By Dr. Caleb Harris M.Ch.(Surgical Oncology)
The answer to the above could be Yes, No, or Maybe.
It sounds a great idea, right? This is what the medical community thought when it embarked on what is called ‘Screening’- running tests in healthy individuals to detect a disease before its symptoms manifest. It was thought that catching the disease early, even before it starts troubling the individual(making him/her a ‘patient’) would enable the person to live a long, trouble-free life.
One of the earliest screening was done for detecting psychiatric disorders in recruits to the US Army. This was performed using a questionnaire which was later termed as the NSA(Neuropsychiatric Screening Adjunct) Test. Tests for early detection of diseases like Syphilis(a sexually transmitted disease) and diabetes followed. Screening for cancer started with the Pap smear for uterine cervical cancer in the 1940s and 1950s, followed by Mammography for breast cancer. However, screening for breast cancer using Mammography was not found to be very effective.
To understand this, I want to cite an example used by Siddhartha Mukherjee in ‘The Emperor of all Maladies’. Hope and Prudence are identical twins who live together. In 1990, breast cancer cells develop in both of them and keeps growing slowly. While Hope opts for a screening program and undergoes a mammogram in 1995, Prudence-true to her name, refuses the mammogram. Hope goes through a mastectomy(surgery) and chemotherapy. Being the positive person that she always is, she is a successful ‘fighter’ till she is found to have a recurrence in 2000 and dies after brief treatment. Prudence noticed a breast lump in the year 1999 and underwent mastectomy and chemotherapy, but she also succumbed to the disease in 2000, around the same time as her sister.
At the joint memorial service held in the honour of the twins, the question on everyone’s mind was, who was the more prudent of the twins? Though both had similar length of life, Prudence probably had a better quality of life. Screening the entire population has resulted in several women who may never have been troubled by the cancer during their lifetime being branded as a ‘cancer survivor’, after being subjected to treatment which is not pleasant. While the number of patients with breast cancer increased because of the women with small tumours being detected, there wasn’t a significant decline in the number of women dying due to breast cancer. Hence the focus shifted onto screening a smaller target group, instead of the entire population.
A large study was conducted in Kerala, wherein trained healthcare workers examined the mouths of patients in some parts of the state, which was compared with other localities where this was not done. It was found that while such screening was not found effective in the overall population, in people who used tobacco, there was a reduction in the deaths due to oral(mouth) cancer.
The National Lung Screening Trail was done in the US to find out if performing annual CT scans would detect early lung cancers more than chest X-rays. And yes, it proved that those who underwent CT scans had a 20% reduced risk of dying due to lung cancer due to early detection of their cancer. But it is important to note that people were eligible to participate in this study only if they had smoked at least 30 ‘pack-years’. If a gentleman smokes one packet of cigarette a day for one whole year, he has clocked a pack year. In effect, this study was effective only in patients who smoked cigarettes. Or, in other words, people are allowed to use carcinogens (tobacco) and these tests are being done to ‘minimise the damage caused’.
World No Tobacco Day is observed on the 31st of May every year, since the year 1987. An initiative of the World Health Organisation(WHO), this year, the focus is on “tobacco and lung health.” The campaign will increase awareness on:
- the negative impact that tobacco has on people’s lung health, from cancer to chronic respiratory disease,
- the fundamental role lungs play for the health and well-being of all people.
The campaign also serves as a call to action, advocating for effective policies to reduce tobacco consumption and engaging stakeholders across multiple sectors in the fight for tobacco control.
So, Does early detection of cancer really save lives?
Yes, if the cancer manifests itself through symptoms(like breast lump, difficulty in swallowing, etc.)
Does early detection of cancer through screening save lives?
Maybe, for cancer of the uterine cervix, screened using vinegar (VIA test).
Does abstaining from tobacco save lives?
Certainly YES, as about two-thirds of all cancers in Meghalaya are caused by tobacco.
(The writer is Associate Professor and Head, Department of Surgical Oncology, NEIGRIHMS, Shillong [email protected])