Cancer, a global challenge, is increasing every day. The main reason behind it is ignorance and lack of awareness in every level. Scenario in Calcutta, India is in no way different. To combat the situation, growing awareness amongst the public is absolutely necessary. Besides awareness, prevention and early detection of this dreaded disease is also equally important.

In the 70s and 80s, a major portion of the Indian population was not aware or did not understand the importance of maintaining good health. Things have changed since India witnessed a spate of economic and industrial activities, which lead to a major lifestyle change among common men. People gradually felt the necessity of maintaining an active health regime in order to keep pace with the rising competition and stress. Unfortunately social organizations and government health departments made scarce attempts to promote public awareness on healthy lifestyle. Hence, counseling in an organized way has become a key factor, to make people aware, achieve good health and combat stress. The number of primary health care centers and sub-divisional hospitals are much less compared to requirements. Moreover they lack in modern diagnostic and pathological investigation set up. Age-old manual methods are adopted for evaluation tests, which lack accuracy, precision and timely delivery of reports. This situation still continues leading to delayed treatment of critical diseases.

Cancer is one of the most dreaded and feared disease in India and awareness about prevention and early detection of cancer is very much lacking in our society even now. There are number of myths about cancer in the mind of the people from different backgrounds. As for example, cancer is considered to be a communicable disease, many think cancer is not curable and some consider it a sin to have cancer.

The indigent population inhabiting the slums of Calcutta has poor literacy level and they live in absolute unhygienic conditions. The women are married at a very young age and the men often have multiple sexual partners. These are the main contributory factors, in the occurrence of cancer of cervix, the number one cancer in this population. Unfortunately, these women do not have access to systematic cervical cancer screening and they restrain themselves from going for gynecological checkups even if they have symptoms out of shyness. As a result most of the women suffering from the disease are diagnosed at an advanced stage. Breast cancer is the second most common cancer and is showing a rising trend.

Prevention of cancer through diet modification, maintenance of physical activity, body weight control, avoidance of tobacco use, betel nut chewing is an urgent and critical issue in our society. Early detection through screening is also vital to keep the mortality from the disease down.

Cervical and breast cancer is an issue that can be easily addressed. It is unconscionable that we don’t have the most effective screening program available in India. While there have been distinct steps taken towards the development of an organized program and many of the required components are in place, we must not lose momentum or let this important issue fall by the wayside. Our relationship with our local health authorities has become much closer. We are further committed to supporting the needs of the dying and their families in the community where we serve. We believe that we can achieve much more for the community we serve by sharing our skills and experience with others.

We encourage all individuals and organizations with an interest in women’s health to contact their nearest Regional Cancer Centers / State Health Authorities so that they get necessary support to organize such screening / early detection program towards a Wonderful Cancer Free Future.

Cancer Prevention

According to Mayo Clinic, there are 7 steps to prevent cancer.
  • Avoid tobacco use: As already discussed, tobacco is the major risk factor for cancer. Hence, it is important to avoid tobacco in all forms, like both active and passive smoking and chewing tobacco.
  • Eat a variety of healthy foods: It is important to consume plant-based foods, rich in fruits and vegetables, reduce the intake of fat and alcohol.
  • Stay active and maintain a healthy weight: Regular exercise should be an integral part of one’s daily routine.
  • Protect yourself from the sun: Exposure to sun is the major cause of skin cancer. It is important to avoid the sun’s ultraviolet rays, especially from 10 am to 4 pm and applying adequate amounts of sunscreen lotion with a sun-protecting factor (SPF) of at least 15, especially before venturing outdoors during these hours
  • Get immunized: Vaccination against Hepatitis B should be regularly administered, as this infection could lead to liver cancer.
  • o Healthy practices: Sexually transmitted diseases like human papilloma virus infection, hepatitis B and HIV can lead to an increased incidence of various cancers. It is thus important to practice safe sex by using condoms, limit the number of sexual partners, or abstain from sex and never share needles. In case of drug addiction, it is important to seek help. Get screened: Regular screening and self-examination for certain cancers helps in early detection of cancer and improves the prognosis.

Turmeric has many advantages. A pilot study on its efficacy in fighting the virus that causes cervical cancer could have significant impact -

Benita Sen

  The number may seem small, but the impact promises to be significant. At a health clinic in the Sunderbans, West Bengal, Najmun Nahar and a team from Kolkata’s Chittaranjan National Cancer Institute (CNCI), are beginning the world’s first curcumin trial to fight cervical cancer, mostly caused by HPV.

