Goa is reeling under a fear psychosis due to fish being laced with formalin! As if to add fuel to the flame, we were further thrown into a tizzy, by a recent study published in “The Lancet Oncology” which makes patently clear that there is an alarming rise in cancer incidence in our small state of Goa. Formalin, to wit, is carcinogenic and, in that context, the fear of Goans must be understood. Regrettably, the Goa FDA (and the politicians in control of FDA) have done precious little to allay our trepidation… except for “theatrics”.
Among dietary factors that are associated with breast cancer development are the excessive consumption of dietary fat, meat and alcohol. Exposure to formaldehyde, both dietary and environmental, has been associated with breast cancer deaths in several international studies.
If not for many other reasons, the attitude of the powers that be has been deplorable in this regard. The top political brass shockingly didn’t allow the Goa FDA (Food and Drugs Administration) to function as an autonomous body. I am pained to say that in the process we have also witnessed the slow asphyxiation of an important regulatory body. The result? Habitual offenders, together with fish mafia dons, continue to have a field day even to this day. Ha, ha!
The Lancet study states that out of the different cancers diagnosed here, breast cancer is the major killer among females. Dr R. G. Wiseman Pinto, Head of Pathology department at the Goa Medical College, draws attention to the high frequency of breast cancer in Goa (27% of all cancers now!) Why this high incidence? It is speculated that there is probably an interaction between a pre-disposing Goan genome and environmental factors.
As far as breast cancer is concerned, early detection by screening methods was traditionally thought to be important. Among the screening methods “Breast Self-Exams” (BSEs) have therefore been advised, believing that doing so would allow women to find potentially cancerous lumps and get diagnosed and treated for breast cancer more quickly. Unfortunately, scientific studies designed to measure the efficacy of BSEs have not found that women who perform BSEs are any less likely to die of breast cancer than women who don’t perform them. For this reason, many medical guidelines and health organizations no longer recommend monthly BSEs.
A “Clinical Breast Examination” (CBE), on the other hand, is a physical examination of the breasts by a trained health care provider. Generally, this happens during a routine annual check-up but here too there is no evidence that CBE reduces breast cancer death rates.
“Mammography” is the primary means and it involves X-ray radiation passing through the breast to produce an image on film or on a digital recording plate. It utilises a low dose of radiation to identify malignant tumors, especially those not easily felt by hand. But, it may come as a surprise that mass screening programs have been found to not really hold the key to the present reduced mortality.
A recent study from Aarus University, Denmark, brings in the stunning news that mass breast cancer screening – even with mammography – does not reduce mortality.
The study concedes that fewer and fewer women have died from breast cancer in recent years yes, but surprisingly, the decline is just as large in the age groups that are not screened. What is the reason then for the overall decline in breast cancer mortality? Aarus investigators feel the decline is really due to better treatment methods available nowadays and not due to mass screening for breast cancer in any form.
The original randomised trials examining breast cancer screening were conducted way back in the 1980s, and they apparently showed an effect, but as of today we have to live with the realisation “that the better the treatment methods become, the less benefit screening has,” says Henrik Støvring, associate professor at the Department of Public Health, with biostatistics and screening programmes as his particular areas of expertise.
Støvring of Aarus also addresses the issue of overdiagnosis which is a growing problem in all Western countries where the approach to medicine and examinations is extensive and where national screening programmes are prevalent.
Even though the research results challenge the current health policies, Støvring wishes to clear the air by reasserting that he is not in the business of telling policy makers that they should stop the national screening programme here and now:- “It’s certainly not my task to decide how the research results should be used, but my suggestion would nonetheless be that we should get together and begin to investigate whether it would be beneficial to do something other than mass screening and whether this could have a better effect.”
Our Health Minister Vishwajit Rane has pompously announced that starting from this month, over a lakh women will be screened for breast cancer in all villages.
Whether this screening will consist only of breast palpation by trained doctors or an X-ray mammogram in each woman is not known. But it is necessary that the HM tempers his over enthusiasm in the light of the latest scientific studies to realize that ostentatious screening programmes can only lead to waste of time and money. A polite reminder that the road to hell too is paved with good intentions!
(Dr. Francisco Colaço is a seniormost consulting physician.)
