This World Cancer Week, let's separate the myth and reality surrounding it

Top doctors untangle facts from speculations, assumptions and plain fiction on the eve of World Cancer Week. Plus a glance at the latest cancer stats and research. 
 

Published: 09th February 2020 05:00 AM  |   Last Updated: 08th February 2020 10:43 AM   |  A+A-

cancer

For representational purposes

Fake, fun and fantastic, myths usually tell us something about why the world is the way it is. But believing myths about cancer can be outright dangerous. Consider this: cancer is contagious and you need dollops of positivity to beat the dreaded C-word. Or this: cancer is caused by a fungus and it’s actually your body’s attempt to protect itself from the infection. From coffee to carbonates to cannabis, millions of pages on the internet tell us every day about “miracle” cures for cancer. And it is hard to distinguish fact from fiction, because few illnesses cause as much terror or have as many misconceptions that refuse to die. Here, some of the country’s leading oncologists bust old myths and bring new hope, as an explosion of new research changes the way cancer is perceived, understood and treated.

Dealing with cancer means making some tough choices. How you decide to seek medical help will determine your chances of cure. Hence, education is vital. The most common concerns patients come to me with are often some of the biggest myths. I find it painful that the myths are very much alive even among the educated classes. I make time to engage with my patients to dispel the misconceptions and to create awareness about the bad effects of these myths. Remember, you have a far better chance of beating the disease if you can dispel the fallacies and false notions.

Myth  Biopsy can disturb cancer cells and cause them to spread to other parts of the body.

Reality

It disturbs me that people still come to me and say, “I don’t want to do a biopsy.” The truth is: there is little reason to worry that a biopsy allows cancer cells to spread within the body. Medical evidence shows that this is unlikely. In fact, patients who have biopsy procedures to confirm their diagnosis and determine the cancer’s stage have a better outcome and longer survival than patients who do not have a biopsy. 

The point is, how can you diagnose a cancer without biopsy? Cancer treatment starts only after biopsy. It is the first landmark event in the definitive diagnosis of a cancer. That is crucial in determining and planning the correct treatment for a patient. If a biopsy indicates a benign disease, the patient is spared unnecessary treatments. 

Dr Harit Chaturvedi

Biopsy may involve discomfort and bleeding, but the gain far outweighs the risks. I ask my patients if biopsy is responsible for cancer spreading, then all the people coming to me should have initial stage cancers, since they haven’t done biopsy as yet. I bring in their own examples: how come your own cancer has spread, as all the imaging, MRI, CT and PET scans show, although you have not done biopsy? Yet faith in this myth continues. It is a key reason why treatment gets delayed in our country. We have to understand that cancer does not wait for any procedure to spread. 

Myth  Chemotherapy means the cancer is terminal. Hence, avoid chemo.

Reality

The second set of cancer myths I come across revolves round chemotherapy. My patients ask a lot of questions about it: they want to know if chemotherapy means the illness is terminal, if the side-effects of chemo will completely disrupt their life completely, and if chemo is really worth it. A lot of patients do not wish to go through it.

The truth is: chemotherapy certainly does not mean a cancer is terminal. It is essential for many cancer patients. The more advanced cancer you have the more you need chemotherapy. In fact, chemotherapy is often a preventive measure to prevent recurrence and to improve the odds of cure. It also ensures faster recovery. Chemotherapy has evolved considerably over the decades. The drastic side effects are not as prevalent today. It does not disrupt a patient’s everyday life the way it used to once. With the advances in chemotherapy, more and more people are surviving and doing well after cancer treatment.

We need to understand that cancer is something that happens in all multicellular organisms—from the smallest hydra to the biggest whales. Cancer is more common in animals that are domesticated or in the zoo, because they live longer than those in the wild. Studies from India have analysed fossils of dinosaurs that suffered from cancer. Cancer is a disease of cell regulation. In multicellular organisms there are many cells, some of which become bones, some tissues, some the brain. In that process of evolution, things can go wrong. And sometimes they can become uncontrollable. Cancer is such unchecked cell growth. 

Dr Mohandas K Mallath

More recent studies show cancers are caused by three broad groups of cell alterations: the smallest group is that of people born with some genetic alteration that runs in the family. It makes up about 5 percent of all cancers. Of the environmental factors, the biggest is tobacco, which causes damage to the DNA—cigarettes and passive smoking, chewed tobacco, hookah, dant manjan—making up 25 percent of cancers. The next big group is infection, which is coming down now as hygiene is improving. The big ones are papilloma virus—a sexually transmitted disease, from the male to the female—it takes about 30 years to manifest, from pre-cancer to cancer and then to metastatic cancer. In the liver you get Hepatitis B and C, from mother to child.

