EDITORIAL: Cancer burden

Government should strengthen capacity to reduce cancer burden by raising awareness so as to improve quality of life of people living with the disease

Cancer is one of the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8 million cancer-related deaths annually. According to the World Health Organisation (WHO), the number of new cases could rise by about 70 per cent over the next 20 years. In Nepal, according to estimates, some 30,000 new cases of cancer are diagnosed every year. The WHO defines cancer as a large group of diseases that can affect any part of the body. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. Major causes of cancer are smoking, alcohol and obesity. Sexually transmitted Human papillomavirus (HPV)-infection, infection by hepatitis or other carcinogenic infections, ionizing and ultraviolet radiation, urban air pollution and indoor smoke from household use of solid fuels also are contributing to rise in cancer cases.

The most common cancer among males in Nepal is lung cancer followed by oral cavity and stomach, while the most common cancer in females are cervical cancer, breast cancer and lung cancer. Of late the number of spine cancer patients is also increasing in the country. According to the WHO, the toll of cancer and other chronic diseases is greater in low- and middle-income countries, where people develop chronic diseases at younger ages, suffer longer — often with preventable complications — and die sooner than those in high-income countries. Nepal, however, lacks the data to drive cancer policy. The National Health Research Council said in January that it had launched population-based cancer registry. The move aimed at collecting data on cancer patients is a good move.

The WHO says between 30 to 50 per cent of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Imposing higher taxes on tobacco and alcohol, promoting healthy diets and physical activity and raising awareness about Human papillomavirus vaccination can be instrumental in reducing cancer burden. The government has been providing free treatment to cancer patients. But there seems to be a lack of awareness among patients about the government scheme. There is a need to run campaigns to bring cancer patients to hospitals. Similarly, the government and non-government agencies must also launch campaigns to aware people about the detrimental effects of smoking and unhealthy lifestyle. Cancer is more likely to respond to effective treatment if there is early diagnosis, which can result in greater probability of surviving. Early diagnosis also could mean making significant improvements in the lives of patients. Cancer has a greater economic impact than all causes of death. The financial costs of cancer are high for the person with the disease and the society as a whole. Early detection greatly reduces the financial impact. The government should strengthen capacity to reduce cancer burden by raising awareness about cancer so as to improve survival and quality of life of people living with the disease. Cancer does not need to be a death sentence.

Unjustified demands

The new constitution has empowered the local level units to regulate and manage education system up to Grade XII. Some local level units have already drafted new regulations with regard to management of the secondary education. However, various teachers’ organisations, affiliated to political parties, are opposed to the new system and are demanding that the central government take back the power given to the local level.

Their argument is that the local levels are supposed to monitor and enhance educational quality in public schools and that issues related to curriculum development, teachers’ recruitment, evaluation and job security must be managed by the federal government. What can be said in a nutshell is that public school teachers need to give better performance under direct supervision of the local level authorities. Federal government, however, cannot monitor all public schools on a day-to-day basis. The local level units have been given this right to enhance the quality of education. Their demand is unjustifiable. There should be no compromise on quality of education.