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Esophageal Cancer Awareness Month helps spread information about esophageal cancer. This type of cancer affects the esophagus, the tube that food travels through from the mouth to the stomach.

Esophageal cancer happens when tumors grow anywhere along the esophagus, the muscular tube that leads from the mouth to the stomach.

If this type of cancer is detected early, treatment may be effective and the outlook is better. But most people do not receive a diagnosis until esophageal cancer is in the later stages.

Symptoms of Esophageal Cancer

If you or someone you know is exhibiting symptoms of esophageal cancer, seek medical attention immediately.

Symptoms include:

• Difficulty in swallowing
• Unintentional weight loss
• Chest pain
• Heart burn
• Indigestion
• Coughing
• Hoarse voice

This is to bring to the attention of all stakeholders and general members of the public that the Cabinet Secretary for the Ministry of Health, pursuant to section 36 of the Cancer Prevention and Control Act, No. 15 of 2012 has developed:

1. The Cancer Prevention and Control (Standards of Care) Rules, 2023

2. The Cancer Prevention and Control (Public Awareness and Education) Rules, 2023

3. The Cancer Prevention and Control (Cancer Registries) Rules, 2023

4. The Cancer Prevention and Control (Consent to Research) Rules, 2023

5. The Cancer Prevention and Control (Inspection and Certification) Rules, 2023

Under the Statutory Instruments Act, 2013, the National Cancer Institute of Kenya plans to engage members of the public and stakeholders on the same through public hearings. The purpose of the hearings shall be to get oral submissions on the draft Regulations to ensure that persons likely to be affected by the Statutory Instruments have adequate opportunity to give their views on the Instruments. The Draft Regulations can be obtained from the Institute’s website (The National Cancer Institute of Kenya – NCI Kenya)

This month provides an opportunity for us all to focus on breast cancer and its impact on those affected by the disease in our community.

The total breast cancer cases notified by county of usual residence between the years 2020 and 2023 amounted to 4,824 people in Kenya, Nairobi County leading with the highest number of diagnosed people at 550 followed by Nakuru County which registered 398 people.

Finding breast cancer early provides the best chance of surviving the disease. While mammograms can help to detect cancer before you can feel a lump, breast self-exams help to be familiar with how your breasts look and feel so you can alert your doctor if there are any changes.

Take the time to ‘get to know’ how your breasts normally look and feel through normal regular activities such as showering, getting dressed, using body lotion or looking in the mirror.

You don’t need to use a special technique, but ensure you look at and feel your breasts regularly. Make sure this includes all parts of your breast, your armpit and up to your collarbone.

For women of all ages, it is recommended that you be breast aware.

Changes to look for include:

• a new lump or lumpiness, especially if it’s only in one breast
• a change in the size or shape of your breast
• a change to the nipple, such as crusting, ulcer, redness or inversion
• a nipple discharge that occurs without squeezing
• a change in the skin of your breast such as redness or dimpling
• An unusual pain that doesn’t go away.

Visit a doctor in case you notice any changes in your breast.

Breast cancer signs

According to doctors, it is quite difficult for breast cancer to get diagnosed for women under 40 because their breasts are denser. This means that a tumour, if present, is not likely to show up in a mammogram.

The most common way to detect breast cancer in younger women is to keep a close check on the changes in your breasts. In fact, according to Healthline, a majority of young women diagnosed with breast cancer discover an abnormality themselves. If you notice any changes in your breast, like changes in the skin, nipple discharge, pain, tenderness, or a lump or mass in the breast or underarm area, please report it immediately to a doctor.

Breast cancer is one of the most common cancers in women and there is a misconception among people that it only happens to older women. While it’s true that most breast cancers are found in women who are 40 years or older, it is imperative to know that it can strike any female at any age.

Pain in any Area of The Breast

Check for pain and tenderness in any area of your breast. While lumps don’t usually hurt, some may cause a prickly sensation. However, pain in your breasts can also be due to numerous other benign reasons and hormonal changes. 

Unusual Nipple Discharge

An unusual nipple discharge that’s clear, red, brown, or yellow (other than breast milk) can be an early sign of breast cancer. If you notice this, consult a doctor for an evaluation.

Breast Changes

Look for changes in shape, swelling, and difference in size, texture, or temperature of either one or both breasts.

Unexplained Redness/Rash

Early warning signs of breast cancer can include unexplained redness, swelling, itchiness, or rash on one or both breasts.

Swelling around the Collarbone or Armpit

Consult your doctor if you notice swelling around your collarbone or under the arm. It could be a sign that the breast cancer has spread to the lymph nodes in that area.

While these are some of the early signs of breast cancer, it is important to remember that these can also be caused by benign conditions. It’s always best to consult a doctor so that they can evaluate and help you determine whether it is cause for concern.

