Dealing with a Cancer Diagnosis in the 21st Century: What is the Way Forward?
The 21st century has seen significant advancement in the prevention, diagnosis, treatment, and follow-up of different forms of cancer. Gone are the days when everyone given a cancer diagnosis, was automatically handed a death sentence. While, there is still a lot of work to be done in cancer research, diagnosis, and therapeutics, it is important to highlight that some progress has been made in the fight against this deadly disease. However, more needs to be done in the field of research and continuous improvements initiatives.
I remember when my family had to deal with a cancer diagnosis and how from the very beginning, we were told the dire prognosis of my aunt’s condition. I was just about getting into high school, but I can remember vividly how it all played out. She had been having what at the time had looked like a sore (ulcer) on one of her breasts and hadn’t taken it seriously. In fact, she later confirmed the fact that she had ignored what had begun like a boil (lump), but only became concerned when instead of the “boil” to regress, it kept getting bigger and ultimately became ulcerated.
My aunt was diagnosed with breast cancer, and I recall seeing my mom cry incessantly after repeated visits with the doctor. My aunt was given a bleak prognosis of several months to live regardless of surgery or chemotherapy, because her cancer had metastasized to other organs at the time of presentation. She eventually died. The experience was painful and was one of the motivating factors for me to become a medical doctor.
Now, as a physician in training in pathology, I am tasked with the responsibility of diagnosing different forms of cancer, amongst many other disease entities. I must say that I have been hugely impressed by the amount of success that has been made in this field.
First, with the use of molecular genetics, researchers and scientists are better able to understand the genetic profiles of different cancer phenotypes, which may be amenable to different forms of chemotherapy. For example, some breast cancers (depending on the degree of spread or expression of certain genetic markers), may respond to currently available treatment options including chemotherapeutic agents, surgery, radiotherapy, immunotherapy, hormone therapy, stem cell transplant, precision medicine or targeted therapy and increase the life expectancy of survivors. This multi-disciplinary therapeutic approach confers several survival years to the patients and may even have the potential benefits of a definitive cure. In contrast, when my aunt was diagnosed with cancer, she wasn’t given the opportunity of an option for survival. It was an ‘all or none’ situation, irrespective of whether she had surgery or chemotherapy (the only treatment options available at the time) or not. She was told that she was going to die, regardless. And she eventually did.
Another example is cancer of the lungs. Through recent advances in research, it’s now known that some lung cancers which express certain genetic markers and without clinical or radiological evidence of spread outside the lungs may be more likely to respond to certain chemotherapeutic agents than others, when combined with surgery, radiotherapy or other forms of therapy, as listed above. Therefore, the fact that someone is handed a diagnosis of lung cancer does not automatically hand them a death sentence. Chances are they may be fortunate to have been afflicted with genetically responsive phenotypes, for which curative treatments may be possible through a multi-therapeutic approach.
The scenarios highlighted above also apply to several other cancers. However, there is still a lot that needs to be done. Government and Aid organizations must prioritize cancer research, in order to find lasting cures for this deadly disease. Research and development in this area should be globally focused, including the impoverished and less developed nations of the world. Every country, region, and continent should be involved in this fight. No one or nation should be left behind. If we must nail this scourge in the head, then we must all put our monies where our hearts are, to encourage research and therapeutic discoveries in the fight against cancer. Then, like my family, no family should be handed an automatic death sentence, due to a cancer diagnosis.
A cancer diagnosis can diminish hopes, truncate destinies and paralyze families. Cancer advocacy efforts aimed at public education about causation, prevention, opportunities for research, treatment, follow-up, and resources for survivors should be prioritized. According to the World Health Organization, cancer was the leading cause of death globally in 2018, accounting for an estimated 9.6 million deaths, i.e. about 1 in 6 deaths in 2018 was due to cancer. Of this number, approximately 70% of those deaths occurred in low- and middle-income countries. This is a global fight and not reserved for the high and mighty nations of the world. And we should never stop until we create a cancer-free world!
Evi Abada, MD, MS, is a resident physician in pathology and writes about life, global health and cancer prevention, diagnosis and treatment.
