What is Cancer?

Cancer is the diseases in which the body's cells become abnormal and divide without control.
Cancer cells may invade nearby tissues. And they may spread through the bloodstream and
lymphatic system to other parts of the body.

Cancer is a group of diseases characterized by uncontrolled cell division leading to growth of

abnormal tissue. It is believed that cancers arise from both genetic and environmental factors that
lead to aberrant growth regulation of a stem cell population, or by the dedifferentiation of more
mature cell types.

Cell multiplication (proliferation) is a normal physiologic process that occurs in almost all
tissues and under many circumstances, such as response to injury, immune responses, or to
replace cells those has died or have been shed as a part of their lifecycle (in tissues such
as skin or the mucous membranes of the digestive tract). Normally the balance between
proliferation and cell death is tightly regulated to ensure the integrity of organs and tissues.
Mutations in DNA that lead to cancer appear to disrupt these orderly processes.

The uncontrolled and often rapid proliferation of cells can lead to either a benign tumor or
a malignant tumor (cancer). Benign tumors do not spread to other parts of the body or invade
other tissues, and they are rarely a threat to life. Malignant tumors can invade other organs,
spread to distant locations (metastasize) and become life threatening.

As it grows, it may damage and invade nearby tissue. If a cancerous tumor outgrows its
birthplace (called the primary cancer site) and moves on to another place (called the secondary
cancer site), it's referred to as metastasizing.
Researchers divide the causes of
cancer into two groups: those with
an environmental cause and those
with a hereditary genetic cause.
Cancer is primarily an
environmental disease, though
genetics influence the risk of some
cancers. Common environmental
factors leading to cancer include:
tobacco, diet and obesity,
infections, radiation, lack of
physical activity, and
environmental pollutants. These
environmental factors cause or
enhance abnormalities in the
genetic material of cells. Cell
reproduction is an extremely
complex process that is normally
tightly regulated by several classes of genes, including oncogenes and tumor suppressor genes.
Hereditary or acquired abnormalities in these regulatory genes can lead to the development of
cancer. A small percentage of cancers, approximately five to ten percent, are entirely hereditary.
What are the types of Cancer?
Breast: A lump or thickening of the breast; discharge from the nipple; change in the skin
of the breast; a feeling of heat; or enlarged lymph nodes under the arm

Bladder: Blood in the urine, pain or burning upon urination; frequent urination; or
cloudy urine

Bone: Pain in the bone or swelling around the affected site; fractures in bones; weakness,
fatigue; weight loss; repeated infections; nausea, vomiting, constipation, problems with
urination; weakness or numbness in the legs; bumps and bruises that persist 

Brain: Dizziness; drowsiness; abnormal eye movements or changes in vision; weakness,

loss of feeling in arms or legs or difficulties in walking; fits or convulsions; changes in
personality, memory or speech; headaches that tend to be worse in the morning and ease
during the day, that may be accompanied by nausea or vomiting

Colorectal: Rectal bleeding (red blood in stools or black stools); abdominal cramps;

constipation alternating with diarrhea; weight loss; loss of appetite; weakness; pallid
complexion

Kidney: Blood in urine; dull ache or pain in the back or side; lump in kidney area,
sometimes accompanied by high blood pressure or abnormality in red blood cell count  

Lung: Wheezing, persistent cough for months; blood-streaked sputum; persistent ache in

chest; congestion in lungs; enlarged lymph nodes in the neck

Leukemia: Weakness, paleness; fever and flu-like symptoms; bruising and prolonged

bleeding; enlarged lymph nodes, spleen, liver; pain in bones and joints; frequent
infections; weight loss; night sweats

Ovarian: Abdominal swelling; in rare cases, abnormal vaginal bleeding; digestive

discomfort
Oral:  A lump in the mouth, ulceration of the lip, tongue or inside of the mouth that does
not heal within a couple of weeks; dentures that no longer fit well; oral pain, bleeding,
foul breath, loose teeth, and changes in speech

Prostate: Urination difficulties due to blockage of the urethra; bladder retains urine,

creating frequent feelings of urgency to urinate, especially at night; bladder not emptying
completely; burning or painful urination; bloody urine; tenderness over the bladder; and
dull ache in the pelvis or back