What is HPV?

The human papilloma virus (HPV), an umbrella term for more than 100 viruses found till now, is the most common cause of cervical cancer. It is mostly transmitted through sexual contact. “HPV is the most common sexually transmitted infection in the world,” observes P.S. Basu of CNCI. It seems to affect young people more. A monogamous woman may pick it up from an infected partner. “Unfortunately,” points out Dr Basu, “there is no treatment for the HPV infection till date.” The good news is that most HPV infections are overtaken by the body’s immune system. The bad news is that some cannot fight back.

There are fears that HPV may cause not just cervical cancer but also cancers of the breast and mouth. The Cancer Atlas also mentions respiratory cancers caused by HPV.

Women are most at risk

Dr Basu says: “About 1 lakh women die of cervical cancer in India, every year. Yet, it is preventable at the pre-cancerous stage.” At that stage, it gives doctors a lead of about 10 years before the cancer sets in.

The researchers are trying to find out if curcumin works in fighting HPV. It will be available as a vaginal tablet or cream.

Advantage curcumin

The pilot project of a clinical trial of curcumin began in September 2007 under the aegis of the department of biotechnology (DBT). The other projects are being conducted by the Institute of Cytology and Preventive Oncology (ICPO), Noida, and the Tata Memorial Centre in Mumbai.

What curcumin does

Curcumin is the main extract of the turmeric plant (Curcuma longa) and is not patented. Bindu Dey of DBT explains, “Curcumin is a potent anti-oxidant, anti-inflammatory component.” DBT picked up this compound for clinical testing in squamous cells carcinoma, (a form of skin cancer) after a large number of in-vitro (laboratory) and in-vivo (in a living organism) studies.

Although turmeric has been described in Ayurveda as a treatment for inflammatory diseases, curcumin, a yellow pigment in turmeric, has many pluses. It binds to a variety of proteins to inhibit the activity of various enzymes. It has anti-biotic properties and has been found effective against HPV. It scavenges for free radicals, and stalls DNA damage. Dr Basu says: “HPV is a local infection. So a locally applied agent may be able to clear the virus.”

The flip side

In 2005, S. Kawanishi, S. Oikawa and M. Murata of the department of environmental and molecular medicine, Japan, noted that curcumin is a “double-edged sword”. While it does have anti-cancer properties, they says it can also be carcinogenic as it “exerted pro-oxidant properties after metabolic activation”. Bhudev Das, director of ICPO since 2004, disagrees. DBT is just as convinced. “It is protective against any cancer,” says Dr Das. “There are thousands of anti-oxidant herbal agents, but most are in a crude form. Curcumin is the only product that is marketed in the purified form. So it is unlikely to vary.”

A new chapter?

“Our hypothesis is that it would clear women of HPV infections. If it is proven to be so, it (curcumin) has the potential of being the first therapeutic molecule against HPV infection,” says Dr Dey of DBT. Curcumin may not be available over the counter for another few years. But once it is, it promises to change things.

Virus alert: this one could cause cancer

This is a virus as deadly as the HIV and as common as the cold. A German virologist who has shown that the human papilloma virus (HPV) triggers cervical cancer shares the 2008 Nobel Prize (for physiology or medicine)

Benita Sen

It’s the year of the virus. The Nobel Prize for physiology or medicine for 2008 is shared by French researchers Luc Montagnier and Françoise Barré-Sinoussi, and German virologist Harald zur Hausen for “the discovery of two viruses of great importance in diseases for humans”, according to a statement by the Nobel Committee. Montagnier and Barré-Sinoussi’s conclusion that the human immuno-deficiency virus (HIV) causes AIDS, and Prof. Hausen’s discovery that the human papilloma virus (HPV) causes cervical cancer have armed mankind in its fight against these two dreaded diseases.

Bhudev Das with Stemming infection: German virologist Harald zur Hausen.

SWe know about the deadly HIV. But HPV? Most of us haven’t even heard of it. But a growing number of doctors from all over the world have started believing that HPV is an equally deadly virus. Worse, it is as common as the cold, anywhere in the world.

