Fighting Cancer through Prevention and Early Detection

The project to set up a Centre for Prevention and Early detection of cancer was launched by the Rotary Club of Colombo, recognizing the urgent need for a dedicated national facility for prevention and early detection of this killer disease.

The Rotary Club of Colombo already has several major landmark initiatives in healthcare, to its name. These include setting up of the Centre for Prevention of Tuberculosis (CNAPT) and the Sri Lanka Anti Narcotics Association (SLANA).

Statistics indicate that each year over 13000 new cases of cancer are detected in Sri Lanka, and two out of three of these patients eventually lose their lives to the disease. It is also a significant fact that the incidence of cancer is on the increase. Furthermore over 80 percent of these patients come from the rural areas, whilst over 60 percent are women.

According to the National Cancer Control Programme (NCCP), the very high morbidity and mortality of cancer, is primarily due to the fact that in most cases the disease is detected only at a very late stage. The main reason is the absence of a dedicated national facility for early detection of cancer. It is well known, for instance, that breast and cervical cancer can be detected well before malignancy sets in and the disease can be prevented totally.

With proper early Detection facilities in place whereby the disease can be detected at the early stages, ,the National Cancer Control Programme estimates that at least 30% of deaths due to cancer could be prevented. This would mean saving up to 4000 lives each year.

For the last three years, the Rotary Club of Colombo, in co-operation with the National Cancer Control Programme, functioning under the auspices of the Ministry of Health, has been making available screening facilities for early detection of cancer through their Cancer Early Detection Centre, set up by the Club, at Narahenpita.

Despite being open only five hours each day, the Centre is now well established in the area and visited by many who visit to get themselves checked, being more aware of the need for screening, whilst others are referred to the Centre by their own Doctor. Up to date several hundred cases, particularly females, have been detected showing signs requiring further investigation, many which have thereafter been confirmed as early signs of cancer.

Basic screening is presently carried out for cancers such as breast and cervical cancer.. However, once a permanent and fully fledged Centre comes up, more detailed investigations could be conducted, and many more cancers could be detected.

The NCCP presently reaches out to the rural areas through its Mobile Units and co-ordinates with the Medical Officers of Health Clinics in those areas to carry out screening, early detection and prevention activities.

In addition, through the present Early Detection Centre, selected high risk groups in the working population mainly women, are being targeted in the awareness programme conducted on the need for screening and early detection.

Over the last year, several of such groups have been screened at the Cancer Early Detection Centre, from Government Institutions as well as the Private Sector.

This is an ongoing programme and the NCCP can be contacted by Businesses with a view to arranging awareness programmes for prevention of Cancer, to be conducted at their work place, as well as to arrange for the employees, particularly females, to undergo basic screening at the Cancer Early Detection Centre.

The Rotary Club of Colombo, with the support of generous donors, has already embarked on the construction of a permanent Centre, centrally located and easily accessible to the general public.

This Centre will be a fully equipped modern facility carrying out screening, diagnosis, lab investigations, counselling, record keeping and awareness programmes for prevention.. The Club will build and assist to equip the Centre, which will be operated by the National Cancer Control Programme under the auspices of the Ministry of Health.

Already a MOU has been signed with the Ministry for the smooth functioning and continuity of the Centre.

Once complete the Rotary Club of Colombo will hand over the Centre to the Ministry, as its gift to the people of Sri Lanka

Education and building awareness is a vital aspect to prevent and arrest the incidence of cancer. In this regard the Club has plans to embark on a planned educational programme to address this aspect.

The emphasis would be placed on the importance of a healthy life style , which includes diet, living habits etc. This is to be targeted not only at adults, but more importantly at children of school going age to stress the importance of a healthy life style to avoid non communicable diseases such as cancer as well as diseases such as heart disease, diabetes etc Meanwhile awareness building for early detection and the importance of early detection will continue to be a key part of education as well.

In this regard the Club has printed and distributed through the NCCP, literature covering this aspect, as well as displaying posters on this to educate the Public.

The Rotaract Club of Colombo, sponsored by the Rotary Club of Colombo has also come forward to support this project by creating awareness on the vital need for screening and early detection, through a printed and electronic communication to the public.