Pancreatic: Upper abdominal pain and unexplained weight loss; pain near the center of
the back; intolerance of fatty foods; yellowing of the skin; abdominal masses;
enlargement of liver and spleen

Stomach: Indigestion or heartburn; discomfort or pain in the abdomen; nausea and

vomiting; diarrhea or constipation; bloating after meals; loss of appetite; weakness and
fatigue; bleeding - vomiting blood or blood in the stool

Uterine: Abnormal vaginal bleeding, a watery bloody discharge in postmenopausal

women; a painful urination; pain during intercourse; pain in pelvic area.
What are the causes of cancer?
Majority of cancers are sporadic. Causes of cancer, any type of cancer is unknown and unclear.
There is no clear cause why one person gets cancer and another does not. Cancer develops over
time when certain normal genes start mutating. Such cells multiply rapidly and become
malignant. These gene mutations occur due to a complex mix of factors related to lifestyle,
heredity and environment.

A risk factor is anything that increases a person's chance of developing cancer. Different cancers
have different risk factors. Many forms of cancer are associated with exposure to environmental
factors such as tobacco smoke, radiation, alcohol and certain viruses. While some of these risk
factors can be avoided or reduced, there is no known way to entirely avoid the disease.

Up to 85 per cent of cancers can be prevented by avoiding environmental risk factors like
smoking, sun exposure, alcohol abuse and poor nutrition. Use of tobacco, certain diets, alcohol,
exposure to ultraviolet (UV) radiation, and to a lesser extent, exposure to disease causing agents
(carcinogens) in the environment and the workplace are some of the potential catalysts of cancer.
It is important to remember, however, that these factors increase a person's risk but do not
always "cause" the disease.

The known risk factors for cancer include:

Radiation
Ultraviolet (UV) Radiation
Viruses
Chemicals
Tobacco
Alcohol
Diet
Twenty percent of cancers are hereditary. This means that the abnormal gene responsible for
causing this type of disease is passed from parent to child, posing a greater risk for that type of
cancer in all descendants of the family. However, just because someone has a cancer-causing
gene doesn't mean they will automatically get cancer.

Signs of hereditary cancer include:

Genetics
Ethnic Groups
Family History

Cancers are primarily an environmental disease with 90-95% of cases attributed to

environmental factors and 5-10% due to genetics. Environmental, as used by cancer researchers,
means any cause that is not genetic. Common environmental factors that contribute to cancer
death include: tobacco (25-30%), diet and obesity (30-35%), infections (15-20%), radiation (both
ionizing and non-ionizing, up to 10%), stress, lack of physical activity, and environmental
pollutants.

The many causes of cancer:

There are about 200 different types of cancer. They can start in any type of body tissue. What
affects one body tissue may not affect another. For example, tobacco smoke that you breathe in
may help to cause lung cancer. Overexposing your skin to the sun could cause a melanoma on
your leg. But the sun won't give you lung cancer and smoking won't give you melanoma.

Apart from infectious diseases, most illnesses are multi factorial. Cancer is no exception. Multi
factorial means that there are many factors involved. In other words, there is no single cause for
any one type of cancer. 

 
Cancer-causing substances (carcinogens):

A 'carcinogen' is something that can help to cause cancer. Tobacco smoke is a powerful
carcinogen. But not everyone who smokes gets lung cancer. So there must be other factors at
work as well as carcinogens. 

Age:

Most types of cancer become more common as we get older. This is because the changes that
make a cell become cancerous in the first place take a long time to develop. There have to be a
number of changes to the genes within a cell before it turn into a cancer cell. These changes can
happen by accident when the cell is dividing. Or they can happen because the cell has been
damaged by carcinogens and the damage is then passed on to future 'daughter' cells when that
cell divides. The longer we live, the more time there is for genetic mistakes to happen in our
cells.

The immune system:

People who have problems with their immune systems are more likely to get some types of
cancer. This group includes people who

 Have had organ transplants and take drugs to suppress their immune systems to stop
organ rejection
 Have HIV or AIDS
 Are born with rare medical syndromes which affect their immunity
The types of cancers that affect these groups of people fall into two, overlapping groups

 Cancers that are caused by viruses, such as cervical cancer and other cancers of the
genital or anal area, some lymphomas, liver cancer and stomach cancer
 Lymphomas
Chronic infections or transplanted organs can continually stimulate cells to divide. This continual
cell division means that immune cells are more likely to develop genetic faults and develop into
lymphomas.

