Data suggest that cancer is indeed winning against modern medicine. Globally, there will be about 18 million new cancer cases - and 9.6 million people will die from cancer - in 2019.
As countries become wealthier, more people get cancers related to lifestyle rather than those linked to poverty. The same scenario is witnessed in Tanzania.
While treating cancer is very expensive - and, most times, it is unsuccessful - cancer prevention in a systemic manner makes sense. As such, this should be our priority. Cancer prevention will also have an impact on other non-communicable diseases (NCDs) like diabetes, heart disorders and hypertension.
So, we need a well-defined systematic approach to prevent cancer. There should also be political will and relevant institutions must be supported. I know World Cancer Day (WCD) is observed on February 4th; but it simply does not make much sense to me.
On WCD there is a lot of fanfare, speeches, slogans and anti-cancer rhetoric that make good reading.This is repeated year after year - but, in reality, nothing tangible comes out of this.
A single day in a year doesn’t increase awareness. In any case, those who really need the education are never reached on World Cancer Day.
On WCD in 2018, the minister for Health promised that a population-based cancer registry would be established. But, today we do not yet have such a registry. Sadly, we even do not have a national hospital-based registry - although it is fairly easy to establish and manage. That’s why I am saying political will is essential.
The primary strategy should be prevention; emphasis should be on primary prevention - which, unfortunately, does not take centre stage.Why? Despite this grim picture, doctors have made great progress in understanding the biology of cancer cells - and they have already been able to improve the diagnosis and treatment of cancer.
But, instead of just waiting for new breaks-through, you can do a lot to protect yourself right now. It is very important to create awareness about regular medical check-ups - especially for people entering their fifth decade in terms of age.
Early cancer detection is possible through screening tests. Once cancer is detected in its initial stages it can be treated. This should be the message to all Tanzanians. Screening should be readily available at affordable cost. The main preventive strategy should be health information and education so that there is change of behavior to healthier practices.
The ‘C-A-U-T-I-O-N’ list of symptoms is used worldwide to create awareness regarding cancer symptoms.
‘C’ stands for Change in bowel or bladder habits. ‘A’: A sore that does not heal. ‘U’: Unusual bleeding or discharge. ‘T’: Thickening or lump in the breast or elsewhere. ‘I’: Indigestion or difficulty in swallowing. ‘O’: Obvious change in a wart or mole. ‘N’: Nagging cough or hoarseness. Admittedly, this is a rough guide at best; but - coupled with specific screening tests - it raises the possibility of early cancer detection and, therefore, better treatment outcomes.
Cancer does not have a specific cause; instead, doctors talk about ‘risk factors.’ If the risk factors are avoided, this decreases the likelihoog of getting cancer. Common risk factors are tobacco use, obesity and diet (red meat vs. fruits and vegetables), lack of exercise, carcinogens in the workplace, viruses (hepatitis, human papillomavirus), family history of cancer, women’s reproductive factors (late or no childbearing, late menopause, early periods) and excessive alcohol consumption.
So, there should be an active population campaign to avoid the above risk factors. If this is done appropriately, there is the real possibility of decreasing cancer incidence and prevalence.
Is the government creating an enabling environment for changing lifestyles? Perhaps more should be done.
There should be people-focused laws, regulations and policies that discourage smoking and other uses of tobacco. For example it is known that chewing tobacco causes oral cancer. What, then, is being done to reduce smoking tobacco?
The same applies to alcohol consumption. This is increasing with the passage of time, since there is no active campaign against it.
Obesity is also increasing due to unhealthy diet - and its business as usual since, once again, there is very little that is being done about this. During my time at Muhas (the Muhimbili University of Health and Applied Sciences), there was a discussion to open a pub.
After all, there was one already in the Dental faculty premises where staff members could relax after a hard day’s work. But, surprisingly, there was no discussion on establishing a gym! Are there enough open-air gym facilities in Dar? This life-style change is a complex issue. But, still - as always - prevention is the best way forward.
Zulfiqarali Premji is a retired MUHAS professor. His career spans over 40 years in academia, research and public health.