Cannabis addiction: A colossal mental health problem in the community

Dr. Ruwan M. Jayatunge MD

Cannabis is an illicit and also a dangerous drug. According to police reports cannabis usage in Sri Lanka is increasing. A large number of people use cannabis day-to-day basis in rural and urban areas.

Many consider cannabis is a harmless even used in ayurvedic preparations which cause no harm to the human body.

This is totally a misconception. The empirical findings indicate that cannabis abuse can cause severe psychological as well as sociological ill effects despite this misconception. Drug awareness as well as health education is needed to eradicate such misconceptions in the society.

Serious adverse effects

Serious adverse effects of cannabis have been reported. Among the adverse effects dependence on cannabis, adolescent developmental problems, permanent cognitive impairment as well as development of psychosis are evident. Prolonged use of cannabis can lead to depression, lack of volition and a history of gradually deteriorating social ability and contact with others. People who are addicted to cannabis suffer from very poor memory and concentration.

Usage increasing among the youth

Cannabis usage is drastically increasing among the youth. The most pathetic scenario is even schoolchildren indulge with this dangerous substance without knowing the consequences. Cannabis related subculture is forming in our country.

In order to popularise and de-stigmatise the usage various funny names are used to indicate cannabis smoking. Often it's called 'cone', 'joint', mala (flower) or rocket. This subculture attracts more and more young people to the inner circle.

Cannabis used even in betel preparations

Betel chewing is no longer a traditional habit among the elderly. Nowadays even young people chew betel gum with some preparations which contain cannabis.

The law and enforcement is not powerful enough to tackle this type of illicit trade. Therefore vendors continue their business near schools and public places.

Low awareness cause for spreading

Cannabis usage is widely spreading in our community as a result of low awareness, peer pressure, and sometimes as a negative stress coping method. Very often tobacco smokers are attracted to cannabis.

Therefore tobacco addiction can be considered as a risk factor.

The psychiatrists point out a number of dysfunctions associated with cannabis abuse.

These are...

(1) Apathy and sedation

(2) Disinhibition

(3) Psychomotor retarda tion

(4) Impaired attention

(5) Impaired judgement

(6) Poor self care

Psychotic disorders

Cannabis use may increase the risk of psychotic disorders and result in a poor prognosis for those with an established vulnerability to psychosis. In addition prevalence of cannabis use is higher among people with psychosis in our country. This is one of the hidden and acute problems in the community. There is a growing significant link between cannabis use and vulnerability to psychosis. This condition is known as cannabis induced psychosis.

Psychosis

Psychosis is a generic psychiatric terms for mental states in which the components of rational thought and perception are severely impaired.

Persons experiencing a psychosis may experience hallucinations, hold paranoid or delusional beliefs, demonstrate personality changes and exhibit disorganised thinking. Cannabis use may also precipitate a latent psychosis. Cannabis use can trigger psychotic episodes in a person who already has a mental illness.

The Government has to spend a huge amount of money to treat people with mental health problems caused by cannabis abuse. This is a huge financial burden to a country like Sri Lanka.

Dealing with the problem

How to deal with this acute social problem? The health workers as well as law and enforcement officers need to work actively. The community awareness about the ill effects of cannabis abuse play a vital role. Educating public about this dangerous substance is a key issue.

In the mean time we need to address the users and help them to quit. Counselling and psycho social support is essential in this aspect. We have to advance the treatment measures and do wider screening in the community.

Empowering the legal framework

Empowering the legal framework is another important measure. Those who sell cannabis and the preparations which contain cannabis should be punished despite their social status or political backings.

Essential to understand the damage

It is essential to understand the damage caused by cannabis abuse in our society.

The problems will aggravate more if we do not address these issues. After all prospective future of this country will depend on better mental health.

Opinion Poll on Generic Branded Drug Debate

The Sri Lanka Medical Association SLMA held an opinion poll from the invited audience on the Brand Drug Debate, which it conducted last week (March 21st) at the Cinnamon Grand Hotel, Colombo.

The debate, which was part of the SLMA programme on its Annual Scientific sessions which was held from March 19th to 23rd was to debate the point why should some doctors continue prescribing brand name expensive drugs, when there are cheap generic drugs which are very effective thus imposing an unbearable cost on healthcare on the average family.

