“United by Unique”: A call to action on World Cancer Day 2025
February 4 marks World Cancer Day, an initiative led by the Union for International Cancer Control (UICC). It is a global call to come together to take action against a devastating disease that affects millions worldwide. Cancer goes beyond a medical diagnosis; it impacts lives in profoundly personal ways.
The World Cancer Day theme for 2025-2027, “United by Unique,” places individuals at the centre of care and their stories at the heart of the conversation. It encourages us to adopt a people-centred approach to cancer care that fully integrates each individual’s unique needs with compassion and empathy, leading to the best health outcomes.
Cancer burden in Sri Lanka: A growing challenge
According to the latest statistics, 37,753 new cancer cases were diagnosed in Sri Lanka in 2021, with 103 new patients diagnosed daily. The leading cancers in males were lip, tongue, and mouth (15%); trachea, bronchi, and lungs (9%); colon and rectum (9%); esophagus (8%); and prostate (7%). Among females, the leading cancers were breast (27%), thyroid (10%), colon and rectum (8%), ovary (7%), and cervix uteri (6%).
Among those with staging information, 37% of breast cancer, 47% of cervical cancer, and 63% of lip, tongue, and mouth cancers were diagnosed at advanced stages (stages III and IV), according to the National Cancer Control Programme (NCCP), Sri Lanka Cancer Registry 23rd publication, December 2023.
Although considerable advancement in cancer services has been made island-wide, challenges remain in Sri Lanka. Limited access to high-quality cancer care due to geographical disparities, inadequate infrastructure, and a shortage of specialised healthcare professionals contribute to delayed diagnosis and suboptimal treatment outcomes. Limited availability of early detection programmes, along with low public awareness of cancer risks, early diagnosis, and treatment options, lead to delayed diagnoses and missed opportunities for intervention and prevention.
In Sri Lanka, certain cancers like breast, ovarian, and colorectal cancer show familial clustering, suggesting a potential genetic component. Despite this growing burden, public awareness about hereditary cancer syndromes and the importance of genomic testing remains relatively low.
Understanding the genetic basis of cancer
Cancer is a complex disease with environmental and genetic risk factors contributing to its development. While lifestyle factors like tobacco smoking, betel quid chewing, alcohol consumption, physical inactivity, obesity, and unhealthy diets play a significant role, some individuals are genetically predisposed to cancer due to inherited genetic variations in cancer susceptibility genes. These variations can significantly increase the lifetime risk of developing specific cancers, often at a younger age.
A Genomic perspective
The transformative potential of integrating genetic counselling and testing into cancer care is undeniable. Genetic testing can identify healthy individuals at high risk for common hereditary cancer syndromes, such as hereditary breast and ovarian cancer, familial adenomatous polyposis, and Lynch syndrome, which are linked to colorectal cancer. The early identification of individuals at high risk of developing cancer allows for personalised risk assessment and targeted interventions, including enhanced surveillance (regular screenings for early detection of cancer), chemoprevention (medications to reduce the risk of cancer development), risk-reduction measures like prophylactic surgeries (preventive surgical procedures to remove organs at high risk of developing cancer), or lifestyle modifications (dietary and lifestyle changes to minimise cancer risk).
In many high-income countries, genomic technologies are revolutionising cancer care. Genomic tests that identify actionable variants in oncogenes, tumour suppressor genes, and mismatch repair genes enable personalised treatment plans with targeted therapy and immunotherapy, improving prognosis and survival rates. In contrast, in low and middle-income countries (LMICs) like Sri Lanka, integrating genomic medicine into standard oncology practices remains challenging, primarily due to a lack of resources. Access to genetic testing and counselling services remains limited to a few specialised centres. The high cost of testing and the lack of insurance coverage for these services further worsen disparities. Additionally, cultural stigmas associated with cancer and genetic conditions often discourage families from seeking genetic counseling and testing, thereby hindering early detection and preventive measures for high-risk individuals and families that are genetically predisposed.
Bridging the gap: A path forward
To address these challenges, a multifaceted approach needs to be adopted:
- Enhancing public awareness and community engagement: Educational campaigns are crucial to dispelling myths about cancer and promoting the benefits of early detection and treatment.
- Strengthening cancer screening programmes: Integrating genetic risk assessments into screening programmes for common cancers such as breast, colorectal, oral, and cervical cancer could further refine screening strategies.
- Making Genomic testing accessible and affordable: Subsidizing the cost of genetic tests and integrating genomic services into public healthcare can make them accessible and affordable for high-risk individuals and families.
- Training healthcare professionals: It is essential to build the capacity of healthcare providers to recognize hereditary cancer syndromes and refer patients for genetic assessment early. Incorporating genomics education into medical training and continuing professional development programmes can ensure a more genomically informed healthcare workforce.
- Fostering research and data collection: Local research on the genetic basis of cancers prevalent in Sri Lanka can offer valuable insights and inform targeted interventions. Creating a national cancer registry that includes genetic data would represent a move towards precision medicine oncology.
A message of hope
World Cancer Day serves as a reminder that while cancer can affect us all, our responses must be as unique as the individuals and families we support. Let us stand united – healthcare providers, policymakers, administrators, and the general public to create a future where every person impacted by cancer receives the compassionate and personalized care they deserve.
(The writer is a Professor in Medical Genetics, Department of Anatomy, Genetics & Biomedical Informatics Faculty of Medicine, University of Colombo)
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