By Dr Caleb Harris
Change is the flavour of the season and everyone seems to talk about it. While we in Meghalaya would get to know if there is truly a change on March 3, it remains to be seen if a change in the political dispensation would really bring about a change in our lives. As a child, I used to be excited about changes in my life, such as a new year, fresh academic year at school, new clothes, and so on. But not all change is pleasant. It was always painful to shift from one house to another or to change schools. Though change for the better may seem pleasant, we might still tend to cling on to the past, feeling hurt.
Apart from the several cancer patients I see daily, during my social interactions here in Shillong, I find a cancer patient in almost every family. As soon as I’m done introducing myself, people connect with me on that thread and share about their experiences. It pains me a lot as this is not the case in the other parts of the country where I’ve lived.Northeast India is considered the ‘cancer capital’ of India, as it reports 3.1% of the total cancer cases in the country, despite accounting for only 1.4% of the population.
Can we expect a change in this predicament on March 3rd? Unlikely, but we can begin the process today. World cancer day, observed on February 4th annually, is an initiative of the Union for International Cancer Control(UICC), which is based in Switzerland. The theme for the years 2016-18 is ‘We can, I can’. It is certain that we can bring about a change in this high incidence of cancer by initiating changes in our lifestyle.
Some of you might be wondering what can be done to reduce cancer, which, as someone commented recently ‘was a result of divine justice’. Quite a lot of people I have interacted with feel that cancer is hereditary and feel that the high incidence of cancer in the Northeast Region may be due to some genetic defects. It is true that some cancers are transmitted hereditarily but the good news is that this is less than 10% of all cancers.
These generally manifest at a younger age and the person may suffer from several cancers. Also these may affect more than one person in the family. However, if several members of a family suffer from a particular cancer, it might also mean that all of them are exposed to the same cancer-causing agent.
While it is insensitive for someone to say that people(cancer patients) cannot compensate for the sins committed against the Unseen,(and he graciously apologised for the comment), I would say that several cancers are the result of sins which people commit against their own bodies and unfortunately for several of them, their bodies cannot compensate for the toxins produced, resulting in cancer.
Meghalaya has a very high incidence of esophageal and hypopharyngeal(parts of the food pipe) cancers, in addition to oral, lung and other cancers. The main cause for all of these cancers is tobacco and other substances like betel nut, alcohol, etc.. People usually tell me about the old man in their village who smoked continuously till the day he died, at the ripe age of 101. But as I said earlier, people respond differently to the toxins(carcinogens) produced by tobacco(and other substances). There is no way one can know about his inherent susceptibility to carcinogens and while research is on to find these factors, it would be safe for us to avoid exposure to these carcinogens in this generation.
Some people do blame us for not doing enough research to find out ways to prevent cancer, despite continued use of tobacco. But so far none has been able to provide even a single benefit for the use of tobacco. I remember, as a kid, watching the advertisements for tobacco and trying to make sense. It was in general portrayed that smoking would elevate the person to the next level in life, but it is baseless.
It is heartening that our government has taken steps to ban advertisements for tobacco, but the message is still spread by these tobacco giants indirectly, through surrogate advertisements and movies. The glorification of smoking by movie stars is a major influence on youngsters in initiating the habit. It is important to note that these companies target youngsters as they are at an impressionable age and they get habituated for life.
The Global Adult Tobacco Survey(GATS) is a global standard for systematic monitoring of adult tobacco use and helps in tracking the key tobacco control indicators. GATS is a household survey of persons aged 15 years and above in all the 30 states and two union territories of India. The first round was conducted in 2009-10 and the second round in 2016-17. This was conducted by the Tata Institute of Social Sciences for the Ministry of Health and Family Welfare, Govt of India.
While 28.6% of all Indians use tobacco in any form, it is unfortunate that 47% of people aged 15 years and above in Meghalaya use tobacco. For men, the figure comes to 59.8%, which means almost two of every three men use tobacco. Though this is cause to worry, we can find solace in the fact that the usage has reduced by about 15% as compared to GATS-1. This is attributed to the curbs on advertisement and the pictorial warnings on cigarette packets. Recently there was an effort by the tobacco lobby to get these warnings reduced from the current 85% to 40% but the Supreme Court has thwarted this attempt.GATS-2 showed that 52.9% of smokers considered quitting because of the pictorial warnings.
On world cancer day 2018, I implore you all to change your habits before it is too late. For those who feel that they have tried and failed, there is a ‘Tobacco Cessation Clinic’ at NEIGRIHMS which can help you through the process. It is difficult, but surely not impossible.
As a society, we must protect our children from getting initiated into use of tobacco, betel nut and other addictive substances.
This survey revealed that the age of initiation for smoking was 17 years. The Juvenile Justice Act forbids the sale of tobacco products to minors and does not allow establishments selling these within 100 yards of educational institutions. The penalty prescribed is imprisonment upto 7 years, with or without a fine upto a lakh rupee. But this is hardly enforced. We have to be the custodians of our society and ensure our children don’t fall prey to the false propaganda of these businesses, whose only aim is to make money, at the expense of our health.
Changes effected today will bear fruit in due season and transform us into a society with ‘less cancer’.
(The author is an assistant professor of Surgical Oncology at NEIGRIHMS)