Prof. Colvin Goonaratna led the generic side on the debate with Prof. Githa Fernando, while the brand name side was led by Dr. with Here are some of the questions posed in the opinion poll.

Generic Drug Branded Drug Debate

SLMA 2008

Please answer this opinion poll at the end of the debate and hand over to the staff. Tick appropriately (one or more)

Do you personally believe there is any difference between using Branded or Generic Drugs in their action on your patient?

* Yes ...........................

* No ...........................

* I am not sure .................

Do you believe that Drug Companies/Drug Representatives are influencing our doctors towards prescribing Branded Drugs?

* Yes ............................

* No. ............................

* I don't know ...................

How would you like the doctor to prescribe if you were the patient?

* Generic Drugs only ........................................

* Branded Drugs only ........................................

* I would like both Generic and Brand names written so that I can choose (with the help of a pharmacist/dispenser) ......................

* I leave it entirely to the doctor's choice as he knows which Brands/Generics are effective and he knows my financial status. I trust my doctor ..................

If you go to purchase a drug "over the counter" without prescription and the pharmacist/dispenser offers you a choice of three other brands which are available, would you accept it as being a reasonable approach as it is convenient to you?

* Yes ......

* No ......

In a Brand oriented consumer society we live in, does it seem logical to exclude only drugs from carrying a Brand name as it is resulting in doctors being targeted by the media.

* It is a fair issue to highlight so much in the media ...............

* It is an unfair issue to highlight as it may confuse the public .....

* It may be good to debate it as we do today ..........................

Should newspapers stop highlighting this issue any further?

* Yes .......

* No .......

Do you think SLMA should play a bigger role in this issue?

* Yes .......

* No .......

Results of the Poll expected this week.

The Generic team comprised Prof. Colvin Goonaratna and Prof. Githa Fernando and the Branded team Dr. Sarath Gamini de Silva (leader) and Adrian Bandarage - Chairman Pharmaceutical Chamber.

Mom's fish intake may boost child's brain power

Preschoolers whose mothers regularly ate low-mercury fish during pregnancy may have sharper minds than their peers, a study suggests.

Researchers found that among 341 3-year-olds, those whose mothers ate more than two servings of fish per week during pregnancy generally performed better on tests of verbal, visual and motor development.

On the other hand, tests scores were lower among preschoolers whose mothers had relatively high mercury levels in their blood during pregnancy. And mothers who regularly ate fish during pregnancy were more likely to have such mercury levels than non-fish-eaters were, the researchers report in the American Journal of Epidemiology.

The findings add to evidence that fish can be brain-food, but underscore the importance of choosing lower-mercury fish during pregnancy.

"Recommendations for fish consumption during pregnancy should take into account the nutritional benefits of fish as well as the potential harms from mercury exposure," write the researchers, led by Dr. Emily Oken of Harvard Medical School in Boston.

Oily fish such as tuna, salmon and sardines contain omega-3 fatty acids, which are important in fetal and child brain development. The problem is that fatty fish are more likely to be contaminated with mercury, a metal that is toxic to brain cells, particularly in fetuses and young children.

Because of this, pregnant women are advised to avoid certain fish altogether: shark, swordfish, king mackerel and tilefish.

These fish are particularly high in mercury because they eat other fish and are long-lived, over time accumulating mercury in their fat tissue.

Less clear is how the benefits of other omega-3-containing fish stack up against the potential risks. Currently, U.S. health officials recommend that pregnant women eat no more than 12 ounces, or roughly two servings, of fish per week.

For the current study, Oken's team collected blood samples from 341 women during their second trimester and asked them how often they ate various foods, including fish. When their children were 3 years old, they took standard tests of vocabulary, visual-spatial skills and fine-motor coordination of the hands and fingers.

Overall, the researchers found, children whose mothers ate fish more than twice a week had higher test scores. However, children whose mothers had mercury levels in the top 10 percent of the study scored more poorly than those whose mothers had lower mercury levels.

Only 2 percent of mothers who never ate fish during pregnancy had blood mercury levels that high, versus 23 percent of those who ate fish more than twice weekly.

Reuters