|Year : 2011 | Volume
| Issue : 2 | Page : 235-236
Conversation with Dr. G. K. Rath
GK Rath1, Sapna Gupta2
1 Department of Radiotherapy, Chief, Dr. B.R. Ambedkar Institute-Rotary Cancer Hospital, 7, AIIMS, Delhi, India
2 Department of Radiation Oncology, Dr. Balabhai Nanavati Hospital, Mumbai, India
|Date of Web Publication||12-Jul-2011|
G K Rath
Department of Radiotherapy, 2nd Floor, Dr. B.R.A. IRCH, AIIMS, Ansari Nagar, Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rath G K, Gupta S. Conversation with Dr. G. K. Rath. J Can Res Ther 2011;7:235-6
Dr. Sapna Gupta (Duttta): What really is the burden of tobacco-related cancers?
Dr. G.K.Rath: The tobacco-related cancers (TRC) include lip, tongue, mouth, pharynx (including oropharynx and hypopharynx), esophagus, larynx, lung, urinary bladder, nasal cavities and nasal sinuses, stomach, liver, kidney (renal cell carcinoma), uterine cervix and myeloid leukemia. Luo et al., have recently shown that smoking is associated with an increase in breast cancer risk among postmenopausal women. 
According to a World Health Organization (WHO) report (2009), tobacco use is the leading cause of preventable death, and is estimated to kill more than five million people each year, worldwide. The burden of tobacco use is greatest in the low- and middle-income countries, and will increase more rapidly in these countries in the coming decades. If current trends persist, tobacco will kill more than eight million people worldwide each year by the year 2030, with 80% of these premature deaths in the low- and middle-income countries. By the end of this century, tobacco may kill a billion people or more, unless urgent action is taken. In the United States, cigarette smoking causes about one of every five deaths each year. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. 
According to the Population-Based Cancer Registry (PBCR) data of the Indian Council of Medical Research (ICMR); in males, the highest relative proportion (%) of TRC was seen in Ahmedabad district (other than Ahmedabad urban) (50.6%), followed by Bhopal (47.6%), Kolkata (45.8%), Chennai (41.7%), Mumbai (40.5%), Delhi (39.1%), Barshi (36.8%), and Bangalore (33.4%). In females, the relative proportion (%) of TRC ranged from 10.7% in Delhi to 15.2% in Bangalore and Chennai. 
Among the TRCs, in males, the lung was the leading site in all the registries contributing to 20.4 - 35.4% of all TRCs except in the registries at Barshi (7.9%) and Ahmedabad district (other than Ahmedabad urban) (18.3%). In Barshi, the leading site was the hypopharynx (23.6%) and in Ahmedabad district (other than Ahmedabad urban), the mouth and tongue were the leading sites contributing to 42% of the total TRCs. The four leading sites lung, esophagus, mouth, and tongue contributed to 51.7% in Barshi to 74.2% in Bhopal, of the total TRCs in different registries, in males. In females, the three leading sites were the esophagus, mouth, and lung, which contributed to 54.5% in Kolkata to 83.8% in Barshi, among all the TRCs. 
Gupta et al., carried out a cohort study in the city of Mumbai to estimate the relative risks for all-cause mortality among various kinds of tobacco users. An active follow-up of 52,568 individuals in the cohort was undertaken. A total of 4358 deaths were recorded among these individuals. The annual age-adjusted mortality rates were 18.4 per 1000 for men and 12.4 per 1000 for women. For men the mortality rates for smokers were higher than those for non-users of tobacco across all age groups, with the difference being greater for the lower age groups (35 - 54 years). The relative risk was 1.39 for cigarette smokers and 1.78 for bidi smokers, with an apparent dose-response relationship for the frequency of smoking. Women were basically smokeless tobacco users, with the relative risk among such users being 1.35, with a suggestion of a dose-response relationship. 
Rath and Chaudhry (1999) conducted an ICMR task force study on the estimation of the cost of tobacco-related cancers.  There was an average loss of Rs.134,449 to the society on account of the treatment of each patient of tobacco-related cancers in the cohort during 1990 - 1991. Most of this loss was due to their premature death (83.7%), which resulted in loss to the Gross National Product (GNP). With this estimate, the loss to the nation due to the treatment of these TRCs amounted to approximately Rs. 14.52 billion for the year 1990.
S.G.: What should be done to prevent tobacco abuse like chewing, as there are no effective laws?
