The curse that is cancer

Much is said and written about Aids, and its potentially crippling impact on companies in South Africa. But, writes CHARLEEN CLARKE, there is another – equally devastating – disease that could shatter the lives of employees and destroy company profits. And that is cancer …

I don’t normally write about myself in SHEQ MANAGEMENT. I don’t think I am that interesting; and I certainly don’t think it’s wise to bore readers with the dreary details of my life.

This issue is different. I am going to tell you a story about cancer – and how it can impact on your life and on the profitability of your company.

I was diagnosed with cancer four years ago, with one of the doctors giving me a 1% chance of surviving the disease. Understandably, this was not a good thing for my productivity or peace of mind – after all, it’s scary being told that you stand a hell of a good chance of dying.

That was, however, my problem. What was slightly more worrying – because it impacted on the profitability of Charmont Media, which publishes FOCUS and SHEQ – was the fact that I was unable to work for four months. I am lucky to have the support of a particularly plucky and determined business partner, and she dragged the business by the scruff of its neck though those four tumultuous months.

The company survived. And so did I.

But why I am relating this intensely personal story? Because I believe that we have not yet scratched the tip of the cancer iceberg in this country. We are so far away from finding a cure – and, as each day goes by, more and more South Africans are contracting this dreaded disease.

In fact, according to the World Health Organisation, cancer-related deaths worldwide will exceed the combined deaths caused by malaria, tuberculosis and HIV/Aids by 2030.

Boxing in the dark
But what is happening right now? Truth be told, we don’t really know. We do have an entity in South Africa called the National Cancer Registry (NCR), which publishes pathology-based cancer incidence data. It was first established in 1986 and some 36 000 new cases were recorded in South Africa that year. The main objective of the registry is to monitor the cancer burden in South Africa and report cancer incidence for each year, stratified by sex, age and population group, as well as time trends over the past 20 years.

In February 2009 the NCR was incorporated into the National Institute for Occupational Health, which currently has a staff of seven which receives approximately 80 000 cancer notifications annually. About 60 000 are new cases, forming the basis on which the cancer incidence is estimated. The remaining reports are duplicate entries and are therefore excluded from the yearly estimates.

But, as the Cancer Association of South Africa (Cansa) points out, the NCR is a pathology-based registry, resulting in under-reporting of many malignancies. Plus there are other issues at play – the NCR has gone on record as stating that, since 2001, patient confidentiality issues and lack of legislation have led to difficulties in receiving data from the private pathology groups, resulting in severe delays in published reports. The National Department of Health is supposedly addressing the situation and draft regulations on cancer registration have been drawn up.

In the meantime, we are sitting with data that is almost a decade old, meaning it’s virtually useless and we don’t really know what’s happening in South Africa. But according to Dr Daniel Vorobiof, oncology director of the Sandton Oncology Centre in Johannesburg, and Dr Paul Ruff, professor of medical oncology at the University of the Witwatersrand’s Faculty of Health Sciences in Johannesburg, one thing is certain: cancer remains a major killer throughout the developed and developing world, including South Africa. Furthermore, they maintain that cancer incidence rates in South Africa are among the highest reported in Africa.

Writing in ASCO Post, the US-based oncology newspaper, they stress that it is vitally important to monitor cancer incidence in this country because it helps to detect changes in cancer patterns that might occur as a result of environmental conditions, or in association with other diseases (for example, HIV/Aids). “Such records are also essential for the detection of new cancers and to measure effectiveness of cancer control programmes,” they note.

We also need accurate data to monitor fatal malignancies. Just one such potentially fatal malignancy is hepatocellular carcinoma (cancer of the liver). “Some cancers are sub-optimally reported because of a lack of tissue diagnoses. An important example is hepatocellular carcinoma, which is diagnosed clinically and by blood tests (alpha-fetoprotein) – without tissue diagnosis – but still remains among the top 15 most common cancers. Approximately 700 000 new cases yearly are diagnosed worldwide, especially in southern Africa and the Far East, which are endemic for the hepatitis B virus. Future population-based registries, as well as better cancer diagnoses, especially in rural areas, will give us a more accurate picture of this usually fatal malignancy, as well as other pathologically under-diagnosed cancers,” write Vorobiof and Ruff.

Scary predictions
As stated, cancer related statistics in this country are virtually a decade old – and they weren’t particularly accurate anyway. Having said that, in 2002, 28 126 South African males officially developed cancer; cancers of the prostate (1 in 23), unknown primary site (1 in 64), lung (1 in 71), esophagus (1 in 91), colon/rectum (1 in 99), and bladder (1 in 109) predominated. That same year, 28 430 South African women were diagnosed with cancer; with cancer of the breast (1 in 29) and cancer of the uterine cervix (1 in 36) predominating; cancers of an unknown primary site (1 in 91), corpus uteri (1 in 148), colon/rectum (1 in 158), and esophagus (1 in 199) followed.

