Topic:

RISK FACTORS AND CONTROL OF CANCER

IN PAKISTANI SOCIETY
SUBMITTED TO: Dr. M. Mansha

SUBMITTED BY: Muhammad Azhar Hussain

ROLL NO: MSF1900019

SUBJECT: Cancer Biology

CLASS: MS- Zoology

SEMESTER 2nd (Evening)

SESSION 2019-21
RISK FACTORS AND CONTROL OF
CANCER IN PAKISTANI SOCIETY
INTRODUCTION
Cancer is the uncontrolled growth of abnormal cells in the body. Cancer develops when the
body's normal control mechanism stops working.
Old cells do not die and instead grow out of control, forming new, abnormal cells. These extra
cells may form a mass of tissue, called a tumor. Cancer refers to any one of a large number of
diseases characterized by the development of abnormal cells that divide uncontrollably and have
the ability to infiltrate and destroy normal body tissue. Cancer often has the ability to spread
throughout your body. Cancer is the second-leading cause of death in the world. Old cells do
not die and instead grow out of control, forming new, abnormal cells. These extra cells may
form a mass of tissue, called a tumor. Some cancers, such as leukemia, do not form tumors.

STATISTICS OF CANCER IN PAKISTAN

This statistical data is published by WHO on the bases of data that was collected in 2018.
MAJOR CATEGORIES OF CANCER
 Carcinomas begin in the skin or tissues that line the internal organs.
 Sarcomas develop in the bone, cartilage, fat, muscle or other connective tissues.
 Leukemia begins in the blood and bone marrow.
 Lymphomas start in the immune system.
 Central nervous system cancers develop in the brain and spinal cord.

COMMOM TYPES OF CANCER AND PREVENTIVE MEASURES

BREAST CANCER
Breast Cancer is one of the leading causes of death worldwide. According to WHO estimates it
represents 10% of all cancers diagnosed worldwide and constituted 22% of all new cancers in
2000 in women making it the most common cancer in females. Pakistan alone has the highest
rate of Breast Cancer than any other Asian country as approximately 90000 new cases are
diagnosed every year out of which 40000 die. According to a research conducted approximately
1 out of every 9 women are likely to suffer from this disease at any point in their lives and about
77% of invasive breast cancer occurred in women above 50 years, but if diagnosed early the
survival rates approach 90%. Mortality in Breast cancer can be prevented in 1/3rd of women if
routine mammography is done in women over 50 years, hence the longer a woman lives the
lower is her risk of breast cancer therefore a 50 year old woman who has not had breast cancer
has 11% chance of having it, whereas a 70 year old woman who has not had breast cancer has
7% chance of having it.

BRCA1 and BRCA2 are the two most major breast cancer-susceptibility genes identified and
testing for mutations in BRCA1 and BRCA2 is an important tool for predicting breast cancer.
Besides that lack of breast feeding, diet, less parity and smoking are most significantly
associated with breast cancer in patients. Therefore a short breast examination can prevent this
cancer and protect women from this most horrifying and horrendous nightmare. The above
mentioned facts highlight it beyond any doubt that breast cancer causes significant mortality in
Pakistan. Hence the government should create widespread awareness in Pakistan.
The focus of the awareness should be about:
1. The dangerously high incidence of breast cancer in Pakistan.
2. The disease is not fatal and is curable.
3. It can be detected early if routine breast examination is done.
4. The life after this cancer is same as before the diagnosis and is worth living. This can
significantly control the burden of disease in a developing country like Pakistan with a paucity
of financial resources.
Prevalence of Breast Cancer Breast cancer is considered to be the most common malignancy in
women. Its prevalence data indicate that one million new cases are reported each year in the
world and it accounts for nearly 18% of all female cancers. According to a report of the
American Cancer Society (ACS) published in 1992, Australia, North America, New Zealand
and Europe are considered to be the high-risk zone while, Africa and Asia represent the zone of
lower risk. Similarly, in Japan and China the incidence is low, while in Pakistan, breast cancer
is the most common malignancy in females. Except for Jews in Israel, Karachi is supposed to
have the highest incidence of breast cancer among Asian population.

