Journal of Head & Neck Physicians and Surgeons

GUEST EDITORIAL
Year
: 2019  |  Volume : 7  |  Issue : 1  |  Page : 1--2

What is Enough and is Enough, Enough?


Kaustubh D Patel 
 President, Foundation for Head & Neck, Oncology; HCG Cancer Center, Ahmedabad, Gujarat, India

Correspondence Address:
Kaustubh D Patel
Room 206, OPD Building, HCG Cancer Centre, Science City, Ahmedabad - 380 060, Gujarat
India




How to cite this article:
Patel KD. What is Enough and is Enough, Enough?.J Head Neck Physicians Surg 2019;7:1-2


How to cite this URL:
Patel KD. What is Enough and is Enough, Enough?. J Head Neck Physicians Surg [serial online] 2019 [cited 2019 Oct 16 ];7:1-2
Available from: http://www.jhnps.org/text.asp?2019/7/1/1/263512


Full Text



Greetings to you all H&N Cancer Crusaders from Foundation for Head and Neck Oncology (FHNO) India, a prime national body to oversee Prevention, Treatment, Quality of Outcomes, Rehabilitation, Research and Education for H&N Cancer in India.

South East Asia (India being the largest population in that group) has >70% of global oral cancer load, and unfortunately, 90% of these are detected in stage III and IV. National Institute of Cancer Prevention and Research, Indian Council of Medical Research, and Global Cancer Incidence data show that India has an estimated 2.25 million cancer patients.[1],[2] To these, about 1.2 million new cancer patients are added every year, and approximately 0.8 million die annually. According to WHO's latest assessment, cancer cases in India will multiply five times over the next decade.

We all know very well that the major preventable causative agent is the consumption of tobacco and related products. 2018 Global Adult Tobacco Survey data show that 28.6% of adult Indian population uses tobacco.[3] That means, close to 269 million adult Indian consume tobacco. The exponential rise in Indian population from 400 million in 1950 to 1.2 billion in 2017 also gives us an understanding that these data and graph are on their way up in the coming years.[4] In 2018, cancer was responsible for 9.6 million deaths worldwide making it world's second biggest killer. Cancer is estimated to create a burden exceeding $1 trillion every year. The 2019 index of cancer preparedness has assessed 28 countries for adequacy of measures to treat and prevent cancer. India ranks among the worst overall. India's healthcare system and infrastructures are the third worst in the index (Economist Intelligence Unit 2019 report).[5]

There is a significant increase in numbers of H&N cancer patients in India as per hospital-based and population-based registries. My personal communications with leading H&N Oncologists at tertiary cancer centers across the country also reflect the same. Government projections show that the country needs minimum of 600 additional quality cancer centers by the end of this decade to meet the rising number of patients. Adding to this complex need is the fact that we have approximately 2000 qualified oncologists to cater around 10 million cancer patients. We have huge void of qualified treating cancer specialists as well as infrastructure in our country. Lancet study published in October 2018 also draws the same gloomy picture.[6] This brings us to the question that are we doing enough to combat this problem?

FHNO has started a structured 2-year fellowship program across the country, and in its very 1st year, there are 19 reputed cancer centers where fellows are being trained. Many more centers have applied and are being inspected and evaluated to increase the fellowship intake. FHNO leadership and young faculties have greatly contributed for this important initiative. This of course is a small step to decrease the ratio between workload and quality outcome providers. However, lots of persistently dedicated efforts are needed, and it is poignantly germane in today's time to ask us What is Enough?

We conducted two pilot projects with Ahmedabad Cancer Foundation.

In presently ongoing project with Ahmedabad Municipal Corporation School Board, we conduct modular cancer awareness programs in various municipal schools. During this initiative, we asked three questions to middle school students (10–14 years of age) which they had to answer in confidential way on folded piece of paper. 1255 students responded to all the three questions. Analysis of those answers revealed that 2.6% of students consumed tobacco, 68.5% confessed that their family member uses tobacco, and 60.1% revealed that their friend/near relative consumes tobacco. These figures are way above the prevailing assumptions.

The other project with Ahmedabad Traffic Police Department involved detailed cancer-related examination of those employees who consumed tobacco. Of 127 tobacco chewers, we could find 2 invasive cancers and 32 premalignant lesions [Table 1].{Table 1}

If one extrapolates this to 269 million adult tobacco users of India, it becomes absolutely unthinkable situation.

So, it seems that whatever we have in literature and publications, might turnout as the tip of the iceberg raising the dreadful question.

What is Enough and Is Enough, Enough?

It seems overdue that a focused and true multidisciplinary effort by politicians, policymakers, government workforces, NGOs, legislators as well as professionals from healthcare, media, and law enforcement specialties is coordinated to really make a meaningful impact.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.

Ethical approval

The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

1Mehrotra R, Kaushik R. A stitch in time saves nine: Answer to the cancer burden in India. Indian J Med Res 2018;147:121-4.
2International Agency for Research on Cancer – World Health Organization. Population factsheets. Available from: http://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf. [Last accessed on 2019 Jun 10].
3World Health Organization. GATS 2 India Fact Sheets. Available from: https://www.who.int/tobacco/surveillance/survey/gats/GATS_India_2016-17_FactSheet.pdf. [Last accessed on 2019 Jun 05].
4Ritchie H. India's Population Growth will Come to An End: The Number of Children Has Already Peaked. Available from: https://ourworldindata.org/indias-population-growth-will-come-to-an-end. [Last accessed on 2019 Jan 15].
5The Economist Group. Cancer Preparedness around the World National Readiness for a Global Epidemic. Available from: https://worldcancerinitiative.economist.com/pdf/Cancer_preparedness_around_the_world.pdf. [Last accessed on 2019 Mar 30].
6Correction to lancet oncol 2018;19:1289-306. Lancet Oncol 2018;19:e581.