Cancer needs everybody’s attention, says University of Pretoria professor
The prevalence of cancer is increasing worldwide. Globally, 14 million people are diagnosed with cancer each year, and approximately nine million lose their lives to cancer annually. Four of those nine million are aged between 30 and 69 years. According to the Cancer Association of South Africa, breast cancer in women and prostate cancer in men are among the top five cancers prevalent in South Africa. However, according to the World Health Organization, between 30 and 50% of all cancer cases are preventable! It is therefore crucial to constantly emphasise cancer awareness and alert people to strategies that address the burden of this disease.
4 February is World Cancer Day. This initiative by the Union for International Cancer Control provides an opportunity to enhance cancer awareness and to report on the current status of cancer statistics in relation to global health.
Breast cancer and leiomyosarcoma have been diagnosed in several of my family members and friends over the years. This has led me to the conclusion that cancer needs everyone’s attention. We have to be alert; taking risk factors into account. Everyone can contribute towards cancer mindfulness to overcome barriers to early detection, cancer treatment and palliative care.
Public awareness of risk factor is crucial. Fundamental risk factors include acute/chronic stress, alcohol consumption, tobacco products, diet, lack of physical activity, environmental pollutants, ultraviolet radiation, reproductive and hormonal factors, occupational exposures, genetic predisposition to cancer, and infection-attributable cancers. In addition, symptomatic cancer presentation also remains one of the most prevalent means of cancer diagnosis.
Cancer is defined as a malignant tumour caused by uncontrolled and abnormal cell division. If this is not treated, these malignant cells may metastasise to other parts of the body via the blood stream or lymphatic system. Traditional cancer treatment options include surgery, chemotherapy and radiation. Cancer patients may receive only one type of treatment, but a combination of treatments including surgery with chemotherapy and/ or radiation therapy may be decided on.
In recent decades, considerable progress in cancer cell biology paved the way and advanced technology for early cancer detection, screening and surveillance in modern oncology. Cancer treatment approaches may include immune modulating drugs, antibodies targeting and destroying the cancer cell per se, hormone therapy, epigenetic drugs that regulate genes causing cancer, vaccines, cell cycle checkpoint inhibitors, and cell-based therapy. The principle of stem cell transplants is based on restoring blood-forming stem cells in cancer patients when their blood-forming stem cells have been destroyed due to high doses of chemotherapeutic drugs or radiation therapy.
In recent years, precision medicine or personalised medicine in cancer treatment has evolved. Precision medicine aims to deliver individualised ‘precise’ treatment to patients. Precision medicine in cancer takes into account the genetic, molecular and biological characteristics of the patient that subsequently influence the treatment selected by physicians. Although there is currently no consensus about personalised/ individualised cancer treatment, it is envisaged that precision medicine will contribute to the development of therapies that will target the cancer cells or cellular pathways affected with minimal trauma and side effects, to improve quality of life. There is definitely also no ‘one-size-fits-all’ treatment for cancer patients.
While huge strides have been made with regard to the medicines available, a caring environment nurturing the discovery of new knowledge to contribute to the fight against cancer is also imperative. There are millions of cancer survivors worldwide, again emphasising the importance of cancer awareness, early detection and treatment. For each of us that starts promoting cancer mindfulness, there is increased hope that what will happen next might just change the world.
Below: Cancer cell response after treatment with a potential anticancer agent.
Professor Annie Joubert is Head of the Department of Physiology at the University of Pretoria. Professor Joubert’s research focus is cancer cellular physiology. She studies cancer drug design and cancer cell signalling to identify targets for therapeutic intervention in the fight against cancer.
“Kidney Health for Everyone Everywhere” Kidney disease is a global health problem with a growing disease burden in both developed and underdeveloped countries. The magnitude and the impact of kidney disease is unknown, and will remain so, if no concerted effort is made to develop a national data collection system to collect data on surveillance practices, (screening and preventive care) and access to treatment. In South Africa, as in many countries in the world, poor socio-economic circumstances, cultural and political factors lead to significant disparities in the burden of disease and availability of care. A case in point is the 2016 Report of the South African Dialysis and Transplantation Registry revealing that of the 1 472 patients who started renal replacement therapy, 86% received treatment in the private sector and 14% in the public sector. The drivers behind the growing kidney disease burden include adult essential hypertension, obesity and diabetes mellitus. Hypertension and cardiovascular disease are both recognised non-communicable diseases worldwide. However, chronic kidney disease is not, and is also not given the attention needed at a national or international policy level. The WHO Global Action Plan 2013-2020 for non-communicable diseases (NCDs) only briefly mentions chronic kidney disease (CKD). It fails to address the important interaction between CKD and other major NCDs, particularly hypertension, cardiovascular disease and diabetes mellitus. CKD is an important cause and consequence of these diseases. There is evidence suggesting that the coexistence of diabetes and CKD increases the risk of cardiovascular diseases, whereas overall mortality rates are tripled for diabetes patients who also have kidney disease. Therefore we believe and strongly motivate that kidney disease must be included in our national NCD policy as one of the main NCDs to be dealt with in the imminent future. Prevention strategies should begin with educational programs of children in school, including information on healthy lifestyles, increase in physical activity, less sedentary behaviours and dietary advice. Universal screening programs for measurement of blood pressure of all schoolchildren and young adults should be implemented along with assessment of anthropometry. Preferably, urine dipsticks should also be done during the assessments. There are however many constrains which will need to be addressed before these suggestions can be put into action. According to guidelines, correct measurement of blood pressure in children requires three blood pressure measurements at each health visit and calculation of the average. Hypertension is defined as systolic and or diastolic BP 95th percentile for age, gender and height on 3 occasions. These guidelines are not feasible in the South African health setting. It will require more health personnel, equipment for measurement of height and BP, and health personnel will need to be trained on using standard blood pressure percentile charts. The MRC Research group suggested that cut-off values be used for the screening. The aim with the screening is to identify the children with hypertension, particularly those with other positive risk factors, who can then be referred for further management and implementation of preventative measures. The ultimate aim is to prevent the consequences of unidentified and untreated hypertension in children, prevent development of end organ damage and an ever- increasing adult population with cardiovascular disease and CKD. Since 2016 South African legislation has enforced a decrease in the maximum sodium content in a range of processed foods, with a further decrease becoming mandatory later this year (2019). Rapid urbanisation has caused a change in the lifestyle of the SA population, with many families eating unhealthy high carbohydrate high fat foods with little fibre, coupled with a lack of exercise. The consequence is an increased prevalence of overweight and obesity, which are the major drivers for the development of insulin resistance, diabetes and metabolic disease, all of which are linked to hypertension. The NKF of SA along with the entire nephrology community in SA request an increase in the investment in kidney disease. A plea is made to the National Department of Health for a change in policies and intervention strategies. An integrated national NCD strategy should focus on prevention, early detection and management of early stages of all relevant NCDs, including CKD. Failing to do so translates into kidney disease being neglected, and patients will only be identified when they have reached end stage renal failure (ESRF). Once a patient has ESRF, all opportunities for preventive care has been missed! Prof Gertruida van Biljon is a Paediatric Nephrologist at University of Pretoria and Steve Biko Academic Hospital