In a tête-à-tête with Gomantak Times, Onco-Surgeon Dr Shekhar Salkar talks about the rising cases of cancer in Goa, cancer treatment in the state and more on the occasion of World Cancer Day.
Tell us about the cancer situation among the people of Goa?
Goa has a population of around 14 lakh. Every year, new cancers are being discovered and around 1,400 to 1,500 new patients are added, which is 100 per lakh of the population. In the state, the situation is not too serious, but abroad, there are many cases compared to Goa.
What are the reasons for cancer in Goa?
In Goa, out of 1,500 cases of cancer, there are about 300 cases of breast cancer. So, if women account for half the population in the state, which is 7 lakh, then the number of cases is very high. And, if you consider a specific organ-related cancer, then breast cancer ranks first.
What is the cancer situation like in India and in Goa?
In India, there are around 8 lakh to 19 lakh new cases of cancer each year, of which breast cancer ranks first, and cervical cancer is the next highest. Ten years ago, cervical cancer was number one. But over a period of time, it has changed, and the first changes we noticed was in urban areas like Mumbai, Delhi and metropolitan cities. You will see that in second tier cities, too, the numbers are increasing, just as the case in Goa because we are also following Western culture.
Late marriage is believed to be one of the reasons for breast cancer. So, what are different reasons for breast cancer?
It is not late marriage, but conceiving a child late in life. Women who don't want kids at all are at highest risk because having a child is like a ‘protection’ for a woman. Breast feeding is like ‘double protection’ for a mother and child. The obesity rate has also increased because the number of people eating junk food has increased. If a woman is overweight and is going through menopause, which is around 30 to 40 years, it is a dangerous signal for her.
In Goa, what is the mortality rate from cancer?
Our studies show that around 600 to 700 people die of cancer every year. We give a rough estimate of around five to six years for the survival of the person. For example, if 100 people get cancer, approx 50% to 60% people will survive. The problem is that many people seek medical help at a very late stage in the illness.
You say that people seek medical help at very late stage. So, who is to blame, or is it due to a lack of medical skills?
: I wouldn’t say that it’s a lack of medical skills. It’s not like people go to the doctor and the doctor diagnoses them. We need to train our physicians; we also need to train our family doctors. What do you do if your back pains? One has to understand that if your back pain keeps increasing, and the pain doesn’t subside within three weeks, then it is vital that the person visit a doctor; and everything is available here.
You say that everything is available. But medical expenses are very high. What do you have to say about that?
It is costly everywhere. But in Goa, the GMC has the best medical facilities. We have a good team of doctors, a radiology specialist Dr Sardesai, and many top doctors.
Would you say that the treatment in the GMC is better than that of private hospitals?
We have all the facilities available in the GMC. A person who has trained in the field of cancer and is available is Dr Anupama. But then, for cancer, you at least need 8 doctors. We, in India, also have doctors. For example, Dr Eugene and I are Surgical Oncologists, Dr Jacob is a Medical Oncologist, Dr Swami looks after children who have leukemia, bone marrow transplant etc. We have all the doctors that we need, and a new machine will be available soon. It might take time because of the elections, so we expect it to come after at least a year.
People who go through chemotherapy say that it affects the body too much, and so many people used to avoid it in the past.
I agree. When I began administering chemotherapy to patients, a few of them told me that they would feel like vomiting when they see a machine or even see my face! This shows how stressful it was at that time. However, better medicines are available currently. Nowadays, all you need is money. If new medicines are launched, then within the next few months, they are available — legal or illegally.
A few years ago, someone told me that if anyone suspects that they might have cancer, they should go Mumbai instead of Goa. Is the situation still the same?
Absolutely not! Only 5% to 10% of cancer patients need high end surgeries and have to go to Mumbai for treatment, while the remaining 90℅ of all cancers can be safely treated in Goa. If you go to Mumbai, you should meet certain specialists. Only then will your visit be fruitful. But if you go there and visit an ordinary surgeon, then your trip to Mumbai will be a waste. We have four doctors, who trained at Tata Memorial Centre, Mumbai.
A lot of cancer research has been done. How much progress has been made?
I would say that tremendous progress has been made. When I had started practising, we had never seen a lung cancer patient survive. But now, there are patients who have lived for around 5 to 6 years.
Once I visited a hospital in Mumbai and there was board put up about the causes of cancer. The first was food, cigarettes, tobacco; and second was family and heredity and third was bad luck.
If you don’t have good luck, nobody can save you! Science is important; but if you have bad luck, then science is useless. We can avoid many things like cigarettes, tobacco, alcohol, processed food — things that we know cause cancer. Yet, people continue to do these things, and then attribute the illness to bad luck. However, there are some people who don’t drink or smoke, and still get cancer; that is back luck.
How many people in Goa fall in the ‘bad luck’ category?
At least 10% to 15% come under the bad luck category. Recently, we had a patient who had four kids and breast-fed, married in her 20s, and still had cancer. One thing we need to understand is that not everything is in our hands. But, we can improve whatever is in our hands. For example, getting married early, breast feeding, avoiding smoking and drinking, reducing processed food and management of health and weight.
Today, on World Cancer Day, what message would you like share?
World Cancer Day started in Switzerland to create awareness among people. The current president of the Union International for Cancer Control (UICC) is my classmate, Dr Anil D’Cruz. This year’s theme is 'Close the Care Gap'. For eg, many sick people meet a doctor in time, but don’t have the finances needed for treatment. And, some people have the finances, but don’t require treatment. For others, travelling to different states for treatment is a nightmare. So, we need to focus on decreasing this sort of thing. We need to identify loopholes. For eg, under the DDSY scheme, we have given free treatment to 20,000 people in private hospitals. Even if we get less finance from the government, we still do it because it is worth it. With us, a treatment which costs Rs 4-5 lakh gets done within Rs 10,000 to 15,000 in a private hospital with the best surgeons and treatments because the balance charges are paid by the government. It is like a subsidy given by the government to the people.
People should do proper research. In Goa, many things have been upgraded — we have good doctors, surgeons — people don’t have to worry, just come to a proper centre. For eg, if you go to Manipal Hospital (in Dona Paula), all the necessary procedures, right from investigation till your last treatment, can be done under under one roof. Secondly, if we have any query then we can communicate with Tata Memorial Centre, Mumbai.
This week, we are starting a tobacco cessation clinic, so that we can help those who want to leave the smoking habit. It is a free clinic, and people can come and get treatment. Secondly, it is important to stop drinking, smoking and processed food. Studies have shown that 3.7 lakh people died of cancer in India in 2020, and 25% died due to tobacco use. It is high time that this subject should be introduced in school curriculums.