RISK FACTORS
A risk factor is anything which increases the incidence of getting a disease. Different kinds of
risk factors exist for different cancers. Some factors cannot be changed; these are known as non-
modifiable risk factors. These include a person's race or age. Some factors are linked to the
environment. Other factors which are related to personal behavior, such as drinking, smoking
and diet, can be controlled. These factors are known as modifiable risk factors. Different
cancers have different risk factors and same is the case with breast cancer. However, risk factors
are not the ultimate signs of developing breast cancer. Many patients having breast cancer do
not have any predominant risk factors, whereas many females having one or more risk factors
do not develop this pathology at all.

TYPES OF RISK FACTORS

NON-MODIFIABLE RISK FACTORS
According to ACS, non-modifiable risk factors for breast cancer include gender, advancing age,
genetic factors, family history, race, ethnicity, dense breast tissue, tobacco smoke, certain
benign breast conditions, previous chest radiations and diethylstilboestrol exposure.
MODIFIABLE RISK FACTORS
Lifestyle-related risk factors include the number of children given birth to, birth control,
hormone therapy, breastfeeding, alcohol use, overweight or obesity and physical activity.

CONTROVERSIAL RISK FACTORS

Some factors have uncertain, controversial or unproven effect on the risk of developing breast
cancer. These factors include diet and vitamin intake, anti-perspirants, bras, induced abortions,
chemicals in the environment, and night-shift works.
AGE
Age is the strongest risk factor for breast cancer. Age is proportional to risk i.e. the older the
woman, the higher the risk throughout her life, but chances increase markedly in post-
menopausal years. After age, women of higher socio-economic status, who experience early age
of menarche, late menopause and those conceiving in their 30s, are at a higher risk to develop
breast cancer.
SOCIO-ECONOMIC STATUS
Socio-economic status is a powerful risk factor for breast cancer. Women above 40 and of
higher social class carry an elevated risk of developing breast cancer. As high socioeconomic
status is directly related with increased risk, women in developed countries are at a greater risk
of breast cancer development than women of less developed countries. According to different
studies, this relationship is associated with the fact that women in developed countries have
fewer children on average, and limited and less frequent duration of breastfeeding.
REPRODUCTIVE FACTORS
Reproductive factors also account for the risk associated with the disease. In developed
countries, the average age of menarche fell from 16-17 years to 12-13 years in the mid 19th
century, and this is consistently associated with increased risk of breast cancer. Late menopause
also increases the risk of breast cancer. Risk increases each year for older women at menopause,
either induced by surgery or naturally, by about 3%. Therefore, a woman experiencing
menopause at 55 years of age will have 30% higher risk than one who experiences it at 45 years
of age.
AGE AT FIRST CHILD-BIRTH
Childbearing age is inversely related to the risk of breast cancer i.e. the younger the woman is
when she begins childbearing, the lower the risk to develop breast cancer. It is estimated that a
3% increase in risk occurs for each year of delay. It is also an established fact that childbearing
not only reduces the risk, but the higher number of full-term pregnancies ensures higher
protection for females. In comparison to nulliparous women, there is a 30% reduced risk in
women who have had children, and with each full-term pregnancy the risk reduces by 7%
overall. Similarly, a woman with single issue is at 15% higher risk than a woman with two
issues.
BREASTFEEDING
Breastfeeding is also a protective factor for breast cancer. Women who breastfeed their children
are at a reduced risk, while those who do not are at an increased risk of breast cancer. Duration
of breastfeeding is directly related to protection - the longer the duration, the greater will be the
protection. However, breastfeeding is an uncertain protective factor as the results are
inconclusive. Still, it is regarded as a modifiable risk factor, as the breast never having been
lactated is more prone to cancer than a lactated breast.
ENDOGENOUS HORMONES
It has been hypothesized that higher levels of endogenous hormones increase the risk
