Dr. Caleb Harris M.Ch.(Surgical Oncology)
Assistant Professor and HOD,
‘What’s a little formalin in comparison to the loads of tobacco and kwai?’, I responded to a message forwarded to me on social media by a doctor. It was the order issued by the Commissioner of Food Safety, Government of Meghalaya, which stated that in view of fish samples testing positive for formalin, there would be prohibition on ‘fresh’ fish and crustaceans brought from outside the state.
The mention of formalin took us down memory lane, to our first year in medical college. My initiation into surgery started at the old anatomy hall of a Government Medical College in Tamilnadu, where the first lesson taught was to respect the cadaver(preserved human body) which enabled us to learn human anatomy, which is the study of the internal structure of the human body. Formalin is the main component of the preservative used and hence the entire hall would be filled with the pungent smell. The first week was spent sitting around the cadaver, in an effort to get acclimatized to the odour, and it sure helped us.
My friend recalled her experience, at a Central Government Institution in South India, wherein the dissection hour was followed by the lunch break. She said they were neither allowed to use gloves for dissection nor were there any forks and spoons in the hostel dining hall! I was glad to hear it was the same in other medical colleges too.The problem was worse in our college, with the taps in the anatomy hall running dry just around noon, and us not being accustomed to forks and spoons. So she agreed with me, ‘What’s a little formalin!’. I’m sure many doctors would remember their early years, wherein they left the anatomy hall with a layer of formalin on their hands.
Formalin is an aqueous solution of formaldehyde, which, apart from use in mortuaries and laboratories to preserve biological specimens, is also used in the pressed-wood industry, glues and adhesives, and certain insulation materials. It is also used as an industrial fungicide, germicide and disinfectant. The main source of exposure for non-industrial workers is from indoor air, which contains formaldehde released from the wood products which use it. The acute (short term) effects of exposure to formaldehyde are mainly due to the irritation of the airway and lungs and can result in cough, wheeze, and irritation of the nose and eyes.
The chronic (long term) effects are mainly respiratory problems, skin lesions and menstrual irregularities. There is increased risk of cancer too, and the IARC(International Agency for Research on Cancer) monograph classifies it as a Group 1 carcinogen, which means that it has a role in causing cancer in humans. Formaldehyde is known to cause some leukemia(blood cancer), nasopharyngeal cancer and nasal(paranasal sinus) cancer.
Most of the media hype surrounding this ban on ‘imported’ formalin-laced fish is due to its ‘Cancer-causing’ potential, and it is heartening to see this concern for public health. There was an editorial in this newspaper a few days ago, highlighting this incident and the need to have a health policy which would focus on the prevention of deadly diseases. Prevention is the way forward, but there is a lot to be done. While the efforts of the government in protecting the public from such ‘cancer-causing fish’ needs to be lauded, it would be nice if the other carcinogens are also acted upon.
July 27th is observed as World Head and Neck Cancer Day internationally, in an effort to increase awareness about this cancer. The nasopharyngeal and nasal cancers caused by formaldehyde are also part of head and neck cancers, with the nasal cancer involving the ‘sinuses’ which are in the head and the nasopharynx being the part behind the nose.
The bulk of Head and Neck Cancers are seen in the ‘oral cavity’, which is the mouth. Mouth cancers are invariably associated with use of tobacco and betel nut. India has among the highest burden of head and neck cancers in the world and there are no prizes for guessing why. The widespread habit of chewing tobacco is one of the main culprits for this cancer. 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.
GATS 2 showed that tobacco use is reducing in most parts of the country, including Meghalaya, but this is mostly tobacco smoking. The habit of tobacco-chewing is widespread and unless this is curbed, there will not be a reduction in the incidence of Head and Neck Cancers. The use of kwai(betel nut) can also independently(without the use of tobacco) cause oral cancers.
While tobacco, betel nut and alcohol are all group 1 carcinogens, they are used with apparent impunity by all, including minors. The evidence with regard to the carcinogenicity of formaldehyde is weak, compared to the very strong role played by tobacco and betel nut in causing cancers, but still these factors enjoy strong patronage.
If the media would divert some of the many resources it is using in highlighting the formalin-laced fish on tobacco, betel nut and alcohol, we would have lesser cancers in Meghalaya. The state is staring at a big public health problem caused by the high incidence of cancers and it is important to go after the main cause of this problem, rather than be diverted by smaller carcinogens. While the state has banned crustaceans brought from outside, it should also ban the crab(cancer)within, by curbing tobacco, betel nut and alcohol.