Day to day environment:

By environmental causes we mean what is around you each day that may help to cause cancer.
This could include

 Tobacco smoke
 The sun
 Natural and manmade radiation
 Work place hazards
 Asbestos
Some of these are avoidable and some aren't. Most are only contributing factors to causing
cancers - part of the jigsaw puzzle that scientists are still trying to put together.

Tobacco:

Most people know that smoking is a major risk factor for lung cancer. But it may also increase
the risk of

 Mouth cancer
 Pharyngeal cancer (the pharynx is behind the nose - some come under mouth cancers and
some are nasopharyngeal cancers)
 Cancer of the larynx (also called laryngeal or voice box cancer)
Because smoke passes over these areas as it is breathed in. Smoking also increases the risk of

 Cancer of the oesophagus (gullet)

 Stomach cancer
Because some smoke is swallowed. Smoking is also linked to
 Cancer of the pancreas
 Liver cancer
 Cancer of the cervix
 Acute myeloid leukemia
Because some carcinogens from the smoke get into the bloodstream and circulate around the
body.

Smoking is also linked to kidney cancer and bladder cancer because the carcinogens in the blood
are filtered into the urine.

The more you smoke, the younger you start, and the longer you keep on smoking, the more
likely you are to get cancer.

A long term exposure to environmental tobacco smokes at home or at work increases the risk
of lung cancer. It also increases the risk of cancer of the larynx and pharyngeal cancer. Exposure
to environmental tobacco smoke in childhood may cause bladder cancer later in life.

The sun:

Most skin cancers are largely caused by over exposing your skin to ultraviolet radiation from the
sun. There is more of a risk if you

 Are fair skinned

 Have a lot of moles
 Have a relative who has had melanoma or non-melanoma skin cancer
Non-melanoma skin cancer is linked to more or less constant sun exposure over the years. So it
is common in white people who live in hot countries such as South Africa and Australia.
But melanoma (the most dangerous form of skin cancer) is linked to exposing untanned skin to
the sun in relatively short bursts (for example, going to a hot country for two weeks and frying
on the beach). This is thought to be particularly dangerous in babies, children and young
adolescents. To reduce your risk of melanoma
 Use at least factor 15 sun cream
 Cover up with a hat, long sleeved shirt and trousers or sit in the shade between 11am and
3pm when the sun is strongest
 Don't let your skin burn
 Sun beds can also increase the risk of skin cancer and it is best not to use them at all.

Diet and exercise:

Diet, physical inactivity, and obesity are related to approximately 30-35% of cancer cases. In the
United States excess body weight is associated with the development of many types of cancer
and is a factor in 14-20% of all cancer death. Physical inactivity is believed to contribute to
cancer risk not only through its effect on body weight but also through negative effects on
immune system and endocrine system.

Diets that are low in vegetables, fruits and whole grains, and high in processed or red meats are
linked with a number of cancers. A high salt diet is linked to gastric cancer, aflatoxin B1, a
frequent food contaminate, with liver cancer, and Betel nut chewing with oral cancer. This may
partly explain differences in cancer incidence in different countries for example gastric cancer is
more common in Japan with its high salt diet and colon cancer is more common in the United
States. Immigrants develop the risk of their new country, often within one generation, suggesting
a substantial link between diet and cancer.

Decades of research has demonstrated the link between tobacco use and cancer in the lung,
larynx, head, neck, stomach, bladder, kidney, esophagus and pancreas. Tobacco smoke contains
over fifty known carcinogens, including nitrosamines and polycyclic aromatic hydrocarbons.
Tobacco is responsible for about one in three of all cancer deaths in the developed world, and
about one in five worldwide. Lung cancer death rates in the United States have mirrored smoking
patterns, with increases in smoking followed by dramatic increases in lung cancer death rates
and, more recently, decreases in smoking followed by decreases in lung cancer death rates in
men. However, the numbers of smokers worldwide is still rising, leading to what some
organizations have described as the tobacco epidemic.