of breast cancer. Post-menopausal women with highest levels of testosterone and oestrogen
have 2-3 times the risk compared to women with lowest levels. In oestrogenreceptor-positive
tumours, higher levels of prolactin are associated with increased risk of breast cancer. In women
not taking hormone replacement therapy (HRT), there is a lesser risk of breast cancer due to
increased levels of insulin. Similarly, insulin-like growth factor 1 is associated positively with
breast cancer risk.
ORAL CONTRACEPTIVE PILLS
Risk of breast cancer increases due to the use of oral contraceptives (OC), but the risk is not
significant. Women taking HRT are at an increased risk — at least 66% in comparison with the
non-users.
BREAST DENSITY
Breast density is an independent and a strong risk factor. The composition of breast is epithelial
tissue, connective tissue and fat. Less dense breast is described as the one having high
proportion of fatty tissue. Women with less dense breast have almost five times lower risk of
breast cancer than women with denser breast.
FAMILY HISTORY
Family history of breast cancer increases the risk, especially in the case of a firstdegree affected
relative (mother or sister). The risk is about double in women with some family history of breast
cancer in one of the first degree relatives than in those with no family history. The risk increases
further if two (or more) relatives are affected and even more if the diagnosis of the disease
occurs below 50 years of age.
OBESITY, OVERWEIGHT AND PHYSICAL ACTIVITY
Among the modifiable risk factors for breast cancer are obesity and being overweight. Both
parameters are determined by high body mass index (BMI). They increase the risk of post-
menopausal breast cancer moderately. A strong association is shown between physical activity
and breast cancer in post-menopausal women. More active women are at 15-20% decreased
risk. There should be at least 150 minutes of physical activity per week.
DIET AND VITAMIN INTAKE
Many studies have been conducted to check the link between dietary habits and breast cancer
risk. However, the results are conflicting. There is persuasive evidence that high fat food
content causes obesity which is related to breast cancer. Intake of fruits, vegetables and vitamins
have also been studied as breast cancer risk factors, but the results are conflicting.
ALCOHOL CONSUMPTION
Alcohol consumption is also associated with an increased risk of breast cancer. There is a higher
level of sex hormones in the blood stream in alcohol consumers compared to the non-
consumers. In UK, more than 6% breast cancers are alcohol-linked.
SLEEP ROUTINE AND NIGHT SHIFT
Sleep routine and working in the night shifts also influences the incidence of breast cancer.
Less sleep and increased night shift work-load increases the risk of breast cancer. According to
one theory, this is due to the fact that melatonin is released in lesser amount due to shorter or
disrupted duration of sleep. As melatonin is believed to have anti-carcinogenic properties, and
also suppresses other hormone production directly or indirectly linked to the development of
breast cancer, less release causes an increased risk. Night-time shift is classified as probably
carcinogenic to humans by the International Agency for Research on Cancer (IARC). In the
UK, more than 4% breast cancers are associated with shift workers.
HEALTH-RELATED ISSUES AND USE OF MEDICINES
Use of anti-hypertensive drugs for 5 years or more, oestrogen use during pregnancy, Grave's
disease and longer exposure to ionizing radiations increases the risk of breast cancer. While
regular usage of (NSAIDs), especially aspirin, reduces the risk in up to 25% in women.
Similarly, people with coeliac or other auto-immune diseases also have a reduced risk of breast
cancer with an unclear mechanism behind.
SMOKING
According to previous IARC studies, there was no evidence of relation between the risk of
breast cancer and smoking and second-hand smoke. However, modern studies prove that there
is an increased risk of breast cancer for women who started smoking before delivering the first
baby, or before the age of 20. Smokers have 10-20% increased risk than non-smokers.
However, this relationship is inconsistent in explaining whether smoking causes breast cancer
before or after menopause.
TREATMENT AND SERVICES
Treatment options for breast cancer include:
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it
has spread. People with breast cancer often get more than one kind of treatment.

