Is the Future of Cancer Screening safe?


Cancer is a broad phrase. It describes how disease arises from uncontrolled cell growth and division brought on by biological changes. While some cancer types stimulate quick cell proliferation, others induce cells to grow and divide more slowly than others. While some malignancies, such as leukaemia, may not result in the development of visible tumours, others, such as carcinoma, may.

Most cells in the body have specific functions and lifespans. Cell death, also known as apoptosis, is a healthy and beneficial process even if it may appear destructive. Cancer is brought on by changes (mutations) to the DNA of cells. The DNA of a cell is divided into a large number of unique genes, each of which carries a set of instructions guiding the cell’s growth and division as well as the completion of specific activities. The two components of early cancer detection are early diagnosis and screening (or downstaging).

Breast cancer – India’s most diagnosed cancer in Women today is increasing gradually.

The primary impediments to finding a solution to this are 

  • People are unaware of the severity of this disease
  • Then there is the prevailing taboo of not discussing breast cancer openly and the denial of the existence of any effective therapy for the disease (This may be attributed to their unawareness of what the lump represents)
  • The stigma of being rejected by the community and partner
  • A potential fear of losing the breast, and ignorance of what the lump represents.

While early diagnosis focuses on detecting symptomatic patients as soon as is practical, screening involves evaluating healthy individuals to find those who have cancer before any symptoms arise. Some cancer types currently have a clear function for screening, but each screening test has drawbacks, and better screening techniques are urgently required. 

Unfortunately, there are still numerous cancers for which there are no reliable screening recommendations, or the advantages of screening are only marginally outweighed by the risk of harm. 

Based on the cancer registry data it is estimated that there will be about 800,000 new Cancer cases in India every year! 

And so, at such an alarming rate at which cancer is growing – Screening proves to be the quickest method that can test masses altogether & gives them the opportunity to find cancer early, before symptoms appear, and ideally before metastasis, in both healthy and high-risk populations. If cancer is detected early enough, treatment options sometimes solely involve surgery, which can reduce morbidity and enhance survival. 

But the main question that arises is –

Whether the current methods of Cancer Detection are safe enough?

A computed tomography (CT) scan, bone scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound, and X-ray are a few of the procedures that can be performed to diagnose cancer. Even Biopsy is another way to detect if the tissue is cancerous – Your doctor takes a sample of cells during a biopsy to examine in a lab. 

However, all activities associated with taking said tests can be uncomfortable, awkward, and even stressful at times (for most women). They are made to sit on / lean on heavy machinery and equipment in difficult and strange situations, and they must consciously uncover their top. This is especially strange given that they are most times unaware of the procedure prior to the tests.

Let’s not forget the harmful radiation they are exposed to, and how invasive these procedures can get. The amount of radiation emitted by an imaging test is determined by the imaging test used and the part of the body being tested. 

As an example:

A single chest x-ray exposes the patient to approximately 0.1 mSv of radiation. (mSv: Millisievert – a radioprotection unit measuring the radiation dose received). This is roughly the same amount of radiation that people are naturally exposed to over the course of about ten days.

And a Mammogram exposes a woman to radiation FOUR TIMES that! (0.4 mSv) – or about the amount a person would expect to receive from 7 weeks of natural background exposure.

A CT Scan, on the other hand, has a much higher level of exposure than a Chest mammogram – ranging from 3 – 14 mSv with 7 mSv being the average for a middle-aged woman. 

PET Scan is one of the most effective ways of imaging to scan for cancers and it’s also by far the most invasive other than biopsy. It uses a Tracer (a radioactive medication with glucose) that is most often injected into a vein within the person’s hand or arm through an IV. The tracer will then collect into areas of their body that have higher levels of metabolic or biochemical activity, which often pinpoints the location of the disease. The PET images are typically combined with CT or MRI and are called PET-CT or PET-MRI scans which again expose the person to a higher dose of radiation. Not just that, the tracer injected could:

  • If you’re pregnant, expose your unborn child to radiation.
  • If you are breastfeeding, expose your child to radiation.
  • And although this is relatively rare, can cause an allergic reaction.

These screening methods don’t come cheap! Thousands of rupees are spent, depending on which test you choose to take. 

All these tests also involve a thorough understanding of the medical history of the person (in this case, the woman) It is essential that the doctor or the radiologist is aware of the following conditions of the woman: 

  • If she has ever had a bad allergic reaction to 
  • If she has been sick recently or has another medical condition, such as diabetes
  • If she’s taking any medications, vitamins or herbal supplements
  • If she’s pregnant or she thinks she might be pregnant
  • If she’s breastfeeding
  • If she’s afraid of enclosed spaces (claustrophobic)

It is extremely crucial that the doctor/radiologist is aware of these prior to the tests. It could lead to miscommunication & it is too time-consuming. 

Overdiagnosis is also one of the dangers. Screening exams may detect cancers that grow slowly and would not have been harmful to a person’s health during their lifetime. As a result, some people might undergo unnecessary therapies that are possibly hazardous, uncomfortable, stressful, or expensive. False positive and false negative screening results that necessitate additional research are drawbacks of these screenings. Additionally, a misleading test result could prevent the detection of dormant cancer. There will always be some false positives in screening tests because no test is error-free. These “false positive” or “false negative” results can be dangerous because they could cause someone to undergo unnecessary, invasive, or harmful tests or treatments or to be falsely reassured or alarmed and most importantly, some screening methods may or may not provide a complete diagnosis.

Mammography Breast Cancer screening also carries the danger of missing a malignancy because mammography doesn’t always detect those that are present. Having a mammogram every three years for 20 years increases your lifetime risk of developing cancer by X-rays.

That’s the only reason why it’s banned in a few countries like Italy, Canada, Scotland, and Australia. 

Arent there better, less invasive, no radiation/no side effects technologies available? Technologies that can save time, save cost, aren’t harmful and easy to execute?

The concept of cancer as an ecosystem, a community where tumour cells collaborate with host cells in their milieu, is gaining ground. The ecology adapts and changes as conditions do to ensure that cancer survives and thrives. Our comprehension of the complex interactions in this ecosystem has produced ground-breaking medical procedures, such as immunotherapy. An ecosystem—a coordinated group of researchers, patients, healthcare providers, healthcare systems, regulatory bodies, governments, and business—is also necessary for the successful treatment and prevention of cancer. When resources are scarce, diagnosis and treatment services should concentrate on all individuals presenting with cancers that can be cured, such as early-stage breast, cervical, and oral cancers. Acute lymphatic leukaemia in children is another possibility; it has a good chance of being cured but cannot be caught early. Above all, services must be delivered in a sustainable and fair way. The programme can be expanded to cover other diseases that can be cured as well as cancers for which treatment can significantly extend survival if more resources become available. Since a healthcare ecosystem takes a fundamentally different approach to treating cancer, it is crucial that our healthcare ideals are captured early on in research, institutions, and society. In contrast to standard chemotherapy medications, which have greater general toxicity and affect both healthy and cancerous cells, IO therapies stimulate the body’s immune system to attack cancer. With an unprecedented number of novel experimental medications being developed by both major and up-and-coming pharma companies worldwide, IO is essentially a comprehensive therapeutic master plan to outsmart cancer that is now becoming available in clinics.