Health authorities believe that this situation has changed drastically. Depending on who one talks to, predictions range from one in three South Africans getting cancer to one in six South African men and one in eight South African women.

Prevention is cure
There are over 200 different kinds of cancer, some of which are very hard to treat – such as the rare form of pancreatic cancer that saw Steve Jobs die at the age of 56.  Pancreatic cancer is one of scariest cancers; it spreads fast and only about 4% of patients can expect to survive five years after their diagnosis. Each year, about 44 000 new cases are diagnosed in the United States alone.

The good news is that many forms of cancer can be treated – with huge success. But the frightening aspect is the complete lack of awareness surrounding the disease. Miranda Anthony, community affairs manager at Chevron South Africa, agrees: “We have reason to be nervous. What is most alarming is that 30% of all cancers are preventable and treatable if detected early. As it stands in the registry currently, faulty or not, South African men have a lifetime risk of one in six of getting cancer while women fare marginally better with a lifetime risk of one in eight. And to think that we could improve one third of these South Africans’ lives through basic education,” she says.

Along with Revlon, Chevron recently sponsored the Cancer.vive 2011 Motorcycle Journey, whereby a convoy of 25 cancer survivors embarked on a journey to get South Africa talking about the so-called “shy cancers” – including breast, ovarian, cervical, testicular and prostate cancers.

Looking forward
So what needs to happen? Well, companies would be well advised to counsel their staff and encourage prevention and early detection (see box containing tips and advice).

This could have a positive effect on three counts; firstly and most importantly, lives could be saved. Secondly, it has a positive economic impact on the bottom line of companies (sick employees are costly and are seldom productive).

Thirdly, it could have a huge impact on medical costs – a most worrying factor. As Anthony notes: “Approximately 16% – or eight million out of 49,9 million South Africans – are members of medical schemes. This means that less than 50% can afford access to high-end treatment. The public sector is required to care for the medical well-being of around 85% of the population.”

But one thing is certain: if South Africa is to manage this disease, proper information is needed. There is good news on this front. According to Vorobiof and Ruff, future legislation will make cancer a reportable disease by both pathologists and clinicians, enhancing the existing pathology-based registry while developing population-based registries.

I really hope that government gets its cancer ducks in a row – and makes this a reality sooner rather than later. Too many people have already died.

Cancer prevention: seven tips to reduce your risk
Concerned about cancer prevention? Take charge by making small changes in your daily life, from eating a healthy diet to scheduling regular cancer screenings. 

1. Don’t smoke
Using any type of tobacco puts you on a collision course with cancer. Smoking has been linked to various types of the disease – including cancer of the lung, bladder, cervix and kidney – and chewing tobacco has been linked to cancer of the oral cavity and pancreas. Even if you don’t use tobacco, exposure to second-hand smoke may increase your risk of lung cancer.

2. Eat a healthy diet
Although making healthy selections at the grocery store and at mealtime can’t guarantee cancer prevention, it may help reduce your risk. Eat plenty of fruits and vegetables. Limit fat. 

3. Maintain a healthy weight and include physical activity in your daily routine
Maintaining a healthy weight may lower the risk of various types of cancer, including cancer of the breast, prostate, lung, colon and kidney. In addition to helping you control your weight, physical activity on its own may lower the risk of breast cancer and colon cancer. As a general goal, include at least 30 minutes of physical activity in your daily routine.

4. Protect yourself from the sun
Skin cancer is one of the most common kinds of cancer – and one of the most preventable. Avoid midday sun. Stay in the shade when you’re outdoors. Cover exposed areas. Use generous amounts of sunscreen when you’re outdoors and reapply often. 

5. Get immunised
Cancer prevention includes protection from certain viral infections. Talk to your doctor about immunisation against:
• Hepatitis B, which can increase the risk of developing liver cancer
• Human papillomavirus (HPV), a sexually transmitted virus that can lead to cervical cancer

6. Avoid risky behaviour
Another effective cancer prevention tactic is to avoid risky behaviour which can lead to infections that, in turn, may increase the risk of cancer. For example:
• Practice safe sex. Limit your number of sexual partners and use a condom.
• Don’t share needles. Sharing needles with an infected drug user can lead to HIV, as well as hepatitis B and hepatitis C.

7. Take early detection seriously
Regular self-exams and professional screening for various types of cancers  can increase your chances of discovering cancer early.