SURGERY
An operation where doctors cut out cancer tissue.

CHEMOTHERAPY
Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or
medicines given in your veins, or sometimes both.
HORMONAL THERAPY
Blocks cancer cells from getting the hormones they need to grow.
Biological therapy. Works with your body’s immune system to help it fight cancer cells or to
control side effects from other cancer treatments.

RADIATION THERAPY
Using high-energy rays (similar to X-rays) to kill the cancer cells.
Doctors from different specialties often work together to treat breast cancer. Surgeons are
doctors who perform operations. Medical oncologists are doctors who treat cancer with
medicine. Radiation oncologists are doctors who treat cancer.
Surgery tends to be the first strategy of attack again breast cancer depending upon stage.
There are a number of different surgical options.

LUMPECTOMY
This is the removal of only the tumour as well as a small portion of the surrounding tissue. This
is sometimes known as a breast-conserving surgery.

MASTECTOMY
This describes the removal or all the breast tissue. This type of surgery is the option for more
advanced stages of cancer where the cancer is too extensive to remove without distorting the
breast.

OTHER SURGICAL OPTIONS INCLUDE

LYMPH NODE REMOVAL
This is also known as axillary lymph node dissection. It refers to a surgery that may take place
during either a lumpectomy or mastectomy surgery if the cancer has spread outside the milk
duct breast to the armpit glands.

BREAST RECONSTRUCTION
This is when the breast is re-build following a mastectomy and occasionally after a
lumpectomy.

PROPHYLACTIC MASTECTOMY
This surgery is performed as a preventative measure, and is a removal of the breast to lessen the
risk of breast cancer in those people that who are at high risk of developing cancer.
PROPHYLACTIC OVARY REMOVAL
This is another preventative surgery which reduces the risk of cancer my limiting the amount
estrogen in the body, making it more difficult for estrogen to stimulate the growth of breast
cancer.

LIP AND ORAL CANCER

Lip and oral cavity cancer is the second most prevalent, frequently diagnosed and leading cause
of cancer death in Pakistan, with an estimated 5-year prevalence of 30,647 cases, 12,761 newly
diagnosed cases and 7,266 deaths in 2012. Lip and oral cavity cancer accounts for 8.6% (2.1%
worldwide) of all new cancer cases and 7.2% (1.8% worldwide) of all cancer deaths in Pakistan.
Almost 66.4% of all lip and oral cavity cancer cases and 77.2% of deaths due to this cancer is in
the less developed countries (International Agency for Research on Cancer, 2012).

MAIN RISK FACTORS

Main risk factors associated with the cancer of lip and oral cavity include tobacco smoke from
cigarettes, cigars, or pipes; poor nutrition, drinking alcohol, betel quid and gutka; ultraviolet
light, and HPV infection (American Cancer Society, 2016). The areas of the lips that come in
contact with the pipe stem are prone to the risk of lip and oral cavity cancer. One point must be
kept in mind that the smokers who have received the treatment for oral cavity or oropharyngeal
cancer must refrain from smoking, even in
case their cancer appears to be cured. If such a person continues to smoke then the risk of
acquiring cancer of mouth, larynx, throat or lung increases many folds. The oral tobacco
products such as snuff or chewing tobacco are associated with the cancers of cheek, gums, and
inner surface of the lips. Long term usage of oral tobacco products poses a high level of risk.
Such products leads to diseases of gums, damage to the bone sockets around teeth, and tooth
loss. Similarly, it is quite vital that the people treated for oral cavity or oropharyngeal cancer
need to stop using any tobacco containing product (Torre et al., 2015). Many people in
Southeast Asia, South Asia (i.e. Pakistan), and certain other parts of the world chew betel quid,
comprising of areca nut and lime wrapped in a betel leaf. Inhabitants of these areas also chew
gutka which is made up of betel quid and tobacco. People consuming betel quid or gutka are
more prone to the cancer of the oral cavity (American Cancer Society, 2016).

