Today is World Cancer Day – my thoughts are colored by a sobering email I recently received informing me and the other members of my medical school class that one of our classmates has been diagnosed with an advanced malignancy and is battling for her life. For someone in their 40’s this is indescribable, and I wish her the very best of medical care and a speedy recovery.
The role of imaging in the early diagnosis of cancer cannot be overstated. Today medical imaging can detect early cancers of the breast (mammography), lung (with chest xray), ovary (ultrasound), colon (virtual colonoscopy) and virtually every other organ. The reason I have singled out the breast, lung, ovary and colon for attention is because they are each a part of screening examinations which are routinely performed around the world. In other words, there is a program that drives otherwise healthy individuals to get themselves imaged, given that the statistical probability for the existence of one of the these malignancies is not insignificant, depending on which part of the world one may be, and on one’s risk factors, such as smoking or family history of a similar malignancy.
In India, such screening programs lag far behind those in the west, especially the Scandinavian countries where such image-based screening is the stuff of legend. At the recent RSNA in December 2012 the award for best research paper went to one that analyzed the results of a large multicenter mammography screening program in Sweden. In these countries every woman over 40 is advised to undergo annual mammography (with some recent debate in the US on its frequency) and the recommendation tends to be fully heeded by the female populace.
Screening in India however follows certain atypical patterns. One that is growing in utilization due to increasing corporatization is related to employment and the annual medical exam that is mandated by the employer. Another, which I have observed frequently among my social circle, is when an individual is detected with a life-threatening ailment, all the close relatives of that person immediately present themselves for a related screening examination. However mainly due to cultural and economic factors, the acceptance of routine annual screening, particularly mammography, is not high. This needs to change. Several reports indicate that the incidence of breast cancer among urban women in India closely approximates their western counterparts.
In the West, screening at some point can and has become counterproductive, such as in the case of false positive mammograms resulting in too many unnecessary biopsies, or an increase in population radiation dose related to ‘whole body screening CT scans’ being performed even when not indicated. Obviously a balance and sense of proportion need to be maintained, perhaps at a point intermediate between western and eastern practices.
World Cancer Day is meant to remind us all of the ‘emperor of all maladies’, so that we take appropriate steps, at individual as well as at governmental levels to combat this disease. As individuals, it behooves us to at least think and learn more about image based screening, through websites that provide information on the subject before we take the next step of actually undergoing the test. And at the governmental level, an effort to educate our citizens of the need to ensure their continued health and longevity by obtaining a simple screening test would go a long way in the war against cancer.