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Monthly Report, October and November 2003
Frontiers in Cancer Prevention Research Four
representatives from CPAA attended the Second Annual American Association
for Cancer Research International Conference on “Frontiers in Cancer
Prevention Research: Genetics, Risk Modeling, Molecular Targets for
Chemoprevention, Clinical Prevention Trials, Behavioural Prevention
Research, Science and Public Policy Conference” held in Phoenix Arizona
between 26-30th October, 2003. A report follows.
The
first major meeting on cancer prevention, hosted by AACR, was held in
October 2002. The meeting was a reflection of the changes occurring in the
field of cancer research, which is increasingly directed towards newer
means of reducing the incidence of cancer. In the last five years, the US
FDA issued its approvals for the use of tamoxifen and celecoxib to reduce
risks of breast cancer and familial adenomatous polyposis respectively.
Similarly, the use of finasteride in the chemoprevention of prostate
cancer and non-steroidal anti-inflammatory drugs for sporadic adenomas is
being studied. Genetics and molecular epidemiology help to predict risks
and prophylactic surgery such as mastectomy is used to reduce proven risk.
Research groups that previously studied treatment now focus on prevention.
In
the past, a similar progression occurred in the fight to reduce the risk
of heart attacks, where high blood pressure and elevated cholesterol
levels were initially identified as risk factors. Today we recognise high
blood pressure and elevated cholesterol levels as not just risk factors
which predispose an individual to heart attacks, but as diseases in
themselves and they are treated proactively as such. Cancer too has a long
dormant period during which molecular and cellular changes gradually occur
and finally manifest. If we can recognise these changes in process, they
can be treated proactively to prevent an actual outbreak. Today
scientists understand at a molecular level the changes that make for
elevated cancer risk. Newer generation technology is available in the form
of endoscopy, laser capture microdissection, protein arrays and RNA.
Researchers understand that the development of cancer involves mutations
in crucial tumour suppressor genes or oncogenes, chemical changes in the
DNA structure, genetic changes or incorrect transmission of signals in the
cell. This understanding can be translated into treatment by recognition
of biomarkers associated with carcinogenesis. It is possible to identify
how a chemical could actually reverse an abnormality. It is also possible
to follow treatment and analyse to what degree the treatment has been
successful in checking the cancer progression. The
first part of the conference consisted of an “Educational Session” on
“Methodological Challenges in Population Studies” which discussed how
to carry out research work and surveys on prevention. Eugenia E. Calle,
Director, Analytic Epidemiology, American Cancer Society, spoke about the
pros and cons of large versus small studies. Cause-effect studies can be
conducted in two way-either existing patients can be questioned about
their lifestyles or healthy individuals can be followed to see what kind
of lifestyle results in increased cancer. The latter technique introduces
some bias since patients may not recall events accurately. “Cohort” or
“Prospective” studies on the other hand, must be large (200,000) to
very large (1-1.5 million) to generate sufficient numbers for analysis.
Maintaining records and biosamples (blood and buccal cells) of such large
numbers of subjects is a costly and painstaking job. Some past and ongoing
studies include the investigations on total mortality which looked at the
effects of tobacco, alcohol, Hormone Replacement therapy, pollution;
effect of passive smoking on coronary vascular disease, lung cancer and
breast cancer (no effect). Laurence N. Kolonel, Deputy Director, Cancer
Research Centre of Hawaii spoke about the challenges in enrollment and
retention in a multiethnic cohort which included Latinos, Negroes,
Japanese, non Latino whites and native Hawaiians. Laura
J. Esserman, Director, Carol Franc Buck Breast Care Centre spoke about
biomarkrs which can be used to determine cases at a high risk for breast
cancer. Genetic testing and serum estradiol are considered possible
candidates. Preventive surgery such as oopherectomy and mastectomy were
discussed as well as the use of tamoxifen. Fadlo
Khuri, Assistant Professor, Winship Cancer Institute, spoke on
chemoprevention of lung cancer. Chemoprevention is a pharmacologic
intervention at cellular, tissue and clinical levels which prevents
development of proven biomarkers or reverses a pre-malignant condition
potentially leading to significant disease prevention, arrest or delay.
