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Dr M Krishnan Nair

Issue: Vol.3, No.4 - October 2004

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Article Type: Editorial

Dr. M .Krishnan Nair MD, FRCR

The Austral-Asian Journal of Cancer (AJC) is thr brainchild of the doctors of Regional Cancer Centre, Trivandrum and doctors from Kuwait and Australia. The publication of this International Journal on cancer is continuing successfully under the leadership of Dr Mohammed A.Al-Jarallah, Minister of Health, Kuwait and Dr Thomas Koilparampil, a Senior Staff member in the Department of Radiotherapy and Clinical Oncology in the Regional Cancer Centre, Trivandrum, who are Editors- in-Chiefs of the AJC.

The activities for the publication of this journal started 6 years ago when I was the Director of Regional Cancer. As Chairman of Advisory Committee, I had the privilege of deciding the direction of this journal from its infancy. The main editorial office of AJC was started in Regional Cancer Centre, Trivandrum in 1998.

Austral Asian Region includes major countries like India, China, Japan, Australia and Indonesia, which have a complex ethno-geographic composition. The cancers in this region are mostly preventable such as cancer of the liver, lung, cervix, mouth, breast and stomach. As this region accommodates 2/3rd population of the world in sheer numbers, cancer problem in this region is quite formidable. This region has countries which are economically most backward but some can even match the richest countries of the world. We have emerging economic giants like China and India. While the scarce health service provision in the poor developing countries is justifiable, it is sad to note that even these which have gained economically during the last few years have not correspondingly improved their health budgets.

Certain features make cancer conducive for health action in their region, such as the largest number of preventable cancer, mainly due to smoking and other forms of tobacco use. It is predicted that in China, 1 out of 4 deaths by 2010 will be due to lung cancer. Control of tobacco use as such should be one of the priorities in this region. Due to Hepatitis B Vaccination, the cancer of the liver in China is fast coming down. That experience should be duplicated by countries in the region to safeguard their populations, so also in lung cancer by anti-tobacco measures.

Oral cancer is a problem mostly of South Asia. It is well known that there are two forms of this cancer, one is tobacco related and the other occurring in non-habitual youngsters. The latter is highly aggressive and rapidly fatal. The etiology of such cancer needs extensive research. The ingenuity of commercial firms make sure that when one socially unacceptable habit gets discouraged,it gets replaced with something else even more harmful. A classical example is the replacement of betel nut chewing with pan masala.

Similarly, South African region accommodates more than 250,000 cervical cancer patients. This would certainly justify a major program for HPV vaccine and cancer screening. But with the kind of infrastructure of the health service of the South Asia, a cancer screening program cannot be even thought of. Hence, the IARC's attempt to use visual inspection methods in early cancer detection is laudable.

While in this region, we have got countries with highly developed treatment facilities; there are countries where treatment facilities are almost non-existent or where people have to travel thousand of miles to reach a cancer treatment facility. In India itself, there are certain states like Bihar, Orissa, Uttaranchal etc where the treatment facilities are extremely poor. In the absence of treatment facilities, early detection becomes irrelevant. Now that at least some of the therapy equipments are manufactured locally, governments should attempt to install them in a geographically balanced fashion and provide treatment nearer to their homes. It should be remembered that in the absence of appropriate treatment facilities, the patients will be forced to seek inappropriate therapies with wastage of money and lives.

More than 70% of cancer patients in this region are diagnosed late except in Japan. This emphasizes the need for extensive palliative care facilities. One of the main constraints in delivering palliative care is the non-availability of human resource and drugs. Though, this region produces most of the morphine in the world, because of regulations, Morphine is not available for pain relief of cancer patients. None of the countries in this region seem to take up this issue seriously.

Research in cancer is a very important area to be addressed immediately. If one looks at cancer journals coming out from U.K. and USA, one would find that there are very few references on cancer in Asia. This is because of two things (i) medical scientists in Asia do not care to publish their research, (ii) this may be because these journals do not have much interest in the publication of material on cancers which are less frequent in the West. It is high time that professional organizations in Asia Pacific region lay more stress on cancers of this region.

I congratulate AJC and its editors on the significant success it has so far achieved in projecting the cancer problem of the Austral Asian Region.

Dr.M. Krishnan Nair,
Founder Director (Retd.), Regional Cancer Centre, Trivandrum

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