A better understanding of cancer among a wider segment of the population could lead to a significantly better approach to combating the disease, says Dr. Padmajeeva Ganepola M.D., F.A.C.S., an eminent Sri Lankan surgeon and researcher now based in the USA.
As Medical Director at the Center for Cancer Research and Genomic Medicine at the Valley Hospital, Ridgewood, New Jersey, and as Associate Clinical Professor of Surgery at Columbia University, New York, Dr. Ganepola has devoted much of his professional life examining the genetic components that are known to cause cancer.
In this interview, facilitated by the Ceylinco Radiation Treatment Centre, Dr. Ganepola explains in layman’s terms what cancer is, and how advances in genetic research can help prevent or delay the manifestation of the disease.
Q: How does Sri Lanka compare with the USA in terms of dealing with cancer?
A: Sri Lanka is entering the league of developed nations in terms of health indicators, but lags behind in the area of public awareness especially of diseases such as cancer. Cancer is no longer a disease to hide from. There is a lot more information available about the disease now, and in many countries remedies are planned with the participation of the patients. In Sri Lanka, remedies are still largely planned and implemented by the physicians, and the patients accept this approach because of a lack of knowledge about the disease and the treatment options available.
The most noticeable difference between the approach to cancer in Sri Lanka and many developed countries is in the lower emphasis here on prevention and early detection. There are three key aspects to dealing with cancer. The first is prevention, which is obviously the most important aspect. The second is early detection, which significantly improves the patient’s chances of beating the disease. The third is surgery, radiation treatment and chemotherapy.
Q: In Sri Lanka, there is very little investment in prevention and early detection. These could be important segments of a national policy and programmes to combat cancer.
A: The first and most important requirement in the battle against cancer is for people to gain a better understanding of what cancer is. Cancer is a genetic disease. There are about 20,000 genes that control most of the proteins needed for body functions. Any variation in the process of the formation of these proteins can adversely affect cell metabolism and cause cancer.
Till now, it was thought that cancer was caused by higher cell proliferation that caused a lump. But our research now shows that it is not just high cell proliferation, but the body’s inability to maintain the dynamic balance between cell growth and cell death.
Every second, one million cells in our bodies die and are replaced with new cells immediately. When this balance between death and rebirth is destroyed, cancer is formed. This balance between cell growth and death can be affected by the environment, the parents’ genes as well as unknown conditions. Of the 25,000-30,000 genes, 99.6 per cent are common to all people. The balance 0.4 per cent is responsible for the differences between people, from characteristics, to intellectual differences and resistance to disease. The genes that can cause cancer are also in this group.
Prevention of cancer is a broad strategy that should start at the age of 20, with avoidance of smoking, higher consumption of vegetables, avoidance of greasy foods and maintenance of a healthy lifestyle. It is a long process, and the responsibility of governments to educate their citizens on what can be done to prevent or reduce the chances of getting cancer.
The next stage of the process is early detection. When one cell deviates from normal division and becomes cancerous, the mutant cell will keep on multiplying and become a cancer. This can take two to five or as much as ten years. However, this activity can be detected at a very early stage, when it is microscopic. Imaging techniques have evolved a lot, and the new PET-CAT scan technology for molecular imaging can detect the formation of a cancer when it is less than 1cm in size.
When early detection takes place, the cancer can be destroyed with radiation or removed surgically with a very high degree of success. Surgery and radiation are the primary forms of treatment of most forms of cancer, except for haemotological cancers for which chemotherapy is the primary treatment. Chemotherapy is also used as an adjunct to surgery and radiation in the treatment of some other cancers.
Q: How could awareness be created on the importance of prevention and early detection?
A: In many developed countries, there is a lot of emphasis on generating awareness of the importance of prevention and early detection. In the USA for example, the Surgeon General maintains a website that enables people to have an assessment of their individual degree of risk of getting cancer as well as other diseases. The website https://familyhistory.hhs.gov has a questionnaire that when completed, generates a Family Health Portrait, a tool that enables medical practitioners to assess an individual’s risk of developing not just cancer but other genetic/hereditary diseases. Armed with this assessment, the individual can discuss with his or her physician what needs to be done to prevent or delay the onset of diseases that have been identified as risk factors.
Q: Can people in Sri Lanka use this facility?
A: Developing a family health portrait by visiting this website can be done by anyone, anywhere in the world, so its benefits are not limited to people living in the USA. If Sri Lankans also do this and become more aware of their individual health risk factors, there will more pressure on physicians to acquire more knowledge on cancer and genetics.
In the case of cancer, ageing is one of the biggest risk factors. Childhood cancers are generally manifested before the age of 10. Thereafter, cancer tends to be found in females in the 40 – 45 age group, and in males over 50.
Therefore, people in the 10 to 40 age group are those who should be focused on in efforts aimed at cancer prevention. People in this age group, who are assessed and found to have a low risk of getting cancer, have to be made to understand that if they smoke, drink alcohol excessively or consume a lot of greasy food, they too could be joining the (cancer) ‘club’ later in life, even though they are in the low risk segment.