Trials are presently on to target molecular markers of lung carcinogenesis
and progression such as cyclo-oxygenase-2 (COX-2), the ras signaling
pathway through farnesyl transferase inhibitors or the tyrosine kinase/epidermal
growth factor receptor pathway. The
second part of the conference was the “Presidential Symposium” on
global perspectives in cancer prevention research. Paul Kleihues,
Director, International Agency for Research on Cancer (IARC, France)
pointed out that in developed countries, the most common cancers are lung,
breast, colon, rectum, stomach and liver. The reasons are the earlier
onset of the tobacco epidemic, earlier exposure to occupational
carcinogens, Western diet and lifestyle. In developing countries 23% of
malignancies are caused by chronic infections as compared to 8% in the
west. These include hepatitis B and C virus (liver cancer), human
papilloma virus, especially HPV-16 (cervical cancer) and Heliobacter
pylori (stomach cancer). Richard
Peto, Professor of Medical Statistics and Epidemiology, Oxford University,
spoke on the hazards of smoking and benefits of stopping. It has been
noted that overall cancer mortality started to decrease in the 1990s due
to the decrease in cervical and stomach cancer cases, advances in early
detection and treatment but most of all, due to success in tobacco
control. Even today, tobacco is the most common avoidable cancer risk. It
is estimated that 100 million people died during the 20th
century due to tobacco related cancers, cardiovascular disease and stroke
and chronic lung disease. Half of regular smokers die due to adverse
health effects of their habit. 25% will die prematurely during their most
productive years-35-69. It is recognised that in addition to lung cancer,
tobacco causes tumours of the oral cavity, pharynx, larynx, oesophagus,
pancreas and bladder. In a recent conference of the International Agency
for Research on Cancer (World Health Organisation) this list was expanded
to include kidney, stomach, uterine cervix, liver, nasal cavities and
myeloid leukemia. The Working Group also concluded that passive exposure
results in a 20% increase in lung cancer. In industrialized countries, 30%
of cancers are due to diet and lifestyle characterized by high calorific
diet rich in animal fat combined with low physical activity. Tumours
associated with such a lifestyle are breast, prostate, colon and rectum
and endometrium (uterus). Dr. Peto pointed out that while smoking related
deaths are decreasing in the US and UK, across the channel in France, this
is not so. He stated that lung cancer is a political disease and
governments that do not take cessation seriously will have a serious
problem on their hands. Prevention of a substantial proportion of the
predicted 450 million tobacco related deaths before 2050 will depend on
strongly enforced cessation programmes. Harald zur Hausen, Scientific Director, German Cancer Research Centre, spoke on infection related cancers. About 20% of cancer incidence is caused by infections. Besides the cancers noted above, members of Herpesvirus family Epstein-Barr virus (EBV) and Human Herpesvirus type 8 (HHV-8) are implicated in cancers of the lymphatic systems, nasopharyngeal and gastric cancers and Kaposi sarcoma. The HTLV-1 retrovirus has been identified as the causative agent of adult T-cell leukemia. Parasites like Schistosoma haematobium, mansoni and liver flukes cause bladder, anorectal and bile duct cancers. Vaccines against these infections cann be used as cancer preventives. The Hepatitis B vaccine for example is expected to reduce liver cancer incidence dramatically in future. John
D. Potter, Senior Vice President and Director, Fred Hutchison Cancer
Research Centre, spoke about diet and cancer. It has been proved that lack
of physical activity leads to elevated risks of breast and colon cancer
and adding fruits and vegetables to the diet reduces risk of cancers of
the mouth, pharynx, oesophagus, stomach, colon and rectum. Being over
weight also increases the risk of cancer. Colon cancer is associated with
low quantities of vegetables in the diet which also leads to low folate
levels. Folate is responsible for DNA methylation and its absence results
in abnormal repairs. Genenstein, soya and malts as well as phytoestrogen
exposure in utero can cause mammary tumours. The effect of supplements has
been found to be different from the same nutrients in the diet. Cyclic
fasting and feeding is deleterious in colon cancer, but restriction of
calorie intake has been shown to have a positive effect in mice, rats,
cows and dogs. A high body mass index (BMI) but low weight change has the
least risk, whereas low BMI with high weight gain is related to high risk
of cancer. In combination with low physical activity, the latter has the
most elevated risk of colon cancer. Charis
Eng, Professor and Director, Division of Human Genetics, Ohio State
University, spoke on Genetic Testing in Cancer Prevention. All
environmental exposures must interact with innate genomic composition of
an individual which predisposes or protects against cancer. Germline
mutations and somatic mutations determine cancer susceptibility. The
former, which are seen in every cell in the body, can be inherited while
the latter is found only in the cancer cells and cannot be passed on.
Indications of inheritable disease include bilateral occurrence on organs
and early onset. How genetic alterations interact with germline variations
and macro environmental exposures pose the challenge for the practice of
clinical cancer genetics and prevention for this century. Brian
Reid of the Fred Hutchison Cancer Research Centre spoke about cancer
prevention in Barrett’s oesophagus, a premalignant condition that could
lead to oesophageal adenocarcinoma. Being overweight and reflux are strong
risk factors and NSAIDs and selenium appear to be preventives. 17pLOH
(Loss of hyperzygocity) is the best predictive indicator. Walter
C. Willett, Harvard University in a talk about alternative medicines vs
chemoprevention said that typical Indian spices such as turmeric in vitro
showed antioxidant effectsand may have preventive action against colon
cancer. He emphasized that the use of supplements is not as effective as
getting nutrients from the diet. Also, ingesting supplements over the
recommended daily amounts can actually be harmful. A
special presentation was made by Hamilton Jordan, former White House
Chief-of-Staff who has survived NHL, skin and prostate cancers and is now
an advocate and author of a book he autographed for each registrant at the
conference. Shubha
Maudgal made a poster presentation of her survey on cancer awareness among
educated adults in Mumbai. In India, as many as 70% of common cancers are
caused by faulty lifestyle patterns and can be prevented. The survey was
conducted among 500 adults employed in companies such as advertising
agencies, multinational banks, IT firms and manufacturers of industrial
tapes and tires to assess the level of awareness on cancer prevention. The
results were compared against findings of a survey by the American Society
of Clinical Oncology's (ASCO) Cancer Prevention Committee and the Cancer
Research and Prevention Foundation. The questionnaire covered awareness of
the role played by diet, exercise, tobacco and alcohol abuse, optimum
weight, family history and supplements. To
make best use of the knowledge available, the meeting brought together
leaders from academics, government, industry, policy makers and
non-government organisations. The topics covered ranged from
chemoprevention, risk reducing surgery, behavioural science, health
services, diet and nutrition, molecular genetics, epidemiology and
imaging. For us at CPAA, it was a unique opportunity to learn more about
the next stage of cancer management, and make it a part and parcel of our
stated objective of “Total Management of Cancer”. Department
Reports Cancer Awareness ProgrammeMs.