Hep C comes through transfusion, tattooing. Then there is the Helicobacter pylori, a waterborne bacterium that is usually acquired in early life. If one is exposed to other carcinogens, like salted meat, cigarette smoke and so on, it triggers the cancer. Infections are responsible for 15-25 percent of cancers in India. The rest of the cancers are now thought to be random occurrences. Our body is a continuous workshop of cell regulation, replacement, regeneration: when cells get damaged, old cells are removed and new cells grow. The skin, the bone marrow, the linings of the gut, bladders and the kidney—are changing continuously. Stem cells provide new cells to the body as it grows and replace those that are damaged or lost. They can divide over and over again to produce new cells. As they divide, they can change into the other types of cell that make up the body. And just sometimes, things go wrong—at random—that have carcinogenic potential. That means, anyone can get cancer. Call it plain “bad luck.” 

Myth Cancer is fast turning into an epidemic in India.

Reality

That to me is the biggest myth. You may see a large number of cancer patients in hospitals. You may know a lot of people with cancer. But the epidemic is more apparent than real. Cancer is a disease of older age. It usually picks up from about age 40-50 and reaches a peak at about 70–80. What has happened in India is that our population has exploded and we have a substantial number of older people. There are a 100 million people above age 60.

The number of cancer patients is also increased. This is typical of what we call an “epidemiological transition”. That means, once people died of infectious diseases—typhoid, malaria, dengue, cholera—and so life expectancy was very low. In 1947, life expectancy was about 30-35 years. Now it is almost 70 years. So you don’t just have more people, you have more older people.

Most importantly, we have started doing lab tests—endoscopies, scans, screens, biopsies—so deep-seated cancers are being picked up. Even 30 years ago, there was no opportunity for this. This is why you are suddenly seeing so many people with cancer. The proof for this lies in some very beautiful studies done 100 years ago by British doctors in India. They had done autopsies on a lot of unclaimed bodies. And the autopsies showed a high rate of cancers—almost as high as it is today. The Mumbai Cancer Registry, which was started in 1962, has been monitoring cancers in the city continuously for nearly 60 years. You will be pleased to know that the rates have not really increased. The actual numbers have gone up, as the population of Mumbai has gone up enormously, but if you standardise the number of cancers in corresponding age groups and compare, there is no increase at all. On the contrary it has decreased a little bit, which is very reassuring.

Myth AYUSH can cure cancer.

Reality

Every day in my chamber, I see patients who have been sitting on their symptoms for months, sometimes years, thinking it would not be cancer. Their doctors have not told them it could be cancer and treated them for dysentery or piles, instead. And when things get out of order, they come to oncologists. But by then, it’s often too late. There is a serious lack of awareness among people and among AYUSH practitioners. The bottomline is, if you have symptoms that continue for weeks, do not go to doctors who cannot do biopsy. You can’t diagnose cancer without doing biopsy.

Myth Cancer is a death sentence.

Reality

People panic once cancer is diagnosed. They seek out immediate treatment, go to people who are not experts, do not understand the upsides or downsides and end up getting treatments that harm them more. One reason could be that they are driven by the messages they hear. So the first thing to remember is that cancer is not a death sentence. Don’t panic. You must do your research and find out people who are doing the right treatment and go to the right place. Cancer cells grow slowly, dividing every three to four weeks. It is not that scary. You have four to six weeks time to find the right place. The best treatments are inevitably found in places that have multidisciplinary teams.

Myth Cancers spread with intervention.

Reality

The biological nature of cancer is to spread. That’s why cancer kills. All cancers will spread depending on its tumour biology. Some fast and some slow. The reason why there is an apparent spread after an intervention via biopsy or surgery is because those procedures can reveal the spread more accurately, and not because cancers spread after the intervention. As the cancer cells divide in geometric proportions, it will take more or less time to double its size from 1 mm to 2 mm and from 5cm to 10 cm. In other words, the growth of cancer will appear to be faster in more advanced stages.

Dr Rakesh Garg

Myth  Don’t tell the patient the bad news.