HPV and cancer

Not many of us know viruses can cause cancer. The hepatitis B and C viruses, for instance, cause liver cancer. The human T-cell virus causes T-cell leukaemia and the human herpesvirus 8 (HHV8) causes Kaposi’s sarcoma. Now, thanks to Prof. Hausen’s pioneering work, the world knows that HPV triggers cervical cancer.

Youngsters, beware

According to the American Cancer Society (ACS), HPV is transmitted largely by an infected sexual partner. “About one-half to three-fourths of the people who have ever had sex will have HPV at some time in their life,” it says.

HPV also finds a ready host in younger people. In the US, for instance, virtually one in two HPV-infected people is below 25. Studies suggest that most sexually active men and women will contract HPV at some time in their lifetime. The good news, though, is that most will never even know it and the virus does not always cause disease. Often, the body clears up HPV infections on its own within two years or less.

Cervical cancer, however, is largely incurable. It goes undetected in developing economies where there are no facilities for early detection. Incidentally, according to World Health Organization, since developing countries do not have a mandatory screening programme (the pap smear test for women, for example, and anal pap smear tests for men), they account for 80% of cervical cancer cases worldwide. Prof. Hausen, from the German Cancer Research Center in Heidelberg, cloned the virus in 1984. Says Dr Bhudev C. Das, professor of biomedical sciences, Ambedkar Center for Biomedical Research, University of Delhi, and formerly founder director, Institute of Cytology and Preventive Oncology (ICPO) of the Indian Council of Medical Research, Noida: “In spite of the fact that the two high-risk and carcinogenic HPV types 16 and 18, against which two vaccines have been developed, were cloned by Prof. Hausen and his group in the late 1970s, his work was not given much importance compared to HIV, HBV and other viral diseases for more than a decade.” Experts claim that the HPV vaccine offers 95% protection from the HPV 16 and HPV 18 viruses.

HPV vaccine

India’s first vaccine to help prevent cervical cancer caused by HPV was launched recently by MSD Pharmaceuticals (India), the local affiliate of Merck & Co., Inc. of the US. The vaccine, Gardasil (Quadrivalent Human Papillomavirus Vaccine, against Types 6, 11, 16 and 18), helps prevent diseases such as cervical cancer, abnormal and precancerous cervical lesions, vaginal lesions, vulvar lesions and genital warts, all caused by these types of HPV. It is recommended for women between 9 and 26 years of age.

Do I have HPV?

Although genital HPV infection is very common, most of us, except those who develop genital and anal warts, do not know we are carriers. At a later stage, an infected woman may complain of irregular bleeding or bleeding after intercourse. Ironically, the warts are caused by the lower-risk HPV variants, HPV 6 and 11. The high-risk HPV 16 and 18, on which Prof. Hausen has been working and which accounts for about 70% of cervical cancer cases (source: ACS) and cancers of the genital region, show up as cervical lesions, on the way to morphing into cancer. HPV also causes some cancers of tonsils and tongue.

Research in India

The elected president of the Indian Association for Cancer Research for 2006-2009 and recipient of the President’s Medal for the Dr B.C. Roy National Award, Dr Das has worked with Prof. Hausen for several years. He says HPV is present in almost 98% of Indians. His work with herbal preparations such as curcumin (found in turmeric) to counter HPV (reported in Mint earlier, see bottom left) is now in the clinical trial phase. Other cures he is exploring include Praneem, a polyherbal product used against HIV too.

Dr Das says: “In spite of the Nobel Prize and the realization that HPV infection and cervical cancer incidence in India is the highest in the world, it is time we launched a mass awareness programme even among doctors, healthcare workers, public health personnel and NGOs, a majority of whom are ignorant of HPV. The message must reach the youth, who are most susceptible to HPV.”

HPV & You

Genital HPV travels from one person to another through vaginal and anal sex. In the absence of a mass vaccination programme or proper screening, Dr Das warns that the changing sexual behaviour, early exposure to sex and multiple sexual partners are dangerous signs for India 5,00,000: The number of people affected by HPV every year. The American Cancer Society suggests that it is the second largest cause of cancer among women worldwide.

74,000: The number of women who die due to cervical cancer in India. This is more than one-fourth of the deaths attributed to the disease.

2.5%: The percentage of lifetime risk of women in India getting this cancer. This is almost double the risk compared with the worldwide figures (1.3%).

One-in two: HPV-infected persons in the US is below 25, according to the American Cancer Society