MUMBAI: Indian food rich in spices, personal hygiene, circumcision and tobacco use ban are some of the things that can help keep cancer at bay, according to a leading cancer expert.
The word cancer usually sends a shiver down the spine, but it is curable disease if diagnosed early, says Rajendra A Badwe, Director of the Tata Memorial Centre here.
In an interview, he speaks on a range of issues related to cancer and how to tackle with its various forms.
Excerpts of the interview:
Q) How is India faring in tackling the menace of cancer?
A) Cancer in India is remarkably constant, as far as “per lakh incidence” is concerned, over the last 20 years. Unlike the other BRIC countries – Brazil, Russia and China, where the cancer incidence is rising, in India it is a straight line. But there are some geographic variations – if you look at numbers in urban India, it is annually about 90 to 100 per 100,000. The same in a semi-urban area is about 60-70 per 100,000 per annum. And the same in rural India is 40-50 per 100,000.
Q) So do you think cities are causing cancer?
A) It is the urbanisation that is causing cancer. Some cancers are on the rise and some on the wane. In women, breast and ovarian cancers are on the rise; they have risen from 15 per 100,000 to about 30 or 35 per 100,000 in cities.
As against that, uterine cervical cancer has reduced from 13 to 8.5 in Mumbai, which is a remarkable reduction. The incidence of cervical cancer in rural Barshi, a town in Solapur district of Maharashtra is about 32 per 100,000, while 50 km away in urban Barshi it is 15 per 100,000.
So, there is personal cleanliness that comes in – with running water, sanitation and personal hygiene, privacy of bathroom, (when these basic necessities are available) you will have a reduction in cervical cancer incidence.
You look at the Muslim population in Barshi rural, urban, and in Mumbai – in all three, the cervical cancer incidence is same (5 per 100,000). It is only because of circumcision in males that personal hygiene happens naturally. Whereas in rural areas, men have their baths in common wells – where is the personal hygiene? And the possibility of transmission of virus is extremely high.
We then ask, in the whole of the Middle East, cervical cancer does not exist! It is 4 or 5 per 100,000. Why cannot we have a choice offered? We can do circumcision – the possibility of transmission of human papilloma virus (HPV), human immunodeficiency virus (HIV), all are reduced. Second, we can run screening program for cervical cancer – our own studies have shown that 30 per cent reduction is possible. Third, one can give vaccines.
Q) Do you recommend Hindus to go in for circumcision?
A) They should be given a cafeteria choice. Tell me – what is religion? It is a way of life to make one happier and more comfortable, if there is something good in another religion why not adopt it?
I am not forcing anyone, but we should be given a choice. Genital hygiene is vitally important. Genital hygiene, circumcision, screening, leave all choices for people to decide what they want to do. And if someone opts for a circumcision, why stamp that person as Muslim? If HPV transmission, HIV transmission and cervical cancer are going to reduce, then why not promote circumcision?
The third most fatal cancer in urban India that is reducing rapidly is stomach cancer. Those who get it have a mere 5 per cent five-year survival. 95 per cent of people are dead in the first five years. This cancer is reducing at a breakneck speed in cities – because of proper preservation of food.
In rural India, food is kept overnight without refrigeration and preservation, and that can have fungi, which leads to stomach cancer. This has reduced to less than 6 per 100,000 in cities, and it was earlier 20 per 100,000. So Swachh Bharat is an excellent move.
The second important thing – there are some cancers that are rising; breast cancer, ovarian cancer, lower end of food pipe cancer – all these cancers in additional to intestinal cancer and kidney cancer, six cancers are attributed to obesity, which is entirely in urban India.
In rural India, there is no obesity – people work hard. Obesity produces 6 different kinds of cancer, and almost all are preventable; almost half the breast cancer cases are because of obesity. Immensely preventable through daily exercise and less food.
I do not think today in urban India and cities, there is an entity called hunger – it does not exist. There is so much of food around, yet every mother feels their child does not eat. How does the child become obese then? No exercise.
See, cancer in India is one third to one sixth of that in the US. In America, it is 300 per 100,000. The Bill and Melinda Gates Foundation has put in more than a million USD in Barshi to understand why breast cancer is static at 8 per 100,000 for the last 30 years.
It is around 120 per 100,000 in USA. In the case of large intestine cancer, which is 60-70 per 100,000 in the US.; it is 4 per 100,000 in India. Our diet is excellent, our roughage is fantastic, and our spices are beautiful – all these need to be continued.
We are also working extensively with Tata Trusts on key projects, like the Virtual Tumor Board that provides a platform for doctors across various geographies to virtually share ideas for treatment protocols for cancer and the expert online opinion service, Navya, among others.
Another preventable thing is tobacco – it accounts for 40 per cent of cancers in India. It is the only product which does not require insecticides – insects know that it is bad! The tobacco industry pays the farmer 3 years in advance – we need to do something so that by 2025, there is no tobacco production. Give farmers subsidies, alternative crops, see that there is incentive to stop tobacco production.
Q) On tobacco use do you think the people are addicted, or is the government addicted to tobacco through tax collection?
A) People are addicted, no question about this – it is an addictive agent. The government should have a little bit of a courageous attitude and put (heavy) taxation so that the revenue from that taxation doubles.
You triple the taxation, your revenue will double and your usage will become half. Continue doing it and while you are doing it, give an alternative crop to the farmer so that his livelihood is not affected.
Q) So you do not think the government is addicted?
A) No, I would not say that. They are doing something about it. It is vitally important to understand in India there is an industry that is residing in houses; cottage industry that makes beedis – that is huge money.
And tobacco that is chewed, we have already banned. And this ban on Gutka is effective. The incidence of oral cancer in Mumbai has started declining since last year. There is legislation on reducing consumption of tobacco we need implementation of that law. We just cannot have the sale of tobacco.