Cancer, also called malignancy, is an abnormal growth of cells. There are more than 100 types of cancer, including breast cancer, skin cancer, lung cancer, colon cancer, prostate cancer, and lymphoma. More than 10 million people around the world die each year from cancer. Experts project cancer deaths to rise to 13 million by 2030 if we do not act now. World Cancer Day aims to save millions of preventable deaths each year by raising awareness and education about cancer. At Medicircle we are conducting an exclusive interview series on the occasion of World Cancer Day showcasing eminent Oncologists over a discussion to bring awareness about cancer, its treatments, and myths related to it.

Dr. Pushkal Dwivedi is one of the well-known and recognized consultant oncologist / hemato-oncologist in Bilaspur. He has experience of 13 years in this field. Dr. Pushkal practices at Ramkrishna Care Hospital in Mathpurena, Raipur, and Arogya Hospital, Bilaspur. He is a member of the Indian Co-operative of Oncology Network, American Society Of Hematology, American Society Of Clinical Oncology (ASCO), European Society For Medical Oncology, European Hematology Association, Mumbai Hematology Group, Indian Association For Palliative Care, and Indian Medical Association (IMA).

The gender-based occurrence of types of Cancer

Dr. Pushkal explains the demographic composition of cancer cases amongst the three major types of cancers ie. Breast Cancer, Cervical Cancer, Oral Cancer, ‘‘Considering the facts on the grounds of gender, breast cancer, and cervical cancer, primarily it is a disease of the females. Of course, cervical cancer occurs 100% in female patients and almost 90 to 95% of breast cancer patients are females. Males amount to hardly around five to 10% of the overall population of breast cancer patients. However, Head and Neck cancer cases is a more common problem in males.’’ he says

‘Western Lifestyle’ contributing to the increased number of cases

According to the cancer statistics 2020 report, the majority of the patients with cancer were diagnosed at the locally advanced stage for breast cancer which amounted to 57% of the total cases.

Dr. Pushkal explains the possible reasons for such a massive amount of cases erupting in females, ‘’It is witnessed that around two decades back cervical cancer was the number one, with the maximum cases. However now within two years due to many changes cervical cancer is at the second position while Breast cancer is at number one with the maximum number of cases being diagnosed. The reason is probably the Western lifestyle that we have adopted. When I say ‘Western lifestyle’ I  mean late marriages, women conceiving at a later age, and many times they don't even breastfeed their child, and of course, the unhealthy lifestyle, stress, and dietary patterns all those things affect the cause for the rising incidence of breast cancer. 

While at the same time, better hygiene and vaccination played a major role in reducing the incidence of cervical cancer. We know cervical cancer is mainly driven by the virus called HPV human papillomavirus. And now as we have a vaccine against the human papillomavirus (HPV). Hence, cervical cancer incidence has gone drastically down, and the vaccination also has controlled cervical cancer to a large extent.’’ he says.

The causes of the rise in Cancer Cases

Globally, oral cancer is the sixth most common type of cancer with India contributing to almost one-third of the total burden and the second country having the highest number of oral cancer cases, states research by NCBI. Oral cancer is the most common cancer in India amongst men, Dr. Pushkal throws light on the reasons why this type of cancer is on the rise, ‘’When it comes to head and neck cancer or oral cancer OTC, it is rising. Tobacco consumption is the most important cause of oral cavity cancer, and head and neck cancer, especially among males. It is common in females also but majorly in males. For example, if there are 100 cases of head and neck cancer or oral cancer, out of the 100 cases, 90 patients are males, while females are hardly 10%. And out of the 90% almost 85 to 85 percent consume tobacco in some form, whether it's the gutka or Pan Parag or pan masala, chewing or smoking, or any other way they consume tobacco. Also if one is consuming tobacco and apart from that is also consuming alcohol, then it is the synergistic effect, which is what we call the adding effect of carcinogenesis. Both tobacco and alcohol are carcinogenic in oral cavity malignancy and if somebody is having an addiction to both, then the risk is multiplied many times. People must be aware of this risk. And fortunately, all these three cancers whether it is breast cancer or cervical cancer, or oral cavity cancer, all these cancers are mainly preventable and can be detected at a very early stage. The chances of getting successful treatment depend on which stage we are diagnosing and treating the patient. If we are picking the patient in the early stage which is stage one or stage two, then the chances of cure are relatively very high. While at the same time if we are picking the patient at the advanced stage, then the chances of cure are relatively less. So, fortunately, for all three cancers whether it is breast cancer or oral cavity cancer, or cervical cancer, we have excellent screening programs to which we can pick up the patient in a very early stage but that we have to create awareness. So people should know about it, and people should be aware that which are the subgroups, who are considered a high-risk group, and especially the high-risk group should reach out to the doctors for their regular screening to know the status of such kind of illness.’’ he says.

The influence of Lifestyle over the disease

Dr. Pushkal explains ‘‘It is mainly the lifestyle people are following. If you see the number of cases in India around three to four decades back, cancer was not a major problem for us. It was primarily considered a disease of the Western population, that of the super developed countries. Now due to the aggressive adoption of the western lifestyle things have changed, which I think probably is the reason why we are getting more and more cases of cancer. Lifestyle is one factor apart from that, the pollution and the addiction we are polluting our air, we are polluting our soil, we are polluting our water, the number of pesticides we use in our crops, etc. Somehow all those things have become a part of our food chain and through our food, and water somehow they come into our daily routine. We must understand that cancer is a multifactorial phenomenon. And it is not one thing that causes cancer. Sometimes we come across a patient where there is no history of addiction in spite of the fact they develop cancer. So it's not only the addiction, which plays a role. Apart from addiction, there are other factors like pollution is a very important factor. And if when I say pollution, then there are so many parameters, air pollution, water pollution, soil pollution, and all those things contribute.’’ he says.

Risk of Genetic Predisposition of Cancer explained

There are a lot of myths related to cancer, one of which is that it is genetic. As every cancer is different, Dr. Pushkal explains the risk of genetic predisposition as, ‘‘Yeah, it is partly true, no doubt about it. And every cancer is different since we cannot pass a statement that applies to each and every cancer. Hence If somebody questions the genetic association of cancer, the answer varies for which type of cancer the person is asking about. So if we discuss cancer that has a genetic association, of course, in breast cancer there is genetic potential. If the mother has breast cancer or ovarian cancer, then the doctor is certainly at high risk. And it is again the first-degree relative and second-degree relative and number of family members, the daughter is at an increased risk. But again, at the same time, there is no such evidence for head and neck cancer, and oral cancer, for the genetic predisposition. Similarly, there is no such genetic Association for cervical cancer, to the best of my knowledge. But of course, there is more than enough evidence to say that there is a genetic predisposition for breast cancer malignancy. Also, there is something called breast ovary syndrome, and if somebody has a history of the form of breast cancer, or ovarian cancer in the family, in the first-degree relative or second-degree relative, then she should be cautious. Especially if a lady develops breast or ovarian cancer above 40 years or above 50 years of age, then the risk of genetic predisposition gradually leaves. But if somebody develops below 40 or below 50, then we should be very careful, especially in the case of breast cancer patients for genetic predisposition risk. We have tests now to know exactly the risk of disease to stratify the risk of this genetic predisposition for breast cancer, that your doctor or your oncologist can guide you. But of course, we should, we should accept it.’’ he says.

(Edited by Faryal Siddiqui)