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Colorectal cancer on the rise among Pakistanis in their early teens Even though the risk of cancer multiplies with age, Pakistan is witnessing an increase in the incidence of colorectal cancer among patients in their early teens, and breast cancer among women in the age bracket of 40s. Unlike other countries of the world, where cervix cancer is common, Pakistan has more cases of colorectal as well as head and neck cancers. As such, since cancer patients in Pakistan are different from cancer patients of the world, the country must focus on national collaboration for cancer research. Genetic studies should be conducted in all major cities as a starting point. Views to this effect echoed at a World Cancer Day event organised by the Nuclear Medicine, Oncology and Radiotherapy Institute (NORI) here on Tuesday. The event packaged informative presentations by oncologists Dr. Humaira Mehmood and Dr. Mohammad Faheem, stories of cancer survivors, and an awareness walk. Pakistan Atomic Energy Commission (PAEC) Chairman Dr. Ansar Parvez and Foreign Affairs Secretary Aizaz Ahmed Chaudhry were the guests of honour. The director of NORI, Dr. Javaid Irfan, and former director of Pakistan Bait-ul-Mal Zamurrud Khan were also prominent on the head table. Dr. Faheem alerted the audience to the drastic rise in the incidence of cancer. He said 12.7 million people had cancer in 2008; this number rose to 14.1 million in 2012, and is projected to touch the 19.5 million mark by 2025. There has also been a global increase in the incidence of breast cancer, Dr. Faheem added. In Pakistan too, 1 in every 4 women (from the previous 1 in every 9) can have breast cancer. Delay in presentation to a health facility on account of preference for shortcuts like consulting hakims and quacks or opting for homeopathic treatment, as well as lack of awareness, cultural conservatism, and ignorance of the doctor were quoted as key impediments to early detection and timely treatment of cancers. Poverty and stigma also lead to avoidable delays. In keeping with this year's theme, 'Debunking the Myths,' Dr. Faheem dispelled some of the commonly held notions. He said cancer is not a contagious disease; it is not always painful; all lumps are not cancerous; surgery does not cause the cancer to spread; and all information sources about cancer are not accurate. He also clarified that neither hair dying nor mobile usage can cause cancer; and that cancer is not always fatal. Dr. Faheem said that for many cancers, there are warning signs and symptoms for early detection. He called for concerted efforts at the individual, community and policy levels to prevent the chronic disease. "We cannot direct the wind but we can adjust the sails," he said in conclusion, exhorting cancer patients never to lose hope. Dr. Humaira informed that while one-third of all cancers can be prevented through lifestyle modification, another one-third can be prevented through early detection. She said, the development of cancer, which is projected to cause 13.1 million deaths by 2030, takes many years before it becomes symptomatic. Dr. Humaira said breast cancer, which affects 40,000 women in Pakistan every year, is the most preventable of all cancers. "Bodily changes; frequency in passage of urine or stool; a sore throat that doesn't heal; unusual bleeding or discharge from the body; presence of a thickening lump; indigestion; difficulty in swallowing and a nagging cough or hoarseness merit immediate consultation with a doctor," she advised. The oncologist also discussed the risk factors of cancer such as cigarette smoking, alcohol consumption, increase in serum estrogen, age, and obesity. She urged the public to consume fresh fruits and vegetables, and to indulge in regular physical activity. Dr. Humaira recommended the involvement of LHWs in cancer awareness initiatives, and breast examination of women residing in the rural areas. She also highlighted the role of gynaecologists in cancer prevention, and urged the PMDC to incorporate a chapter on oncology in the curriculum of young doctors. A number of cancer survivors were present to share their stories. Prominent among them was Professor Dr. Syeda Batool, head of the MCH Centre at PIMS. Dr. Batool, an exceptionally brilliant gynaecologist who is better known for her pleasing personality and mannerism, was diagnosed with breast cancer about 8 months ago. "It was a difficult experience but surely not a death sentence," she remarked. Timely diagnosis, a sympathetic faculty at NORI and a lot of goodwill from colleagues instilled hope in her. "Throughout this time, I only prayed that I am able to do twice as much hard work as I did before the diagnosis. Life does not end with cancer. Live with it, cope with it, and carry on the best you can," she said in her brief but motivational remarks. Mahrukh Shah, a survivor of thyroid cancer, stressed the need to educate cancer patients on how to tackle the disease, and care-givers on how to tackle a cancer patient. She also proposed the creation of a patient support system for better endurance. Zahida, a survivor working at NORI, thanked Dr. Faheem for giving her the courage to continue her treatment without allowing disruption of work. Jameela Agha, Shaheen S M Qureshi, and Dr. Kathleena also shared their experiences as survivors. All patients praised NORI for its professionalism. They unanimously agreed that Pakistan has the best treatment facilities for cancer, and that the care and attention that they got at NORI is unseen in any other part of the world. PAEC Chairman Dr. Anwar termed hospital as the last line of defence. "Actual defence lies outside the hospital; in awareness and early detection," he said. The chairman said, since PAEC does not have the resources and time to devote to awareness-raising, the media should fill this gap by running educational campaigns to save cancer patients. Foreign Affairs Secretary Aizaz Ahmed, a cancer survivor himself, praised PAEC for its role in enabling Pakistan to acquire the status of a nuclear state, and for gaining prominence in the field of power generation. "The third feature of PAEC became evident when I contracted cancer three years ago. One option was to proceed abroad but I chose Pakistan because NORI is providing services without any commercial interests, and is doing tremendous work in the field of nuclear medicine. We have shown to the world that aside from various other domains, we excel in peaceful uses of nuclear energy as well," he said. Aizaz said, Muslims are particularly blessed because they have a firm belief in pre-destination of the day of their departure from the world. "Islam gives us hope like no other religion," he added. Earlier in his welcome note, NORI Director Dr. Javed Khan shared that in spite of challenges such as shortage of equipment and lack of cancer surgeons at NORI, the institute is trying its level best to serve cancer patients. He regretted that most patients present to a health facility at a late stage, when treatment becomes challenging and costly, and hope almost totally fades. Dr. Javed complimented PAEC for having established 18 cancer centres across the country. NORI, which was established in 1983, is now laced with all possible cancer-related services including hormonal tests for screening. He thanked Zamurrud Khan for helping NORI during his tenure as head of PBM.

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