Cancer related to one's occupation is believed to represent between 2-20% of all cases. Every
year, at least 200,000 people die worldwide from cancer related to their workplace. Currently,
most cancer deaths caused by occupational risk factors occur in the developed world. It is
estimated that approximately 20,000 cancer deaths and 40,000 new cases of cancer each year in
the U.S. are attributable to occupation. Millions of workers run the risk of developing cancers
such as lung cancer and mesothelioma from inhaling asbestos fibers and tobacco smoke, or
leukemia from exposure to benzene at their workplaces.

Viruses:

Viruses can help to cause some cancers. But this does not mean that these cancers can be caught
like an infection. What happens is that the virus can cause genetic changes in cells that make
them more likely to become cancerous.

These cancers and viruses are linked

 Cervical cancer, and other cancers of the genital and anal area, and the human papilloma
virus (HPV)
 Primary liver cancer and the Hepatitis B and C viruses
 Lymphomas and the Epstein-Barr Virus
 T cell leukemia in adults and the Human T cell leukemia virus
 HPV also probably leads to oropharyngeal cancer and non melanoma skin cancers in
some people
There will be people with primary liver cancer and with T cell leukemia who haven't had the
related virus. But infection increases their risk of getting that particular cancer. With cervical
cancer, scientists now believe that everyone with an invasive cervical cancer has had an infection
beforehand.

Many people can be infected with a cancer causing virus, and never get cancer. The virus only
causes cancer in certain situations. Many women get a high risk HPV infection, but never
develop cervical cancer. Another example is Epstein-Barr virus (EBV). These are some facts
about EBV

 It is very common - most people are infected with EBV

 People who catch it late in life get glandular fever and have an increased risk of
lymphoma
 In sub-Saharan Africa, EBV infection and repeated attacks of malaria together cause a
cancer called Burkitt's lymphoma in children
 In China, EBV infection (together with other unknown factors) causes nasopharyngeal
cancer
 In people with AIDs and transplant patients EBV can cause lymphoma
 About 4 out of 10 cases of Hodgkin's lymphoma and a quarter of cases of Burkitt's
lymphoma (a rare type of non Hodgkin's lymphoma) seem to be related to EBV
infection
  

Bacterial infection:

Bacterial infections have not been thought of as cancer causing agents in the past. But studies
have shown that people who have helicobacter pylori infection of their stomach develop
inflammation of the stomach lining, which increases the risk of stomach cancer. Helicobacter
pylori infection can be treated with a combination of antibiotics.

Research is also looking at whether substances produced by particular types of bacteria in the
digestive system can increase the risk of bowel cancer or stomach lymphomas. Some researchers
think that particular bacteria may produce cancer causing substances in some people. But
research into this issue is at an early stage.
If bacteria do play a part in causing cancer this could be important in cancer prevention.
Bacterial infections can often be cured with antibiotics, so getting rid of the infection could be a
way to reduce the risk of these types of cancer.

How to prevent Cancer?

At least one-third of all cancer cases are preventable. Prevention offers the most cost-
effective long-term strategy for the control of cancer.

Tobacco:
Tobacco use is the single greatest avoidable risk factor for cancer mortality worldwide, causing
an estimated 22% of cancer deaths per year. In 2004, 1.6 million of the 7.4 million cancer deaths
were due to tobacco use.

Tobacco smoking causes many types of cancer, including cancers of the lung, esophagus, larynx
(voice box), mouth, throat, kidney, bladder, pancreas, stomach and cervix. About 70% of the
lung cancer burden can be attributed to smoking alone. Second-hand smoke (SHS), also known
as environmental tobacco smoke, has been proven to cause lung cancer in nonsmoking adults.
Smokeless tobacco (also called oral tobacco, chewing tobacco or snuff) causes oral, esophageal
and pancreatic cancer.

 Tobacco and cancer: evidence and monitoring

 Implementation tools
 Tobacco Free Initiative

Physical inactivity, dietary factors, obesity and being

overweight:
Dietary modification is another important approach to cancer control. There is a link between
overweight and obesity to many types of cancer such as oesophagus, colorectum, breast,
endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against
many cancers. Conversely, excess consumption of red and preserved meat may be associated
with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the
development of diet-associated cancers will also lower the risk of cardiovascular disease.

Regular physical activity and the maintenance of a healthy body weight, along with a healthy
diet, will considerably reduce cancer risk. National policies and programs should be
implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that
people are provided with the information and support they need to adopt healthy lifestyles.