Reality

If you tell the patient the bad news (diagnosis of cancer etc) they will not be able to take it. As a result, often half-truths or white lies are told by doctors to patients. Studies done in India on patients with cancer, however, reveal that 90 per cent of them want to know the correct diagnosis and likelihood of survival, as it helps to plan the treatment and plan their lives as well.

There are a whole range of rumours and myths about cancer that makes it hard for people to know what is true about this widely misunderstood disease. Every day, new myths arise and old ones reappear, leaving patients and family members confused and vulnerable. Many turn to dangerous remedies, others get trapped into believing fallacies that harm them immensely. Here are some of the most persistent and pernicious myths surrounding cancer and its treatment that we face every day. 

Myth No, this cannot be cancer.

Reality

We come across hundreds of patients who show signs and symptoms indicating the possibility of cancer, yet they will not accept it. The first reaction in India, typically, is: “No, this cannot be cancer.” Somebody gets a lump, a hard mass on any part of the body, a coughing spell that lasts for over four weeks. And the first thought is to blame it on infections or pollution—something that will settle down within a week or two. Who will tell them that cancer coughs will not settle down? The first presenting symptom for lung cancer will be cough. We get patients with telltale signs of cancer—blood or discharge through urine, stool, mouth, female genital organs—yet by the time they seek medical opinion, often the cancer has already spread to other parts of the body. This denial mode and not letting treatment start on time, is a very Indian attitude. 

Myth Lifestyle tendencies that lead to heart disease, hypertension or stroke are not related to cancer.

Reality

Think of physical inactivity, of stress, of eating a lot of preserved and processed food. And the first reaction we find among patients is: “Surely, those are not linked to cancer.” They seem to be convinced that the lifestyle tendencies that are linked to heart disease, hypertension or stroke have nothing to do with cancer. That’s just not true. Now we have sufficient literature and scientific evidence to show that patients having more junk food, leading more sedentary lives, living in more stressful environments are more prone to cancer than those who are not under such circumstances. Fortunately, these are modifiable factors. That means, people can change these. Non-modifiable factors mean those that cannot be changed: for instance, somebody with a family history of cancer will have higher chances of getting the disease. These are genetic traits. There needs to be developed the maximum awareness that modifiable lifestyle excesses don’t just bring on heart disease, stroke or hypertension, but also cancer. 

Myth Cancer is contagious.

Reality

This is an important myth that even educated people share. If somebody gets cancer, friends and neighbours do not visit, thinking they may also get it. This is a huge issue, because in India we are dependent on social support for emotional sustenance. That often breaks down for cancer patients, who are anyway emotionally disturbed and need more support. Myths like this make them go through social isolation, bringing in more stress. Cancer is absolutely not contagious. In some people, cancers may be caused by certain viruses (some types of human papillomavirus, or HPV, for example) and bacteria (such as Helicobacter pylori). While a virus or bacterium can spread from person to person, the cancers cannot.

Myth Nourishing food nourishes cancer cells.

Reality

This is a common and dangerous misconception: if you give nourishing food to a patient, the cancer will grow faster. Hence deprive a cancer patient of food and the cancer will die out. People try to avoid taking nutritious food, become malnourished, their immunity gets weak and they are not able to tolerate chemotherapy, surgery, radiation—for all of which a patient needs to be physically as strong as possible. If they eat well, the immunity system of the body will fight the cancer cells. Remember, our body constantly makes some cells that can convert into tumour cells. At the same time, the body also has the immunity to destroy these cells. If immunity goes down, the patient becomes more prone to having cancer. Keeping yourself healthy and stress-free are the vital preventives for cancer. 

  • 75% cancers can be prevented today, if treatment is sought early
  • 80% patients in India come to doctors too late
  • 40% cases are detected early in Kerala, the state that records fewer cancer deaths

THE COST
Cancer is now the leading cause of catastrophic health spending, distress financing, and increasing expenditure before death in India 

Out-of-pocket expenditure is three times higher for private inpatient cancer care in the country 40% of cancer costs are met through borrowing, sale of assets and contributions from friends and relatives These costs exceed 20% of annual per capita household expenditure in  60% of Indian households with a patient with cancer

A lot of my patients ask: “Why did I get cancer? I don’t smoke, I don’t drink, I am a vegetarian, I pray to God regularly, I have never harmed anybody. Then why did I get it?” These are some of the most challenging questions oncologists face. And these are also at the intersection of the myths, misconceptions and facts in all discussions on cancer. 

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