Apart from this, it’s also important to keep in mind that often, women with breast cancer have no symptoms. This is why regular breast screening is important to detect it. The main tool to diagnose breast cancer is a mammogram, which basically shows normal and abnormal breast tissue.

It is recommended that women should start getting mammograms when they cross the age of 40 and should continue getting one every 1 or 2 years. Meanwhile, for women above the age of 20, monthly breast self-examination is recommended.

A Pap test, sometimes referred to as a Pap smear, is a treatment used to detect cervical cancer in female patients.

Cells from your cervix, which is the lower, thin end of your uterus that is at the top of your vagina, are collected for a Pap smear.

You have a better chance of being cured if you have a Pap smear early enough to detect cervical cancer. A Pap smear can also find alterations in your cervical cells that point to the potential for cancer to arise in the future. Your first step in preventing the potential onset of cervical cancer is to have a Pap smear early to identify these abnormal cells.

The Pap smear is usually done in conjunction with a pelvic exam. In women older than age 30, the Pap test may be combined with a test for human papillomavirus (HPV) — a common sexually transmitted infection that can cause cervical cancer. In some cases, the HPV test may be done instead of a Pap smear.

Pap smears are crucial for women’s healthcare and offer a number of advantages, including:

• Pap smears may detect cervical cell changes in your body that could turn into cancer if left untreated 
• Pap smears can help find cervical cancer in its early stages, making it easier to treat
• Pap smears allow for early detection which could mean less treatment and less recovery
• Pap smears catch HPV that has been dormant. The HPV virus can be dormant for years and then suddenly become active so it is still important for all women to get Paps, regardless of age or sexual activity
• Pap smears are extremely accurate and regular screenings can reduce cervical cancer rates and mortality by at least 80%

Cancer screening and testing is the process of checking your body for cancer when you have no symptoms or signs. The main purposes for cancer screening are:

• Help prevent cancer deaths
• Reduce the number of people developing disease
• Helps the government for future planning in the fight against cancer

Development of new cancer screening tests is now an actively cancer research area. Not all types of cancer can currently be screened. Currently, cancer screening is available for the following types of cancers.

Breast cancer

Skin cancer

Lung cancer

Cervical cancer

Prostate cancer

Head and neck cancers

Colorectal cancer

Screening Breast Cancer

Breast cancer screening can be done through the following tests:

Breast self-examination

Mammography

Clinical breasts examination

Magnetic resonance images (MRI)

Mammography is a special type of x-ray specifically designed to view the whole breast. The images produced during a mammogram can show tumors or other irregularities in the breast that cannot be felt during examinations or through other breast changes.

When it comes to clinical-examination, a medical expert feels and looks for any changes in the breast’s size or shape when doing a clinical breast examination. The examiner also checks the nipples and breasts for changes in skin texture.

Breast self-examination – The best technique to test for breast cancer at home is through self-examination. You examine and feel your own breasts to check for any changes during a breast self-examination. You should consult a doctor if you detect any changes.

The routine detection of breast cancer does not include an MRI. But individuals who are at a higher risk of developing breast cancer, those who have dense breasts, or those who discover a lump during a breast exam might find it useful.

Screening for Cervical Cancer

The common tests used for screening cervical cancer include:

1. Human Papillomavirus (HPV) test – The human papillomavirus (HPV) test identifies the presence of human papillomavirus, a virus which can lead to the growth of genital warts and abnormal cervical cells which can cause cervical cancer. Doctors may recommend the HPV test if:

• One is age 30 and above
• When the Pap test is abnormal, presenting a typical squamous cells of undetermined significance.

Currently there is no HPV test for men, it is only available to women. Men can however still be infected with HPV and can transmit the virus to other women.

2. Pap test – A Pap test, commonly known as a Pap smear, is a procedure a doctor uses to check for cervical cancer in female patients. Additionally, it may highlight changes in your cervical cells that could later develop into cancer. A Pap smear is done to look for changes in cervical cells before they turn into cancer, finding cell changes early can help prevent one from getting cancer.

Screening for Colorectal Cancer

There are many different ways for testing colorectal cancer including:

Colonoscopy

Colonoscopy is a test used to look for changes — such as irritated tissues, swollen polyps or cancer in the colon and rectum. During a colonoscopy, a long, flexible tube with a tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

Sigmoidoscopy

A sigmoidoscopy, also called a flexible sigmoidoscopy, is a procedure that lets your doctor look inside your sigmoid colon by using a flexible tube with a light on it. It helps your doctor check for abnormal cells and polyps. Typically, pieces of tissue will be taken as samples to check for any abnormal cell changes.

Fecal occult blood test (FOBT)

Fecal occult blood test (FOBT) is a test that checks for occult or hidden blood in the stool. A small sample of stool is placed in a special collecting tube and submitted to a doctor or laboratory for examination. Blood in the stool could indicate colon cancer or other issues such as polyps, ulcers, or haemorrhoids.