Medication:

The concept that medications could be used to prevent cancer is an attractive one, and many
high-quality clinical trials support the use of such chemoprevention in defined circumstances.
Aspirin has been found to reduce the risk of death from cancer. Daily use of tamoxifen or
raloxifene has been demonstrated to reduce the risk of developing breast cancer in high-risk
women by about 50%. Finasteride has been shown to lower the risk of prostate cancer, though it
seems to mostly prevent low-grade tumors. The effect of COX-2 inhibitors such as rofecoxib and
celecoxib upon the risk of colon polyps has been studied in familial adenomatous polyposis
patients and in the general population. In both groups, there were significant reductions in colon
polyp incidence, but this came at the price of increased cardiovascular toxicity.

Vitamins have not been found to be effective at preventing cancer, although low levels of
vitamin D are correlated with increased cancer risk. Whether this relationship is causal and
vitamin D supplementation is protective is yet to be determined. Beta-carotene supplementation
has been found to increase slightly, but not significantly, risks of lung cancer. Folic acid
supplementation has not been found effective in preventing colon cancer and may increase colon
polyps.

Vaccination:

Vaccines have been developed that prevent some infection by some viruses that are associated
with cancer, and therapeutic vaccines are in development to stimulate an immune response
against cancer-specific epitopes. Human papillomavirus vaccine (Gardasil and Cervarix)
decreases the risk of developing cervical cancer. The hepatitis B vaccine prevents infection with
hepatitis B virus and thus decreases the risk of liver cancer.

Advances in cancer research have made a vaccine designed to prevent cancers available. In 2006,
the U.S. Food and Drug Administration approved a human papilloma virus vaccine, called
Gardasil. The vaccine protects against 6,11,16,18 strains of HPV, which together cause 70% of
cervical cancers and 90% of genital warts. It also lists vaginal and vulvar cancers as being
protected. In March 2007, the US Centers for Disease Control and Prevention (CDC) Advisory
Committee on Immunization Practices (ACIP) officially recommended that females aged 11–12
receive the vaccine, and indicated that females as young as age 9 and as old as age 26 are also
candidates for immunization. There is a second vaccine from Cervarix which protects against the
more dangerous HPV 16, 18 strains only. In 2009, Gardasil was approved for protection against
genital warts. In 2010, the Gardasil vaccine was approved for protection against anal cancer for
males and reviewers stated there were no anatomical, histological or physiological anal
differences between the genders so females would also be protected.
Cancer situation in Bangladesh:
Cancer poses serious health problems both in developed and developing countries. The
prevention and control of cancer in developing countries deserve urgent attention since the
disease is expected to double in these countries in the next 20 to 25 years. The problem of cancer
in Bangladesh is a particularly acute because of poverty, illiteracy, and other diseases associated
with poor nutrition and lack of basic knowledge of people about health matters.

Cancer control means its primary prevention, early detection (i.e. secondary prevention),
treatment, follow-up, treatment of recurrent cases, and palliative care, including relief of pain of
advanced and incurable cases. In other words, the real object of cancer control is to minimize the
total impact of cancer by reducing mortality from cancer.

No reliable statistical data about cancer are available for most developing countries in general
and Bangladesh in particular. In the light of the statistics available from the World Health
Organization, cancer incidence, prevalence and mortality can be estimated approximately as
2,00,000, 8,00,000 and 1,50,000 respectively for the 130 million people of Bangladesh. Based on
the World Health Statistics, new cancer cases in Bangladesh have been estimated at 167 per
1, 00,000 populations.

About 150,000 cancer patients out of the present 1 million die annually owing to limited
treatment facilities in public hospitals and high expenses in private clinics in Bangladesh.

About 200,000 cancer patients are added to this overwhelming size every year, according to the
2005 draft annual report of the National Institute of Cancer Research and Hospital. While
localized cancer can be operated on, patients whose cancer is detected late need chemotherapy
and radiotherapy, which are expensive, said medical experts.
The National Institute of Cancer Research and Hospital in Dhaka and a number of public
hospitals and private clinics that have some facilities for cancer treatment can provide treatment
to only 20,000 to 25,000 patients in a year, according to cancer patients and survivors.