Neeta More gave an awareness lecture at the Laxmi Building Rahivasi Mandal,
Byculla where she addressed 40 women about cancer and the dangers of
tobacco in Marathi. The lecture was filmed by Ms. Pierra Choi of Radio
Television, Hong Kong, who was shooting a programme on tobacco habits in
various southeast Asian countries. Prevention
and Early Detection 28
camps and OPDs were held during the month of September. Camps were held
for Associated Cement Corporation (ACC), Thane and Laxmi Building Rahivasi
Mandal, Byculla (4 camps); Canara Bank, Thane and Dombivli; Rotary Club,
Mulund and Vithalwadi (2 each).
A
total of 859 people, 368 males and 491 females were screened in the camps
organised during September. 197 people were advised follow up. 12 OPDs and
clinics were held during the month. 94 males and 170 females were
screened. 45 people were advised follow up. 335
persons were screened at the Smt. Lila Kishanchand Shahani Clinical
Diagnostic Centre during September. 686 tests were performed, out of which
468 were pathology tests. 111 sonography, 52 x-ray and 46 mammography
investigations were carried out. 9 ECGs were also performed. During
September 118 people were examined, of whom 51 had come for the first
check-up and 67 for renewal check up. Rs 1,78,451 was disbursed towards
the 6 claims settled during the month. A 68-year-old lady was detected
with breast cancer and is getting treatment under the care of Dr. L.J.
DeSouza at DeSa Hospital.
[Top]Patient Care
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PATIENT
CARE AND REHABILITATION (SUMMARY) |
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|
Feb |
Mar |
Apr |
May |
Jun |
Jul |
Aug |
Sept |
|
Total
no. of patients aided |
771 |
585 |
613 |
777 |
773 |
777 |
760 |
804 |
|
Ambulance
service availed |
454 |
719 |
558 |
487 |
540 |
752 |
743 |
688 |
|
Visits
(hospital + home) |
9 |
10 |
12 |
16 |
13 |
26 |
14 |
14 |
|
Total
aid given (Rs lakhs) |
2.61 |
2.48 |
2.45 |
2.30 |
2.37 |
2.41 |
2.00 |
2.65 |
|
Medicine
(Rs lakhs) |
2.32 |
2.05 |
2.04 |
1.94 |
2.03 |
2.01 |
2.00 |
2.08 |
|
Patient
stipend (Rs lakhs) |
1.93 |
1.86 |
1.93 |
2.07 |
2.03 |
2.22 |
1.95 |
|
42
patients were counseled and given guidance by Iva Athavia during
September. 44 ward visits were made. 23 patients were provided guidance
regarding alternative therapy. 5 terminally ill patients were referred to
Shanti Avedana Ashram. 6 group meetings were held on diet and hygiene. Rs.
8,327 was donated towards medicines and radiation costs. 34 packets of
nutritional food; 12 bags of clothes; and 30 packets of biscuits were
distributed.
Nair Hospital (Radiation Department)
48 patients were counseled and given guidance at the Counseling Cell at Nair Hospital Radiation Department by Iva Athavia during September. 29 ward visits were made. 3 terminally ill patients were referred to Shanti Avedana Ashram. 13 patients were given information about alternative forms of medicines. Rs. 23,822 was donated towards radiation treatment. 5 packets of chocolates were distributed. 12 bottles of Feredol, 6 boxes of clothes and 30 boxes of Complan were donated.
Counseling at Bharat Sevashram Sangh
Iva Athavia counsels patients at Bharat Sevashram Sangh, Vashi every Friday evening. 45 patients were counseled and guided during September. 18 group meetings were held regarding hygiene, diet and radiation. 15 patients were given information regarding alternative treatment. 85 patients and their relatives were entertained at a dance programme held at the Chembur Fine Art Auditorium on 7th September.
Cancer
Patients Aid Association Monthly Review is compiled by Dr. Shubha Maudgal
and printed by Mr. Suresh Mishra at Saraswati Printing
Press
Please
write in with your comments to: Smt. Panadevi Dalmia Cancer Management
Centre, Anand Niketan, King George V Memorial,
Dr. E. Moses Road, Mahalaxmi,
Mumbai-400 011
Phone: 24924000,
24928775, Fax: 24973599,
Email: webmaster@cpaaindia.org