CT Colonography

Computed tomographic (CT) colonography, also called CTC, virtual colonoscopy (VC) or CT pneumocolon, is a powerful minimally invasive technique for colorectal cancer screening. 

Stool DNA tests

The stool DNA test is a noninvasive test to screen for colon cancer. Stool DNA testing is intended to screen for colon cancer or precancerous polyps in people with no symptoms. This test identifies DNA changes in the cells of a stool sample and looks for abnormal DNA associated with colon cancer or polyps

Screening for neck and head cancers

This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. During a physical examination, the doctor feels for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be done to help diagnose cancer.

Screening for Lung Cancer

In screening for lung cancer, the doctor feels or checks for any lumps on the neck, lips, gums, and cheeks. The doctor will also inspect the nose, mouth, throat, and tongue for abnormalities, often using a light and a mirror for a clearer view. Blood and urine tests may be done to help diagnose cancer.

Screening for Prostate Cancer

The two major tests for prostate cancer screening include:

Digital rectal exam (DRE)

The digital rectal (DRE) exam is a physical examination of the rectum, the last few inches of the bowel, just above the anus. The doctor uses a gloved and lubricated finger to check for abnormalities of the anus and rectum. It takes about one to two minutes and, although it may cause some mild discomfort, it should not be painful. By feeling through the rectal wall, the doctor can also examine the surface of the prostate gland in men and some of the reproductive organs in women.

Prostate-specific antigen test (PSA)

The PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in males. PSA is mostly found in semen, which also is produced in the prostate. Small amounts of PSA ordinarily circulate in the blood. The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer.

REFERENCES

Armbruster, D. A. (1993). Prostate-specific antigen: biochemistry, analytical methods, and clinical application. Clinical chemistry, 39(2), 181-195.

Bhosle, P., Pathan, H., Tapadiya, G., & Alam, M. I. (2022). Case Study on Oropharyngeal Cancer Prediction and Diagnosis and Management Based upon MRI, CT Scan Imaging Techniques. Disruptive Developments in Biomedical Applications, 91.

Emons, J., Fasching, P. A., Wunderle, M., Heindl, F., Rieger, J., Horn, F., … & Jud, S. M. (2020). Assessment of the additional clinical potential of X-ray dark-field imaging for breast cancer in a preclinical setup. Therapeutic advances in medical oncology, 12, 1758835920957932.

Fekri-Ershad, S., & Ramakrishnan, S. (2022). Cervical cancer diagnosis based on modified uniform local ternary patterns and feed forward multilayer network optimized by genetic algorithm. Computers in Biology and Medicine, 144, 105392.

Lee, T. C., Staller, K., Botoman, V., Pathipati, M. P., Varma, S., & Kuo, B. (2023). ChatGPT Answers Common Patient Questions About Colonoscopy. Gastroenterology.

Schneider, K. A., Chittenden, A., & Shannon, K. M. (2023). Counseling about cancer: strategies for genetic counseling. John Wiley & Sons.

Thomas, L. D., & Henn, M. C. (2021). Perfecting the Gastrointestinal Physical Exam: Findings and Their Utility and Examination Pearls. Emergency Medicine Clinics, 39(4), 689-702.

Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.

Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.

Symptoms

Signs and symptoms of esophageal cancer include:

• Difficulty swallowing (dysphagia)
• Weight loss without trying
• Chest pain, pressure or burning
• Worsening indigestion or heartburn
• Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

If you’ve been diagnosed with Barrett’s esophagus, a precancerous condition caused by chronic acid reflux, your risk of esophageal cancer is higher. Ask your doctor what signs and symptoms to watch for that may signal that your condition is worsening.

Screening for esophageal cancer may be an option for people with Barrett’s esophagus. If you have Barrett’s esophagus, discuss the pros and cons of screening with your doctor.

Cancer is a deadly disease, which is not only detrimental to the health of the individual but wreaks havoc on the family members in many ways. Hence, early cancer diagnosis is crucial in the fight against the disease. Screening is an important aspect of comprehensive healthcare as it enables the identification of the disease before symptoms appears, making treatment more efficient and effective.

When a patient’s cancer is diagnosed at an early stage, there is a much greater chance of being able to treat the disease successfully, often with less invasive procedures and fewer long-term side effects. But too many people are being diagnosed with cancer at later stages.

It’s also important that we diagnose cancers as fast as possible so that treatment can start quickly, as accurately as possible – for example, identifying the genetic make-up of an individual’s tumor tells us how best to treat it – and that we diagnose relapse as early as possible. 

The below are the significance of early cancer diagnosis

• Detects cancer before it spreads, making treatment more simple and short.
• Improves survival rates as early detection increases chances of successful treatment.
• Reduces treatment costs, duration and minimizes the side effects of added and combined therapy.
• Avoids suffering from symptoms caused by the progression of the disease.