TREATMENT
• There are different types of treatment for patients with lip and oral cavity cancer.
• Patients with lip and oral cavity cancer should have their treatment planned by a team of
doctors who are expert in treating head and neck cancer.
• Two types of standard treatment are used:
 Surgery
 Radiation therapy
• New types of treatment are being tested in clinical trials.
 Chemotherapy
 Hyper fractionated radiation therapy
 Hyperthermia therapy
• Treatment for lip and oral cavity cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.

LUNG CANCER
Lung cancer is the third most commonly diagnosed and leading cause of cancer death in
Pakistan, with an estimated 6,800 (4.6%) new cases and 6,013 (5.9%) deaths occurring in 2012.
Lung cancer is claiming too many lives of people in Pakistan, and it is really unfortunate that
youths are suffering from this lethal disease. Recently, it was reported that about 1.3 billion
people are regular smokers world- wide and every day between 8,200 and 9,900 youngsters start
smoking. Smoking is becoming more popular among school children, reportedly, 1,000 to 1,200
teens smoke daily, and most of them lose their lives. If we talk about the tobacco smoking in
Pakistan then it is showing that is legal and due to this, children are taking it for granted.

According to WHO, World Health Organization smoking in Pakistan has increased by 30

percent over the last decade? According to a latest research, more than 80 percent adults begin
smoking before they turn 18 years of age. Children under the age of 18 say that it’s easy to buy
tobacco products, which is a cause of concerns for parents. It is really an ominous thing, and
approximately 1,200 teens start smoking daily which is also increasing the number of diseases.
Plenty of smokers die after suffering from lung and mouth cancer.

MAIN RISK FACTORS

There are so many other crummy things like cigarettes. For me it is so sad to mention that in
Pakistan the people are mostly victims of tobacco and Gutka. Gutka causes many heinous or
horrible diseases; the addicted people of Gutka suffer from the mouth cancer grossly. It is
estimated that more than 75 percent of the people are admitted to the hospitals that are suffering
from mouth cancer and among them 7 percent of the patients are children. Mostly we can see
the people who are staying in Karachi are Gutka addicted or victims of Gutka. Gutka sellers are
spoiling the children lives for this our government must take strong measures to ban selling
Gutka in Pakistan and save the citizens from this loathsome or deadly disease and for the
overcome of smoking tobacco we need to make a splendid culture in our country where
everyone must be aware about the causes of smoking and must not smoke.

CAN LUNG CANCER BE PREVENTED?

Not all lung cancers can be prevented. But there are things you can do that might lower your
risk, such as changing the risk factors that you can control.
Stay away from tobacco
The best way to reduce your risk of lung cancer is not to smoke and to avoid breathing in other
people’s smoke.
If you stop smoking before a cancer develops, your damaged lung tissue gradually starts to
repair itself. No matter what your age or how long you’ve smoked, quitting may lower your risk
of lung cancer and help you live longer.

AVOID RADON EXPOSURE

Radon is an important cause of lung cancer. You can reduce your exposure to radon by having
your home tested and treated.
Avoid or limit exposure to cancer-causing agents
Avoiding exposure to known cancer-causing agents, in the workplace and elsewhere, may also
be helpful. When people work where these exposures are common, they should be kept to a
minimum.

EAT A HEALTHY DIET

A healthy diet with lots of fruits and vegetables may also help reduce your risk of lung cancer.
Some evidence suggests that a diet high in fruits and vegetables may help protect both smokers
and non-smokers against lung cancer. But any positive effect of fruits and vegetables on lung
cancer risk would be much less than the increased risk from smoking.
Trying to reduce the risk of lung cancer in current or former smokers by giving them high doses
of vitamins or vitamin-like drugs has not been successful so far. In fact, some studies have
found that supplements of beta-carotene, a nutrient related to vitamin A, appear to increase the
rate of lung cancer in these people.
Some people who get lung cancer do not have any clear risk factors. Although we know how to
prevent most lung cancers, at this time we don’t know how to prevent all of them.