The treatment of cancer is also hampered by a shortage of oncologists, as the number in the
country is only 98, which is grossly inadequate for the increasing number of cancer patients,
according to president of the Bangladesh Cancer Foundation and Associate Professor of NICRH
Habibullah Talukder.

Common cancers in Bangladesh Based on the data available from the Radiotherapy Department
of the DHAKA MEDICAL COLLEGE AND HOSPITAL , common cancers in males and females can be
figured out as shown in table.

Table 1 Relative percentage of common cancers in Bangladesh

Male Female
Lung 21 Cervix 24
Larynx 13 Breast 17
Oral cavity 12 Oral cavity 13
Leukaemia/Lymphoma 8 Ovary 6
Pharynx 6 Leukaemia/Lymphoma 5
Oesophagus 5 Oesophagus 4
Others 35 Others 31

Source Based on 21,238 cancer (Male 14,222 and female 7,076) treated at the Radiotherapy
Department of Dhaka Medical College Hospital during the period of 1985-92.

Causes TOBACCO smoking is the major cause of lung cancer. About 85 percent of lung cancer
cases are caused by SMOKING. This cancer causes death to about 35 percent of all cancer patients
in developed countries and about 21 percent of all cancer patients among men in Bangladesh.
Tobacco chewing is an important cause of oral cancer and account for about 13 percent of all
cancers in Bangladesh. Most people of the country generally use tobacco products such as raw
tobacco leaf, Jarda, Kimam, etc with BETEL LEAF,BETEL NUT, slaked lime and catechu that are
responsible for oral cancer. Use of Gul and Khaini are responsible for cancers of gum and cheek.
Use of snuff may cause nasal cancer as well. Bad oral hygiene and poor dental care are also
responsible for cancer of oral cavity.

Use of tobacco is not only responsible for causing cancers of the lung and oral cavity, but is also
responsible for causing cancers of the larynx, pharynx, esophagus, pancreas, kidney and bladder.
About 50 percent of all cancers in this country can be prevented in Bangladesh if smoking and
chewing tobacco is stopped.

Table 2 Prevalent cancers in Bangladesh and their risk factors

Sites Risk factors

Lung, Larynx Tobacco smoking
Oral cavity Tobacco chewing
Pharynx Air pollution and chemicals: Asbestos (Lung)
Oesophagus Poor dental care and oral hygiene (oral cavity)
Pancreas Excessive intake of red chilli (oesophagus)
Kidney, Bladder Early sex, early marriage, multiple sex partners, multiple pregnancies, low
socio-economic status, poor personal hygiene, venereal diseases
Cervix HSV-2, HPV, Uncircumcised male partner, nulliparous
Breast Daughters of breast cancer patients, less breast feeding, high fatty food,
alcohol drinking (+tobacco smoking)
Liver HBV
Stomach High fatty food
Colo-rectum Low fibrous food, low Vitamin A,C,E, and Selenium, Zinc in food
Penis Uncircumcised male organ

Cervical cancer, the most common cancer-affecting women of Bangladesh is probably due to
repeated childbirth resulting in lacerations of the cervix and cervicitis. This cancer can be
minimized by limiting the number of children. Early sex life, early marriage, multiple sexual
partners, venereal disease, Herpes virus, human papilloma virus, low socio-economic status, and
poor personal hygiene are also associated with higher incidence of cervical cancer. Prostitutes
have very high risk of cervix cancer.

The practice of circumcision greatly reduces the risk of penile cancer in males and to some
extent of cervical cancer in female partners.

Breast cancer is the second commonest cancer among women of Bangladesh. Nulliparous
women, daughters of breast cancer patients, and those who do not breast-feed their babies and
indulge in high-fat diet suffer more from breast cancer.

Cancer of oral cavity, larynx, oesophagus, and particularly of liver occur more frequently among
heavy drinkers of alcohol, specially when accompanied by smoking and chewing of tobacco.
Hepatitis B virus is also responsible for liver cancer against which a successful vaccine has been
developed and is in use. Aflatoxins produced by the fungus developed in most carbohydrate
foods in hot, humid climates are highly carcinogenic for the liver.

High fatty food may cause certain cancers such as breast, colo-rectum, uterus and prostate
cancer. High fibrous food, on the other hand, helps reduce the risk of colon cancer and foods rich
in vitamins A, C, E for cancers of larynx and lung.

