Monday, March 05, 2012

Lifestyle Diseases 17: On Cancer, COPD and NCD Risk Factors

Cancer -- there are probably 200 types as listed in wiki -- will remain a major killer disease into the future. Aside from natural human biology that allows certain diseases to advance as we grow older, human lifestyle can either prevent or exacerbate such disease advances.

Related to the DOH presentation on non-communicable diseases (NCDs), smoking and tobacco tax hike below, and powerpoint slides from Doc Tony Leachon on NCDs which I will post shortly after this, I am posting three papers by Mr. Reiner Gloor of the Pharmaceutical and Healthcare Association of the Philippines (PHAP) related to NCDS.

The first is on cancer. My older brother, my sister in law, my mother's cousin, two of our wedding godmothers, have all died of cancer. That is why I am really hoping that "magic" medicines will soon be developed that can really kill various cancer cells, especially for younger people in their productive period. My brother died at age 52 only.

The second and third papers are on COPD or chronic respiratory diseases, and on the four risk factors of NCDs. Like cancer, Reiner says COPD is also preventable via change in lifestyle, aside from medication and other treatment.

See, more personal and parental/guardian responsibility in healthcare, more than government responsibility; more preventive rather than curative healthcare, can make a big difference. It's another story of course when we grow older. No matter how healthy is our lifestyle, human biology says that reaching 100 years or older is more of an outlier, more of exception, rather than the rule. Medicines, innovator and generics alike, will help humanity prolong their lives but only to a certain extent. But with endless improvement in the pharmaceutical, medical and biological sciences, human understanding of various diseases and how they expand will improve and hence, their treatment and control will also improve. 


(1) Many cancers can be prevented and cured

August 19, 2011

Medicine Cabinet -- Reiner W. Gloor

Cancer is one of the major noncommunicable diseases (NCDs) that will be given global attention when the United Nations General Assembly convenes for a High-level Summit in September. It is a leading cause of death worldwide which claimed more than 7.5 million lives in 2008. It is projected that it will continue to rise with an estimated 12 million deaths in 2030, a situation which could be a crucial concern.

Cancer knows no boundaries. Rich or poor, young or old, men or women. However, the burden for low- and middle-income countries is growing with more than 70% of the reported deaths occurring in them in 2008. Low- and middle-income countries also stand to be hardest hit by consequences of other major NCDs such as chronic respiratory diseases, diabetes, and cardiovascular diseases. A UN report explained that in developing countries, noncommunicable diseases and their risk factors worsen poverty, while poverty results in rising rates of such diseases.

In the interest of space, this column will discuss cancer in general as there could be more than a hundred types of cancer. This is due to the fact that cancer, also referred to as malignant tumor or neoplasm, can affect any part of the body. It arises from a single cell but transforms and progresses into malignant tumors.

The Philippine Cancer Society explained that cells grow, divide, and produce more cells as needed to keep the body healthy and functioning properly. However, the process goes wrong sometimes and cells become abnormal, forming more cells in an uncontrolled way. The extra cells form a mass of tissue, called a growth or tumor, which can be benign or malignant, meaning cancerous.

The World Health Organization (WHO) noted that “metastasis” is a defining feature of cancer. It is a process referring to the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.

The WHO added that these changes are the result of the interaction between a person’s genetic factors and external agents such as physical carcinogens (ultraviolet and ionizing radiation); chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant); and biological carcinogens, such as infections from certain viruses, bacteria or parasites.

Aging is also a factor for the development of cancer. Other risk factors include smoking, alcohol, unhealthy diet, and chronic infections from hepatitis B virus, hepatitis C virus and some types of human papilloma virus (HPV).

According to the WHO, the main types of cancer are lung (1.4 million deaths); stomach (740,000 deaths); liver (700,000 deaths); colorectal (610,000 deaths); and breast (460,000 deaths).
The 2010 Philippine Cancer Facts and Estimates has provided a glimpse of the burden of the disease in the country.

According to the report, lung cancer is the most common cancer in men and the third most common in women. It added that four out of 100 men and one out of 100 women in the country would have had a likelihood of developing lung cancer before reaching the age 75. In 2010, the same report said that 6,987 men and 2,197 women succumbed to lung cancer.

Meanwhile, breast cancer is the leading cause of cancer deaths among Filipino women while cervical cancer ranked second. Colorectal cancers, on the other hand, is the third most common cancer in the Philippines.

