhnion,
psticide,
ioxins in food
What Leads in colon cancer
Why Red meat, alcotbl
andiobdcco
tack of
personal
hygiene causes
intections like HPv
which could lead to
Hepatitis C and B
Tobacco and
pan
masala,
for lung and oral cancers,
moslly in men
WHAT
GAUSES
CANCERS
'@d'lM'k'41fu0@qi\4fuM
@
12WARNING SIGNS
The symptomsdo not necessarily mean cancer,
butdon't ignore if they
persist
beyond three weeks
Prsistntheada6he
Shortness of breath
@
A cough or hoarseness that refuses to
go
O
Indigestion or difficulty in swallowing
G
Lossofappetite
@
A sore or bruise that does not heal
O
A change in bowelor bladder habits for no reason
(}
unexplained changes to fingernails
0
Bbod in urin. stool or spittl
I
A mole that changes shape, size or bleeds
O
Unxplained weight loss or tirdness
Q
New lumps orgrowths onskin
GRIM REALITY
Indians consult deaths between 30-69
patients die in the
doctors when years in Indiai in US, first year in India,
recovery is difficult 50% deaths above 70 due to late detection
It can lead to
I OTYPESOF
IJCANCER
CHANGING
o
O
PATTERN
AIISTOMACH
the rise
LUNG
up in the
meuos
ORAL
cancerrising
inmen
BREASTcancer
zooming in
younger
fmales
Increasingtrend
ofcancerin upper
part
of stofiach
Decreasing trend
in lower part
of
$omacn
CERVICALcancerdown
Genetic,
mostly brcast
Dit and
poor
food cause
$omacn cancer
cancer from lifestyle
cancer in minors
factors, obesity to
in India;
global
rcbacco use
avemge is 0.5%
in breast,
large
ntestine,
dny, mostly
n the rnetros
b''4Na|hMnl!|hdhrA4Ml.n.h|4l|t:edft',at'kfuLfurqhffue
TBRUARYIo io!
. NorAroDAY 47
COVER STORYM
spreading the word: Don't miss those
cues. lisa RaY had
gone for a rouimc
blood test in 2009just because she was
.iiled
of being tfed all the time .
Yu\raj Singh weni though "months of
denial" before being diagnosed
in
2011 . "For over a yeax, mY system had
ejected..- most ofwhatI at or drunL,"
he \irote in his 2013 book, Z,ire tes, o/
my ltle. Yurraj is now proac[vely cam-
paigning for carly delection though his
cancer non-plofit, Youwecan.
"The biggest poblem bebind the
nsing nunrbers is that most Indians
don't suspect they may have cancer.'
says Dr Hsril Chaturyedi, chief of Ma'x
Institute of Oncology Delhi. as well as
Indian Csncer Society. This exception-
any
poor
'$rspicion
indcx leads 10 de'
layed diagnosis ard treatrnent.
"lf you
have chest
pain, you a.re
prompdy tal(en
to hospital. But cancer happens insidi"
ously.
'
he saj,s. For a.nything that con-
tinues over thee wekFa lump, an
episode ofbleeding, arl ulcer, a cough
one needs to check for cancer: But
we continually come aooss
patients
who change doctors when asked tD
go
for a scleening or a biopsy,' saYs
Dr Chaiunedi. In a mote liierate
Karala.
,lO
per cent cases are detected
eaJy, mearting fewer dealhs.
INTIMATE ENEMY
"If left untreated, cancer car
go
through three srages," says Dr Rajai
Badwe, director of Tata Memodar
Hospital & Cancer Research Inslitute,
Mun$ai. Firsi. cancer cels multiply
quiokly, form a llunp at one
place. cre-
ating iiny blood vessels around il for
blood, oxTgen andnoudshment.
Iithen
stads sprcading: Ffst to l]mph chan_
nels, or the network offluid ihat drains
the body's cels. then the lymph
glands,
and then the blood. Stage 3 meaJls it
has sprcad to ihe llmph nodes a.nd
Stage 4 indicates distani spread. But
not a.ll carcels behave the sallle Some
arc ag$essive snd fdst-growing, while
some
$ow
slowly.
DEATH BY DENIAL
If tha fust baltle of cancer is against
surpris, the othet is against denial.
Cancer is a disease that c-hallenges the
fudamenta.l!
of onet existence: How
onc looks. fecls,lives, work and loves.
Paiients somctimes expcrience
paraly-
sing feax of invasive treatinent, disfig-
urement, economic damage and deaih.