COLORECTUM CANCER
Colorectal cancer is the fourth most prevalent and fifth most commonly diagnosed cancer in
Pakistan, with an estimated 5-year prevalence of 11,917 (3.5%) cases, 5,335 (3.6%) newly
diagnosed cases and 3,903 (3.9%) deaths occurring in 2012. Colorectal cancer (CRC), also
known as colon cancer or large bowel cancer, includes cancerous growth in the colon, rectum
and appendix. With about 65000 deaths per year, it is the fourth most common neoplasm
worldwide and second leading cause of cancer-related deaths in the United States. Nearly
600,000 new cases are diagnosed annually worldwide.

Screening for CRC can reduce mortality and also reduce incidence by preventing cancer
occurrence through the detection and removal of pre-cancerous polyps. The incidence is higher
in men than women. In men, it ranges from 48.3 to 72.5 per 100,000 per year while in women;
it ranges from 32.3 to 56 per 100,000 per year. The same trend is seen in a number of
population-based studies, from other countries including Pakistan. In these studies a high tumor
prevalence has been documented in young patients (<40 years) associated with advanced and
poorly differentiated lesions. Young patients often have more advanced disease on presentation
and their survival is lower than older patients, perhaps because of delayed diagnosis. We present
the data on 23 patients with colorectal cancer with the demography and surgical procedures
under taken.

RISK FACTORS
• Being overweight or obese
• Physical inactivity
• Certain types of diets
• Smoking
• Heavy alcohol use
• Being older
• A personal history of colorectal polyps or colorectal cancer
• A personal history of inflammatory bowel disease
TREATMENT
LOCAL TREATMENTS
Some treatments are called local therapies. This means they treat the tumor without affecting the
rest of the body. These treatments are more likely to be useful for earlier stage cancers (smaller
cancers that haven't spread), but they might also be used in some other situations. Types of local
therapy used for colorectal cancer include:
 Surgery for Colon Cancer
 Surgery for Rectal Cancer
 Ablation and Embolization for Colorectal Cancer
 Radiation Therapy for Colorectal Cancer

SYSTEMIC TREATMENTS
Colorectal cancer can also be treated using drugs, which can be given by mouth or directly into
the bloodstream. These are called systemic therapies because they can reach cancer cells
throughout the body. Depending on the type of colorectal cancer, different types of drugs might
be used, such as:
 Chemotherapy for Colorectal Cancer
 Targeted Therapy Drugs for Colorectal Cancer
 Immunotherapy for Colorectal Cancer
REDUCE RISK OF ALL CANCERS BY
 Early diagnoses

 Giving awareness

 Taking exercise

 Proper diet

 Adequate treatment

 Proper sleep

 Proper breast feeding

 Limit the use of tobacco

 Stop drinking alcohol.

 Try to live in healthy environment.

 More intake of fruits

 Vegetables
  Fluid intake

REFERENCES
 https://jpma.org.pk/article-details/4456

 https://pubmed.ncbi.nlm.nih.gov/25824767/
 https://ecommons.aku.edu/cgi/viewcontent.cgi?
article=1284&context=pakistan_fhs_mc_bbs#:~:text=The%20commonest%20malignant
%20tumors%20in,5th%2C%206th%20and%207th%20decades.

 https://pubmed.ncbi.nlm.nih.gov/25987010
 https://pubmed.ncbi.nlm.nih.gov/25987010/

 https://www.who.int/cancer/country-profiles/pak_en.pdf

 https://www.tandfonline.com/doi/full/10.1080/2331205X.2017.1288773