It was in mid 2021, Zahida (name changed), a young female noted a small lump in her breast. She was too shy to inform anyone. Finally she informed her elder sister who convinced her to seek medical advice.
However, due to the ongoing COVID-19 pandemic, she sought medical advice in January 2022. The doctor advised her to get a Mammogram (X-ray of breast) which revealed an advanced stage breast cancer.
She was inoperable by then and it appeared that she had lost prime time to get operated. It was hard to break this news to the family.
Currently, the world is experiencing the biggest healthcare crisis in modern history, due to COVID-19 pandemic. To curb the spread of the disease, various authorities around the world order partial or complete shutdown of non-essential services.
Additionally, stay-at-home orders and fear of exposure to COVID-19 from hospitals caused many “non-COVID-19” patients to not seek early medical advice. With the result, many patients including cancer patients are now attending the hospital in the late stage of the disease.
The diagnosis & management of cancer is time-sensitive and is substantially affected by these disruptions, as is evident from Zahida’s story. Thousands of patients in Kashmir are battling with various cancers and are diagnosed at a late stage of disease, when complete cure is not possible.
The mere mention of the word “Cancer” sends shivers down the spine. It is not only a life consuming disease but also pushes families to financial burdens, particularly in lower income groups, an effect that has been exacerbated during COVID- 19 pandemic.
In India, around 13.2 million patients are diagnosed with cancer annually. According to Union Health Ministry’s figures, J&K reported over 13 thousand cancer patients in 2020. Lung, Stomach and Colo-rectal cancers are common in Kashmir, with a surge in incidence of Breast and Thyroid Cancers.
The only way we can fight cancer is by early screening programs. Cancer screening is looking for cancer before a person has symptoms. The goal is to detect cancer at an early stage when it is completely curable.
For example, Low-dose CT scan is a useful screening test for lung cancer and Virtual Colonoscopy (CT-Colonography) is a useful screening test for colorectal cancer.
When detected early, cancer is curable. In this context, it is relevant to mention that Radiology helps not only in diagnosis of cancer but is also a useful screening modality for lung, colon & breast cancers.
Mammography (X-ray of the breast) is the most commonly used screening test for breast cancer. The screening guidelines vary from country to country and from time to time, depending on how common a cancer is, and also on the availability of health care resources.
In 2019, National Cancer Grid (NCG) Consensus Group, India came up with resource-stratified cancer screening guidelines for various cancers including breast cancer. These guidelines recommend 2 yearly Mammography starting at age 45 for high resource groups.
The American Cancer Society recommends that women with an average risk of breast cancer should have regular annual screening mammograms starting at age of 45 years. Imaging plays a pivotal role in early detection of cancer, staging (finding out if it has spread beyond the site of origin), treatment, evaluation of response to therapy and long term follow up of patients.
Interventional Radiology has assumed a prominent role in the care of cancer patients. From performing image-guided biopsies, to management of complications of cancer such as removing obstruction in liver and kidney, refractory pain management and chemo-embolisation of tumors (chemotherapy drugs injected directly into blood vessels which supply the tumor), to name a few.
In future, Molecular imaging, Artificial intelligence and Radio-genomics will play a very important role not only in diagnosis but also in personalised cancer treatment. Radio-genomics reflects a paradigm shift from anatomical diagnosis to genetic diagnosis of Cancer.
Coming to our Post Graduate Department of Radio-diagnosis at SMHS Hospital, it caters to Cancer patients from all over the valley. The Department is equipped with “State of Art” 256 –Slice dual source CT scanner with dedicated cancer imaging software (the first of it’s kind in the valley), a high-end Digital Mammography with facilities of Tomosynthesis (3-D Mammography), Computed Aided Diagnosis (CAD) and Mammography guided stereotactic biopsy and a 3-Tesla MRI scanner, besides others.
The recently installed “State of Art” 3-Tesla MRI scanner at National Institute of Mental Health and Neurosciences (NIMHANS) has the facility for MRI-guided breast biopsy of tiny suspected breast lesions.
The Radiology Department also has high-end Ultrasound (USG) machines with Colour doppler and Elastography facility, which is useful in diagnosing Thyroid cancer, a “not-so-uncommon” cancer in young females in Kashmir Valley. The Department also actively participates in “Cancer Board” meetings (to discuss the best treatment option for the cancer patient).
Having had a short-term Observer-ship in Cancer Imaging and Intervention at Roswell Park Cancer Institute, New York my interest in early detection of cancers has increased. I have a desire to get cancer patients early to medical attention where we can help them better . For this we need to build awareness regarding cancer in our society so that people approach us before it is too late.
World Cancer Day is observed on February 4 to make people aware of cancer and this year the theme is “Close the Care Gap.” This theme is relevant, as it will take a long time for our health care system to come up to the ideal standards of care.
To conclude, there are seven warning signs of cancer described in the literature, based on published reports and various studies. We need to be aware of all these so that timely interventions can save lives.
1. Changes in bowel or bladder habits.
2. A sore that doesn’t heal.
3. Unusual bleeding or discharge.
4. Lumps or thickened areas in the breast, testicles, or elsewhere.
5. Indigestion or difficulty in swallowing.
6. A change in the size, colour, shape, or thickness of a wart, mole, or mouth sore.
7. A cough or hoarseness that doesn’t go away.
The author is a faculty at Post Graduate Deptt. of Radiodiagnosis & Imaging, Government Medical College, Srinagar.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.