Over 50 per cent patients ofDr Hemanr
Malhotra, head ofmodical oncology at
Jaipu's Sawai Man Singh Medrcal
College and Hospita.l, do not approach
him on timc due to an il-placed belil
that a canccr
patieni will die and treaf
mnt is useless. "Itt as if the word
'carcer'means death, he says "This
pessimism exists even among hea.lih
workers lnd
makes
paiients and their
families refuse specialjsed treatment
"
GP FALLS SHORT
''cancer
is the or
y disease where the
ftst treatment
has to be the besi ileat-
ment," says Dr G.K. Rath, chief of the
cancer depa$ment at AlIMs. Delhi, as
well as ofthe Naiional Ca.ncer Insltuie
\\'ith only about 1.200
qualiffed oncol-
ogists in the counh-y, the tust docior
ihat 60
per ceni cancer
paiients go to is
generally ihe
general practitioner
(GPJ
Ca.ncer is not something ihey look foa"
he says. Paiienis then lose valuaue
time before finally reac-hing an oncolo'
gist. "Ovr 75 per cancer cases can be
checked. if the right treatmeni is
sought eaJy," sat6 Dr Raih.
Beauty Dewan, 39, of Bardhaman
in wesi Bengal, was 32 when i]le
Pain
<<
SALIL M,ATHUR 33 FA dAbAd
TIPE 0F CAIICER [,4ultiple-organ
cancer
TETECOM TI{GII{EER
He diiln't care much for the
pain in his left shoulder till he
could not lift even his bag.
Tests in May 2oo9 found a
fast-spreading cancer. Aft er
four surgeries, enilless sessions
of chemotherapy and radiation,
Mathur has been free of malig-
nancy since 2011,
F
<<
ANUP-r'x{ KHAN|*A 3 Delhi
TYPEoFCA CER Colorectal
HR PROFESSIOIIAL
She thought she had piles or
fissure brt an early colonoscopy
revealed cancerin early 2oo9.
A surgery removed the organ a
few months later and she has
been cancer-free since. Except
foi swimming, there isn't much
sh can't do now.
"It
was not
easy. But I am alive, for myself,
my husband and two sons."
began in her lolver a-bdomen. An ultra'
sonogtun revealed ffhoids, for which
she rvas put though a partial hystrec-
tom]'. But she was not told that the pro-
cedure required her to go for annual
screenings and Pap iesis to
guard
aganBt cenical carcex And that is pre-
ciscb shat happened to her later
Unlike the US, India does not hav
heallh policies
that include mardatory
screenings or mammograms.
''Oncology
isn't a major paxt of the
medical curdculm in India. cP.i are nol
CANADA
WcovensroRYM
ALASKA
Colorectal
NORWAY
RUSSIA
0rul,larynx,
DENMARK
Allcancers
JAMAICA
Proatate cancer
Thyroid cancer
in Yl/onen
ACROSS
THEWORTD
Places where cancer
is most reDorted
hainedto look for signs ofcarcer," says
Dr Madhuchanda Kax, oncologjsi with
Peerless Hospita.l, Kolkata. In a Studyto
test the awajeness of
physiciaN a,bout
lung cancet
publshed in the Joumal of
Indian Aca.demy of Clinical Medicine in
2012, Dr Kax seni out a
questionnaire
to 101 cps in ight states: About 91
per
cent admitted they were unsure of
diagnosing llmg cancrs eaxly.
COMEATZONE
\4fith 700,000 deatbs, 1.1 million new
cases every yeax. 3.3 million patients at
any
given
time. cancer has emerged as
a leading kiler for the ffIst time, snuff-
ing out 70 per cent younger lives. \4'ith-
>>
DEEPIKA PHUKAN
78 Gul{ahati
TlPt 0tCAICIR Ereast
A|THOR,TNA SI.ATOR
'People would nanate stories
of cancer patients, how they
trieal every doctor anal hospital
anal
yet
the enal was
paiDful
death. 'But I will not die,' I told
them." Diagnosed with cancer
in Januari 2006, she was freed
of it in a
year.
in the nerl decade, it will replace heafi
disease, \auo forecasts. "Cuing cancer
has
provenclifrfl t because it3 notjust
one disease.' says Dr Arvind Kumax,
head of Institute of Robotic Sugery at
Sir Ganga Ralll Hospital, Delhi. "It's a
complx.gtoup of 100-plus diseases
that we call cancer."
According to some, the raw nurn-
bers look blgh because longevity has
gone up. and cancer is typically a dis-
sase of old age. But even using this
analysis, the stark rca.lity is that the
percentage of some ol the most com-
mon canceN in India---.cervical.
gal
bladdea olal and
phaxJ'rx-is the high-
est in the world. According to Irdian
Comcil of Medical Research's Tbreg
Year Repofl of Population-Based
Cancer Registdes 2009-2011, the hgh-
esi rato of ca.ncer is seen in the Aizawl
district of Mizoram-168.2 men and
149.5 women per 100.000. "In Megha-
laya s Bast Khasi HiIs, 30
per cent
women suffer fiom oesophageal can-
cex while 20 per cent in the entire
state axe prone to it " sals Dr A.C.
Kataki, director of Dr B. Borooah
Cancer Iistitute, Guwahati.
