Eleven myths and truths about cancer

Given a choice, most people would choose to live a long life, and die happily in their sleep after years of fulfilment.

However, we are assaulted by many illnesses that threaten to snuff out our lives, slowly and painfully. Chief among them are infectious diseases, followed by cardiovascular diseases.

This is according to World Health Organisation figures that show that cancer is the third highest cause of death in Kenya today.

The statistics are alarming. Disturbingly, 80 per cent of cancers in Kenya are diagnosed at a late stage, not because we lack the medical expertise, but because we are largely unaware of our risks and pay little attention to screening. Yes, there is cancer information out there, but it is riddled with myths and rumours. Only experts can help you separate the half-truths from the facts. Here’s what four experts have to say on the truth about cancer.

WHY IS CANCER BEATING US?

With medical discoveries and technological advances, Kenya and the world at large is experiencing an all-time high in cancer survival rates. People are beating cancer. There are many small successes but the war is still on. With 85 Kenyans dying daily from it, we have a problem that begs the question, what are we doing wrong? Has something happened in the past decade that we didn’t notice?

When she weighs in on the matter, Nelly Bosire an obstetrician and oncologist in Nairobi observes that while the reported cases of cancer are clearly going up, it may not mean that the number of cancer patients has gone up.

“It could be a case of increased diagnosis and better documentation. More people are getting screened for cancer compared to a decade ago when it went undetected sometimes even in death,” she explains.

The other explanation for rising cancer cases is longevity. Living longer means that our likelihood of being diagnosed with cancer in our lifetime increases. But while cancer used to be known as the old man’s disease, now even the younger population has not been spared. In fact, 60 percent of Kenyans with cancer are younger than 70 years old.

Then there is HIV.

“A good chunk of people have HIV. Some cancers like lymphoma and cervical cancer are more likely to occur in HIV patients. Even the medication used to control HIV can’t prevent the incidence of cancer,” Dr Bosire explains.

Lastly, environmental pollution and poor lifestyle choices also add onto  rising cancer numbers.

WHAT ROLE DOES EPIGENETICS PLAY?

Your genes may determine whether you get a positive cancer diagnosis in your lifetime or not. A 2014 study by scientists from Baylor College of Medicine in Texas, US, found that changes in genes alone can trigger cancer. These findings add a valuable view to the big picture. If the cancer-causing genes can be identified, the world might be a step closer to identifying future treatments.

 SOMETIMES, IT IS A CASE OF BAD LUCK

According to Catherine Nyongesa-Watta, a radiation oncologist and the owner of Texas Cancer Center in Nairobi, some cancers can only be chalked up to bad luck.

“Cancer is an insidious disease that often strikes individuals who lack any type of known risk factors,” she says.

Dr Nyongesa-Watta uses a study from John Hopkins University Hospital in the US to support this. During this study, 22 types of cancers, which make up for two-thirds of those reviewed, could only be explained by bad luck or random mutations which occur during multiplication of normal cells.

WHICH LIFESTYLE CHANGES ACTUALLY MAKE A DIFFERENCE?

Cancer is caused by uncontrolled division of abnormal cells in the body. There are things that happen that speed up or slow down the formation of errors in our cells. Some we can control, and some we can’t. Up to a third (33 per cent) of cancers are preventable through lifestyle modifications.

“A good place to start would be stopping tobacco use, moderation in alcohol intake, a diet high in fiber and lots of fruits and vegetables, eating less junk and moderation in red meat, not forgetting the importance of brisk exercise. Vaccinations agaisnt the human papillomavirus (HPV) and Hepatitis B also make a big difference,” says Dr Nyongesa-Watta.

Treatment of H. pylori, a bacterium which causes stomach ulcers and a primary cause of gastric cancer, also helps.

DOES ABORTION INCREASE THE RISK OF CANCER?

Abortion has been linked to breast cancer with the argument that when a woman conceives, her breasts start changing in readiness for breastfeeding thus an abortion may lead to abnormalities in the breast. Turns out that this isn’t just something that is said to discourage abortion.

Dr Nyongesa-Watta confirms that abortion can increase the risk of cancer but not in the breasts.

“If one is not ‘cleaned’ after an abortion, there is the risk of choriocarcinoma. This rare form of cancer occurs when the placental tissue continues to grow even after the termination of a pregnancy.”

So after  a miscarriage, you should see a medical practitioner to ensure that the womb is evacuated properly.