On the brighter side, more than 30% of cancer can be prevented by avoiding risk factors such as tobacco use, obesity, unhealthy diet, low fruit and vegetable intake, physical inactivity, alcohol use, sexually transmitted HPV infection and air pollution, among others.

The WHO also said that cancer mortality can be reduced if cases are detected and treated early. Early detection means knowing early signs and symptoms to facilitate diagnosis and treatment before the disease progresses. Cancer screening, on the other hand, aims to identify individuals with abnormalities suggestive of a specific cancer or pre-cancer and refer them promptly for diagnosis and treatment. (For more information on cancer, go to

According to the C-Network, among the cancers that can be prevented are lung, liver, cervical, oral cavity, stomach, colon, rectum and skin melanoma. When treated early and properly, it added that breast, cervical, colon, rectum, oral cavity, thyroid, and prostate cancers can be cured.
The pharmaceutical industry, through the International Federation of Pharmaceutical Manufacturers & Associations, will present a 10-point Framework for Action on NCDs as key stakeholder and subject matter expert during the High-Level Summit next month.

(2) Dealing with chronic respiratory diseases

September 2, 2011

Medicine Cabinet -- Reiner W. Gloor

Chronic respiratory diseases will be among the major noncommunicable diseases (NCDs) that will be given high priority at the upcoming United Nations High-level Summit along with diabetes, cardiovascular diseases and cancer.

NCDs will take the center stage in September as health leaders around the world converge to tackle the four major chronic illnesses that are the world’s biggest killer diseases. 

Having previously discussed diabetes, cancer and cardiovascular diseases, this column will now broadly take a look at chronic respiratory diseases. Among the preventable chronic respiratory diseases are asthma and respiratory allergies, occupational lung diseases, sleep apnea syndrome, pulmonary hypertension and chronic obstructive pulmonary disease (COPD).

Like the other major NCDs, chronic respiratory diseases pose serious public health concern in all countries particularly low- and middle-income countries. Asthma affected about 235 million people in 2004. More than 80% of asthma deaths occur in low- and lower-middle-income countries. 

As far as COPD is concerned, the World Health Organization (WHO) estimates that around 80 million people worldwide have COPD. More than three million people died of COPD in 2005, representing 5% of all global deaths. Without the proper interventions, it is estimated that the number of COPD deaths could increase by 30% in the next 10 years. 

The WHO likewise predicts that COPD could become the third leading cause of death worldwide by 2030. Like asthma, almost 90% of COPD deaths occur in low- and middle-income countries.

The publication Global Surveillance, Prevention and Control of Chronic Respiratory Diseases emphasized the need to take the disease seriously since a link has also been identified between COPD and other so-called systemic diseases such as cardiovascular disease, diabetes, osteoporosis and possibly peptic ulcer. 

The US National Institutes of Health (NIH) explained that the chronic airflow limitation characteristic of COPD is caused by a mixture of emphysema and chronic bronchitis. In chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This causes the lining to thicken, making it hard to breathe. In emphysema, the walls between many of the air sacs are damaged, causing them to lose their shape. When this happens, the amount of gas exchange in the lungs is reduced. As a result of emphysema and chronic bronchitis, COPD symptoms are characterized by chronic cough, abnormal sputum production, and dyspnea (difficult or labored breathing). A COPD is confirmed by a test called spirometry that records the amount and the rate of air you breathe in and out over a period of time. 

Risk factors for COPD are: smoking (including passive or secondhand exposure), indoor pollution (solid fuel for cooking and heating), outdoor pollution, occupational dusts and chemicals, and frequent lower respiratory infections during childhood. 

The above-mentioned risk factors show that COPD is highly preventable. However, many continue to ignore the warnings against smoking which is the single risk factor for all four major NCDs including COPD. 

In the Philippines, the Family Income and Expenditure Survey of 2007 showed that tobacco and alcohol spending combined is greater than spending for medical care. Apart from smoking, some continue to cook using solid fuels such as coal, wood and agricultural residues that emit toxic gases. The WHO and the UN Development Programme observed that thick acrid smoke arising from stoves and fires inside homes is associated with around 1.6 million deaths per year in developing countries, or one life lost every 20 seconds. 

COPD is not yet fully reversible but the NIH noted that treatments and lifestyle changes can help a patient diagnosed with the disease feel better, stay more active, and live longer. 

Meanwhile, the commitment to pharmaceutical research and development continues to help patients improve their overall health. Medicines have been developed to help open airways to make breathing easier. Other medicines aid in reducing airway inflammation. Flu and pneumococcal vaccines have also been crucial in building up the health defense system of COPD patients. 