Dr Ch. Mohana Vamsy, chief su4i-
cal oncologist with omega Hospital in
Hydem.bad, traces the upsuge: Aooss
the Nofih-east, adolescert $roking
has &amatica.lly
pushed up oesophai
INDIA
AFRICA
Liver,
cervical,
Dreast
cervical,
gall
bladderand
pnarynx
SOUTHAFRICA
Breast
(male),
oesophageal cancer
NEWZEALAND
Bowelcancer
;:\:
7;
50 rNoAroor
'
FsRUARrro zoE
geal
cancer In the Gangetic bolt, inclu-
ding Benga], Bihax and Uttax Pradesh,
ga.U
bladder cancer is dsing. No one
quite
hmws whether it is due io a diet
rich in animal
Fotein,
or tuh, or sedi-
ments in the river. Stomach canccr is
more prcvaleni
in souiherD India, pos-
sibly due to the consrunption ofpicktes
wiih larger anounts of sa.lt and spices;
llmg carcer is dsirg in metropolitan
India because of inffeased tobacco
usage and air pollution_
Researchers
also say cancer death
rates ir India are alout 30-40 per cent
lower in adults thar those in rhe US or
the UK. Yet here too. the complete pic,
tule is disappointing.
MDre people
sur-
vive longer with cancer in ihe West. In
India, 70 per
cent lives arc snuffd our
in the very 6rst year. A wro repo
shows cancer monality in India has
been growing
by 1 1 per cenr armually.
PERILS
OF PROSPERITY
So why axen't we wiruring this decades-
old war? And what can we do to tur.n it
aromd? The clue lies in ihe fact
that most new cancer cases a-re caused
by lifesiyle charges. As Dr Arvind
Kumai sals, There is ar increasirg
frend towad carcer relaied io afilu"
ence." Breast cancer is a classic exam-
A
RAMAC} NDRA SHETTY
/\
50 Bangalore
nPE 0F CAiICER lymphoma
CAIICER AWAN[NEsS CAMPAIGfl EN
"At
first the doctor told me that
T-cell cancerisn't cured. It was
difficult to deal with, especially
when I thought ofmy family. But
after six chemotherapy
sessions,
thb tumour shrunk and I rcalised
there as hope." His treatment
went on for six
yea$
and finally
in 2op, he was cancer-free.
ple.
Women are geiting
married later.
having fewer children, and heasrfeed-
ing them less. Obesiiy, smoking and
higher alcohol inia.ke are a part
of the
urban woman's lifestyle, incleasing the
risk ofbreast canccr by negatively im-
pacting
certain hormones and pro-
teins, sals Dr Ka-r.
"Pollution levels are high, food
ha.bits axe not hoalthy, sexual habits
have changed, and people
have lost
connec.t with whar we used io call
healthy living," sals Dr Vansy. That is
one ofihe rcasons why t]rc age proffle
of cancer is coming down. A decade
back, cancer in a 4o-something was
lmusua.l. Not an)more. "Neaxly 80 per
cent of my patients
were people
alove
50 ihen," says Dr Kumar. "Now I a.lso
teai teenage$ and 20-somethings."
FOOTSOLDIERS
OFTHE FIGHT
For those who rouiinely, and oftn with
very liitle rcsouce, treat the throngtng
crowd of patients,
it's a battle to keep
hope alive. As a student in the '70s, Dr
Chaiurvedi had learit a rode word sur-
geoDs
used:
"KDB
or Hnk, dekho,
bandh *aro
(open,
check and stitch
up)." with rudimentary Undelstanding,
seven oui of 10 times, sugeries could
not b completed. 'We'd open the stom-
ach tbinling itt
gastric
cancer but ffnd
ii has sFead to other orgais," he says.
Those dals axe gone.
Wth cr-pEr
scars and ns in everJday practice,
therc
js
no nasty surprise at the oper-
ating talle allj'rnor. But the cost is
siill beyond most India,I)s. Er?efis axe
working towards o.?erimentt iflvolv"
ing basic science. One such reseaxch by
Tata Memorial doctors is a simple
sffeening progra.Inme
lor cervical car-
cer using vinegar. "It has holped reduce
deaths by 31 per
cent in a group
of
150,000 poor women," says Dr Badwe.
LASTCHANCE
"Everlthing gives
you cafter. There's
no cue, there's no arswer," B iish
rccker Joe Jackson croorcd in the '80s.
Much of cafferb futul'e now depends
on the patient.
lifestt;le changes and
awareness about one's own body.
Kotuala spent a year of sleepless
nights and feax: Of death, disffgme-
ment and chemotherapy. But cancer
has given
her a second chance. Now
she warlts lo fulffl a.lt her dreans, a.11the
work that was to be done, all the time
to be speni wiih loved ones. She hasjust
one simple message: "Don't a.llow can-
cer to ta.k you
by suprise."
wM
glhani
SinEh, Kapshik D*4
M.Ilnl Baaqke, Sontli Ach*je,
Amawth X, Mand aud Rohlt Patihar
To tweeton ih s story, lse
ightasainstcancer,
ogonto
Lww.indiatoday.inft
anisha,cancer
For surv vors siories.log on to
www.indiatoday.in,/suruivoFtates
For Mailslra Koi.ala s accouniol her
EBRUAR ro.r!
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rNDArooA\ 51