DOES HAVING MAN BOOBS INCREASE THE RISK OF BREAST CANCER IN MEN?

About one per cent of all breast cancer diagnoses are in men. It may be a hundred times more common in women but breast cancer in men is real.

 “All men are at a risk of breast cancer, but the risk is small seeing as they have smaller breast tissue,” says David Makumi, the chairperson of the Kenya Network of Cancer Organisations.

Which men are at risk? “Older men as breast cancer is common in men aged between 45 and 80. Also, overweight men and men who have had a history of breast cancer in their family and those who have been exposed to oestrogen.”

Heavy use of alcohol is also a risk factor as alcohol tampers with the liver’s ability to regulate blood oestrogen levels. Men with enlarged breasts also known as gynaecomastia, maybe at a higher risk as they are likely to be overweight or to be exposed to oestrogen. All breast enlargement and lumps in men should be evaluated.

WHY IS THE HPV VACCINE ONLY GIVEN TO ADOLESCENT GIRLS?

One of the many strides that Kenya has made in the fight against cancer is having the HPV vaccine available in local hospitals. The vaccine prevents against infection with some types of the human papillomavirus (HPV) which causes cervical cancer. Calls for the HPV vaccine are usually made to young girls who are not sexually active. Why is this? Can’t a woman who is already having sex get protected from the HPV virus?

“Young girls have not been exposed to the HPV virus. It is the same way we immunise children against other illnesses before exposure,” Mr Makumi explains.He adds that while a woman who is already sexually active can be given the HPV vaccine, the benefit will probably be smaller or it may be a waste of money altogether because she is probably already exposed to these viruses and the immunisation will thus come with no added advantage. For any benefit, a woman who is already having sex would have to be screened first to establish that she isn’t already exposed to the virus.

SHOULD I GET A MASTECTOMY?

American actress Angelina Jolie, evoked strong reactions in 2013, when she decided to get a double mastectomy. Mastectomy, the surgical removal of the breast, is one of the treatment options for people with breast cancer. For people like Angelina who have very strong genetic predisposition to cancer, having the breast removed to reduce the risk of breast cancer has been practised over the last few years.  However, given the attachment of women to their breasts, one wonders whether the medical benefits of the preventive mastectomy outweigh the psychological torture.

Mr Makumi explains that there are some controversies on whether to encourage high-risk women with  BRCA 1&2 gene mutations like Angelina to undergo the procedure or whether to just keep them under close surveillance.

“The decision to have a mastectomy before cancer has occurred is personal, but it should be made after having a very detailed assessment of the woman’s risk of breast cancer, and a thorough discussion of the benefits of the procedure weighed against its potential surgical risks and psychological impact. The woman should also be informed of the alternative options for management, such as very close follow-up and surveillance.”

HOW ABOUT BREAST CONSERVATION SURGERY?

One of the advances that we have made in treatment is breast conservation surgery where the surgeon only removes the affected areas of the breast in the event that the cancer is caught early. Edwin Otieno, a breast surgeon in Nairobi explains that the condition of the patient is what determines the type of surgery that will be performed.

“However, given that there is still breast tissue left, the surgery needs to be followed by radiotherapy to reduce chances of cancer recurrence. Also, having breast conservation surgery as opposed to a mastectomy does not change a patient’s life expectancy,” says Edwin Otieno, a breast surgeon in Nairobi.

DOES HAVING CHILDREN EARLY REDUCE THE RISK OF BREAST CANCER?

Yes. Women who haven’t had a full-term pregnancy or who haven’t given birth to their first child by the age of 30 have a higher risk of breast cancer than women who give birth before the age of 30. This is because breast cancer is uncontrolled growth of breast cells. When a woman has a full-term pregnancy, the breast cells mature and grow in a regular way. This is according to findings published in the journal Cell Stem Cell in 2013.

WHAT IF I DO NOT BREASTFEED?

There is ample evidence showing that breast-feeding actually reduces the chances of a woman getting breast cancer. The latest research, a 2014 study from Boston University in the US, linked breastfeeding to lower risks of aggressive subtypes of cancer. A woman who had four children and did not breastfeed for instance was found to have 68 per cent risk of getting these aggressive types of cancers than a woman who has one child and who breastfed the child.

 Another incentive to breastfeed is that children who breastfeed for at least six months have a lower chance of getting childhood leukemia than those who do not.