Like the three other major NCDs, chronic respiratory diseases like COPD have adverse social and economic effects on the patients, their families and the public health. The Pharmaceutical and Healthcare Association of the Philippines (PHAP), through the International Federation of Pharmaceutical Manufacturers & Associations, commits to be a part of the global efforts to prevent, manage and control NCDs during the summit. 

(3) Four NCD risk factors to avoid

September 9, 2011

Medicine Cabinet -- Reiner W. Gloor

Major noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, chronic respiratory diseases and cancer have caused the deaths of about 36 million people worldwide, a figure already reaching epidemic proportions.

The World Health Organization (WHO) revealed that of the 57 million people who died in 2008, two-thirds were due to NCDs. Furthermore, about 80% of these deaths occurred in low-middle-income countries where many people are poor and are forced to pay for their own health care.
NCDs are being attributed to four behavioral risk factors namely tobacco use, unhealthy diet, physical inactivity and alcohol abuse. The WHO observed that the greatest effects of these risk factors fall increasingly on low- and middle-income countries, and on poorer people within all countries.

Studies have shown that poverty exposes people to behavioral risk factors for NCDs and as a result, forcing many to impoverishment or death. In fact, more than 80% of cardiovascular and diabetes deaths, almost 90% of deaths from chronic obstructive pulmonary disease, and more than two-thirds of cancer deaths occur in low- and middle-income countries.

The Global Status Report on Non-Communicable Diseases published in 2010 outlined how the four behavioral risk factors and other underlying metabolic causes contribute to the rise of NCDs.
The report said that almost six million people die from smoking each year, both from direct tobacco use and secondhand smoke. The deaths are expected to soar to 7.5 million in few years time. Estimates likewise revealed that smoking causes about 71% of lung cancer, 42% of chronic respiratory disease and close to 10% of cardiovascular disease.

Also in the list of risk factors for NCD is the harmful use of alcohol which causes 2.3 million deaths each year. The same report said that more than half of these deaths occur from NCDs including cancers, cardiovascular disease and liver cirrhosis.

The result of the Philippine Family Income and Expenditure Survey in 2007 showed that the poor, considered by the WHO as the most vulnerable when it comes to risk factors and out-of-pocket spending, pay more for tobacco and alcoholic beverages combined (2.7%) than on medical care (1.7%). Also on top of medical care were personal care (3.7%) and clothing and footwear (1.9%), reflecting the priorities of Filipino families.

Meanwhile, about 3.2 million people die each year due to physical inactivity. People who are not physically active have a 20% to 30% increased risk of all-cause mortality, added the report. A boom in the economy and technology resulting in modern comforts, fast-paced life and entertainment may have attributed to the lack of physical activity for many.

The fourth risk factor involves the food we eat. High consumption of salt, saturated fats and trans-fatty acids has been linked to cardiovascular diseases among others.

As discussed in an earlier column, the Philippine Society of Hypertension recommends the Dietary Approaches to Stop Hypertension (DASH) diet to lower blood pressure and address cholesterol problems.

The DASH diet advocates against processed foods to reduce the amount of sodium in our food. It also campaigns for the consumption of food high in calcium, potassium and magnesium. Potassium can be sourced from fruits and vegetables while low-fat dairy products are high in calcium and magnesium. The diet also recommends cutting down saturated and total fat.
Among many other factors, authorities blame this on the lack the education needed to prevent catastrophic diseases.

Keeping the people informed on how to prevent NCDs has been the campaign of this column for the past several weeks now. This effort is in conjunction with the 10-point Framework of Action on NCDs launched by the International Federation of Pharmaceutical Manufacturers & Association (IFPMA) which emphasizes the need for Prevention and Health Education.

The said Framework of Action calls for the promotion of innovative tools to increase health literacy, such as awareness of NCDs, their respective risk factors and the need to adhere to treatment. Finally, the Framework of Action is urging member pharmaceutical companies and associations to continue in actively promoting best practices which advance a healthy work force for employees.

The WHO report concluded that unless the NCD epidemic is aggressively confronted in the most heavily affected countries and communities, the mounting impact of NCDs will continue and the global goal of reducing poverty will be undermined.

The good news about all these behavioral risk factors is that they are all largely preventable and modifiable. If we lower our risks and detect any possible symptoms early, premature deaths due to major NCDs can be avoided.

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