Prevention of cancer At present, about one-third of the cancers affecting people can be
prevented; one third can be cured, and palliation is possible for the rest. Recent data from
developed countries show that there has been a decline in all cancer deaths except lung cancer.
Early diagnosis, improved treatment, and appropriate change in life style have led to this
development. Rise of total cancer deaths is due to consumption of tobacco.

Prevention of cancer may be primary or secondary. Primary prevention indicates steps to be

taken before the development of the disease, for which one must know the causes of cancer, must
take measures to avoid them and must make appropriate changes in ones lifestyle.

Secondary prevention of cancer involves early detection of the disease through increased
awareness achieved by imparting knowledge of early signs and symptoms of cancer, by
screening through promotion of self-examination of breast and mouth, by periodic check-ups, eg
X-ray of chest, mammography, and by other special examinations.

Control of cancer Cancer control program comprises a series of activities to diminish the total
impact of cancer in any community or country by prevention, early detection, and the provision
of facilities for appropriate treatment at an early stage of the disease. Also included are follow-up
and rehabilitation of the treated cases, treatment of recurrent cases, and relief of pain for patients
with incurable cancers. Evaluation of the program is necessary from time to time as per data
provided by the Cancer Registry.

The Bangladesh Cancer Society has prepared 'A Plan for Cancer Control in Bangladesh' and
formally handed it to the Government for implementation. The plan recommends: (i) primary
prevention of cancers related to the use of tobacco, ie those of the lung, oral cavity, larynx, and
esophagus; (ii) development of facilities for early diagnosis of cervical, oral, and breast cancers
and treatment of these and other cancers in existing institutions and other centers in due course;
(iii) efforts for early diagnosis through increased awareness by imparting knowledge of early
signs and symptoms of cancer and by promoting self-examination of breast and mouth, and
where possible down-staging with cytology; (iv) measures for relief of pain for patients with
advanced cancer; (v) training programs for specialists and technicians, and (vi) setting up a
National Cancer Registry in order to monitor the status of cancer in Bangladesh.

The plan calls for a firm political commitment by the Government for implementation of the
program and allocation of necessary funds. There are reasons to believe that the program for
prevention of cancer can be profitably integrated with those for Primary Health Care and Family
Welfare.

Breast Cancer is a malignant neoplasm of the breast. Breast cancer is an important health
problem of women between the age of 40 and 50. Most cancers of the breast occur in the duct of
the milk-secreting gland, while some originate at the gland itself. Early sign is usually the
appearance of a lump in the breast that slowly enlarges with passage of time. Seeking immediate
medical advice is recommended should these signs are detected.
There is no accurate data on the incidence of breast cancer in Bangladesh. Figures available
suggest that about 200,000 patients are treated for cancer every year and that the yearly death toll
is 150,000 per year. There is no statistics as to how many of these are breast cancer cases. But it
would probably be quite small since breast cancer cases at the early stage of illness are rarely
reported to physicians. In cities and towns this medical non-compliance is mainly due to lack of
facilities, while in rural areas the social inhibition also plays in a role. Based on the data
available from the Radiotherapy Department of the Dhaka Medical College Hospital, it is
estimated that the incidence of breast cancer will be about 17%.

Since the early 1990s there has been considerable improvement in diagnostic health services that
have coincided with the country's entry into free market economy. Mammography, which is a
special imaging technique using x-rays, came to be available in the private sector at about this
time. The technique visualizes soft tissue of the breast making it easy to detect breast cancer. In a
small number of Dhaka private clinics, mammography facilities are available that are used in
suspected cases of breast cancer, while a small number of users take the test for monitoring
purpose. Between the ages of 35-40, it is recommended that a woman should take a mammogram
once in two years up to the age of 50, and once a year after 50. However, some recent studies
seem to suggest that routine monitoring for breast cancer by mammograms may not be very
useful for women under the age of 50.

References:
http://www.cancer-info-guide.com/
http://www.who.int/cancer/prevention/en/
http://www.banglapedia.org/httpdocs/HT/C_0033.HTM
http://www.medicalnewstoday.com/info/cancer-oncology/
http://www.wordiq.com/definition/Cancer