World Cancer Day is observed on 4 February every year. This year’s theme, ‘I can, I will’, acknowledges that everyone has the capacity to overcome cancer through early diagnosis, treatment and palliative care. In a recent interview with Prothom Alo, Prof Md Sanawar Hossain, senior consultant of general surgery at Square Hospital, talked about the increased incidence of cancer in Bangladesh, its treatment and related issues.
Prothom Alo: There suddenly seems to be an increase in the incidence of cancer. Is this an actual increase in cancer or are we just more aware now?
Sanawar Hossain: Both, actually. If you look at the world population, you will see that people’s longevity is rising. Previously, while I was a student, people’s longevity was 47 years, and now it is around 75. So we are seeing cancer in the patients because they are alive. Cancer normally appears when a person is over 40 years old, maybe around 50 or more.
Men, for example, develop prostate cancer after 60 and so it is detected only after that age. And 80 per cent of the prostate cancer cases remain undetected. If autopsies were carried out on elderly men who die over 90 years of age, about 70% would be seen to have prostate cancer. This is often asymptomatic and he is more likely to be dealing with diabetes or hypertension. Prostate cancer can be indolent and remain undetected.
So if you ask me if cancer is increasing or is it just the awareness, I would say both. Longevity has increased, awareness has increased and so have the facilities to detect cancer.
Prothom Alo: What is the cause behind the increased prevalence of cancer?
Sanawar Hossain: Despite a common perception, it is not the adulterated food and such that leads to cancer. Certainly adulteration of food is not acceptable at all; not even 00.1 per cent, but that does not cause cancer. It is deep fried food that is bad. Such food produces carbon molecules that can lead to cancer.
Natural food is a protection, not only from cancer, but from diabetes, hypertension and other diseases. If you have untreated diabetes for 5 to 10 years, you will be affected from the hair on your head to the nails on your toes. You don’t need cancer – such diabetes will affect your kidney, then your heart, your liver, all your vital organs.
Prothom Alo: What about the increased prevalence in breast cancer?
Sanawar Hossain: There are 12,000 to 14,000 breast cancer cases detected every year. This is more common in urban areas and rarely seen in rural areas. Lifestyle is a factor, but it is not just one single factor.
The problem is that when a woman detects a lump in her breast, she often delays in going to the physician, sometimes even after 6 months. Back in the sixties, this was true. Now, however, they come within six days, sometimes even in 6 hours of detecting the lump. The media has programmes on TV too which make women more aware of these symptoms and helps them understand what is to be done.
The best way to detect breast cancer is by the woman herself. Regular mammograms are not always possible, given Bangladesh’s reality. In the UK the women are to have mammograms after every three years and there has been a lot of debate about that, even quarrels, as a woman may easily get cancer in those three years between the mammograms. In the US, it is every one year.
Self-examination is the most effective. The woman is the first physician in this sense. No one else can be aware of a women’s cancer other than herself, not even her husband, mother or children.
Prothom Alo: How effective has the breast cancer awareness been in Bangladesh?
Sanawar Hossain: It has been good. But I would say what is most important is education. That makes all the difference. In the past during the Pakistan rule, SEATO had offered South Asian projects related to family planning or to education or other areas. Ayub Khan opted for family planning for Pakistan, but the wise Bandarnaike of Sri Lanka opted for education. That has taken Sri Lanka ahead, with a 100 per cent literacy rate.
Education is required along with breast cancer awareness. The campaign that we have in Bangladesh has made an impact, but meagre. Much more is required. Education is the key.
Prothom Alo: What about the state of cancer treatment in Bangladesh?
Sanawar Hossain: We have a population of over 180 million, but have limited resources. However, there has been an overall improvement. For instance, I have been in this hospital where I have been working for the past 15 years and not one patient has died of breast cancer. Globally there is a 95 per cent cure rate and Bangladesh is not far behind. It will certainly be about 70 per cent. The problem is, many patients come in for treatment 12 months after detecting the symptoms.
There should be a system in place, a referral system where a patient can go to the local health centre. If cancer is detected, then they will go on to the bigger hospital. There is cancer treatment in the medical college hospitals of 8 divisions, though not on the same level as in Dhaka or the bigger cities.
Prothom Alo: We have qualified physicians and hospitals, so why do so many cancer patients choose to go abroad for treatment?
Sanawar Hossain: It is true they are going abroad. The number of visas issued for travel to India is staggering. If you go to Delhi, for example, there are a huge number of hospitals and facilities. And they are building around 20 hospitals around the border area with Bangladesh.
The problem is, a patient going there gets the initial treatment of 3 to 4 weeks, but then there is the rest of their lives. They go to India for only one segment of the treatment.
Cancer treatment entails detection, pathology, diagnosis, then treatment by the oncologist/surgeon and so on. Chemotherapy takes around 4 and a half to 6 weeks, then there is 4 weeks of radiotherapy and then the patient needs to be observed every three months for the first year. If all is well after 2 years, then only the patient is said to be cured.
Prothom Alo: Why is this lack of confidence in treatment here?
Sanawar Hossain: Very frankly speaking, over 90 per cent of the doctors are not honest to their profession. They cannot meet the patients’ expectations. Much of that is due to the crowd, the number of patients. A physician is in his chamber for 5 or 6 hours. I see 4 patients in an hour. That is our hospital regulation too. But I speak to other physicians and they admit to me that some of them see up to 100 patients in those few hours. I ask them, “Do you see the patients, or do the patients see you?” It is only natural that the patients will be neglected if they see so many in just one hour. So there are reasons for their loss of faith and trust.
In the government medical colleges, some of the doctors just go to get up their attendance and then after some time go off to the ministry or to other offices. The patients are neglected then.
Prothom Alo: So how can this problem be resolved?
Sanawar Hossain: The government must recognise this problem. Presently, anyone can open a hospital if they have money. But accountability is a must and the government must enforce this. The government should have certain strict accreditation rules and regulations. There must be an accreditation body. The Bangladesh Medical and Dental Council can oversee this matter.
Only if a physician has commitment, he/she can win a patient’s faith. As a physician, I can expect the people to have faith and trust in me. But also as a physician, I must have a moral background, knowledge and commitment to the people.