G.K.R: I feel, the most important measure to prevent use of tobacco is health education. The public in general and the school children in particular should be made aware of the demerits of using tobacco, whether it is with smoke or smokeless. Anti-tobacco educational programs and messages with the help of print and electronic media help to send the message to a large population. This has been my experience also. Whenever I have interacted with the public through the press, a large number of persons come with questions pertaining to the bad effects of tobacco. Moreover, such interactions also help in the early detection of cancers. Voluntary organizations can help in a big way by organizing awareness and / or early detection activities / camps, and by conducting small group plays that send anti-tobacco messages. Behavioral modifications also help a lot. One should avoid times of boredom, which will lead to tobacco abuse. Keeping oneself busy with recreational activities and physical exercise also helps a lot in preventing tobacco abuse. Nicotine replacement therapy can be used in selective circumstances.
A project, Radio Drugs, Alcohol, and Tobacco Education (DATE) was carried out by the ICMR in collaboration with the All India Radio. This radio program was in the form of 30 weekly episodes of 20 minutes each. Ten episodes focused on tobacco, eight each on alcohol and drugs, and two episodes on the legal aspects. The episodes were simultaneously broadcasted from 84 stations of All India Radio at the prime time, in sixteen languages. Evaluation of the reach and effect of the tobacco component of the program was carried out through two community-based surveys, carried out among persons above 15 years of age, in selected rural areas of Goa and Karnataka, where no organized anti-tobacco programs were being conducted. Most of the listeners considered the program to be very good or good, and felt that it would have an effect on the tobacco users to quit their habit as well as on children to prevent the initiation of the habit. About 4% of the tobacco users in Goa and about 6% of the users in Karnataka quit their habit after hearing the program. About 98 to 99% of the listeners expressed that such programs should continue. 
The World Health Organization has put forth the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control. [M: Monitor tobacco use and prevention policies; P: Protect people from tobacco smoke; O: Offer help to quit tobacco use; W: Warn about the dangers of tobacco; E: Enforce bans on tobacco advertising, promotion, and sponsorship; R: Raise taxes on tobacco]. 2
S.G.: You have been in the forefront of the teletherapy committee. You have really enabled many centers in India to set up radiation Oncology centers. What you think should be done to promote public - private partnership?
G.K.R. : The name of this committee now is, 'Standing committee on radiotherapy development program'.
The Public Private Partnership (PPP) model has already been successfully implemented in many government medical colleges in the country. Under this model, following the procedures laid down, the institution enters into an agreement with a private firm (which provides the radiotherapy facilities). We all know that radiotherapy and imaging facilities need huge investment for establishing a state-of-the-art set-up. Here, the PPP mode can help a lot. This will help to increase the cancer care facilities in the remote areas of our country.
S.G.: There seems to be a high density of radiation oncology centers in metropolitan cities. Should we allow market forces to determine the density of centers? Or should there be a law so that centers are evenly distributed?
G.K.R.: Even distribution of radiation oncology centers is desirable throughout the country. The density of such centers in India is less than the ideal requirement. We need many more centers, even in the metros, to match the western standards. All efforts should be made to provide the minimum number of oncology centers in peripheral areas.
| > References|| |
|1.||Luo J, Margolis KL, Wactawski-Wende J, Horn K, Messina C, Stefanick ML, et al. Association of active and passive smoking with risk of breast cancer among postmenopausal women: A prospective cohort study. BMJ 2011;342:d1016. |
|2.||WHO report on the global tobacco epidemic, 2009. Available from: http://www.who.int/tobacco/mpower/en/. [Last accessed in 2011]. |
|3.||Population Based Cancer Registries Reports. Two-Year Report: 2004-2005. National Cancer Registry Programme, Indian Council of Medical Research. Available from: http://www.pbcrindia.org/PbcrReports/Chapter3_PBCR_2004-2005.pdf. [Last accessed in 2011]. |
|4.||Gupta PC, Mehta HC. Cohort study of all-cause mortality among tobacco users in Mumbai, India. Bull World Health Organ 2000;78:877-83. |
|5.||Rath GK, Chaudhry K. Estimation of cost of tobacco related cancers-Report of an ICMR task force study (1990-96). Indian Council of Medical Research, New Delhi, 1999. |
|6.||Cancer Research in ICMR Achievements in Nineties. Available from: http://www.icmr.nic.in/cancer.pdf. [Last accessed in 2011]. |