There are several different types of cancer screening tests that exist, including laboratory tests, physical exams and history analysis, genetic tests, and imaging procedures. Laboratory tests include blood tests and oral cancer and cervical screening tests, as well as tests for urine, tissue, and hormonal imbalances. A thorough physical exam, along with a review of personal and familial medical history, can also help predict the onset of cancer. Genetic tests look for genetic mutations that are indicative of some forms of cancer.

Imaging procedures can provide pictures of the internal body for further analysis. It’s understandable to feel fear or anxiety when it comes to cancer screenings, but it’s important to overcome these fears. By facing the potential presence of cancer, you can take the first and proactive step towards eliminating the disease from your body. If the results are negative, you can rest easy knowing that you’re healthy. If the results are positive, it’s still best to know so you can take steps to prevent the spread of the disease and seek treatment. Early detection greatly increases the chances of successful treatment, so don’t let fear hold you back from taking control of your health.

Early diagnosis of cancer focuses on detecting symptomatic patients as early as possible so they have the best chance for successful treatment. When cancer care is delayed or inaccessible there is a lower chance of survival, greater problems associated with treatment and higher costs of care. Early diagnosis improves cancer outcomes by providing care at the earliest possible stage and is therefore an important public health strategy in all settings.

Screening is a different strategy than early diagnosis. It is defined as the presumptive identification of unrecognized disease in an apparently healthy, asymptomatic population by means of tests, examinations or other procedures that can be applied rapidly and easily to the target population. A screening programme must include all the core components in the screening process from inviting the target population to accessing effective treatment for individuals diagnosed with disease.

Compared to early diagnosis, cancer screening is a distinct and more complex public health strategy that mandates additional resources, infrastructure and coordination. WHO recommends that screening programmes only be undertaken when their effectiveness has been demonstrated, when resources are sufficient to cover the target group, when facilities exist to confirm diagnoses and ensure treatment, and when the prevalence of the disease is high enough to justify screening.

Chances of getting cancer can highly be reduced by lifestyle choices, at individual level, each one has the ability to help reduce the risks of getting cancer through their ways of living. Cancer screening, vaccination and most importantly the right health choices helps in lowering the risks for many common cancer types.

Better Healthy Choices

Cancer risks can be reduced by practicing healthy choices like avoiding tobacco, maintaining the right weight, protecting your skin from the harmful rays https://ncikenya.go.ke/blog/23 of sun and limiting the amount of alcohol.

Lung cancers, mouth, voice box, throat, pancreas, kidney, cervix and bladder cancers have been linked to the use of tobacco. Avoid being around secondhand smoking (SHS) also called environmental tobacco smoke (ETS) as this has also led to many cases of cancer. Chewing of tobacco has also been linked with the cancers of mouth, throat and pancreas. It is therefore important to quit tobacco smoking to help prevent cancer.

• Eating a healthy diet can also help reduce the risks of cancer. Eating plenty of vegetables, fruits and other foods from plant sources like legumes and whole grains; limiting fat from animal sources and refined sugars and eating lighter and lean food
• Limit processed meats. Eating processed meat often can slightly increase the risk of certain types of cancer. This news comes from a report from the International Agency for Research on Cancer, the cancer agency of the World Health Organization.

People who eat a Mediterranean diet that includes extra-virgin olive oil and mixed nuts might have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts.

Screening

Getting screening tests regularly may find breast, cervical, and colorectal (colon) cancers early, when treatment is likely to work best. Lung cancer screening is recommended for some people who are at high risk.  Screening raises the chances of finding cancer early. That’s when treatment is most likely to succeed.

Vaccination

Vaccines (shots) also help lower cancer risk. The human papillomavirus (HPV) vaccine helps prevent most cervical cancers and several other kinds of cancer, Human papillomavirus (HPV) is a sexually transmitted virus that can lead to cervical cancer and other genital cancers as well as squamous cell cancers of the head and neck. The HPV vaccine is recommended for girls and boys ages 11 and 12. Hepatitis B can increase the risk of developing liver cancer. Adults at high risk of getting hepatitis B are people who have sex with more than one partner, people who have one sexual partner who has sex with others, and people with sexually transmitted infections.

REFERENCES

Arnold, Melina, et al. “Global burden of 5 major types of gastrointestinal cancer.” Gastroenterology 159.1 (2020): 335-349.

Lee, Yun Bin, et al. “Association between hepatic steatosis and the development of hepatocellular carcinoma in patients with chronic hepatitis B.” Clinical and molecular hepatology 25.1 (2019): 52.

Lindsay, Ana Cristina, et al. ““I don’t think he needs the HPV vaccine because boys can’t have cervical cancer”: A qualitative study of Latina mothers’ (mis) understandings about human papillomavirus transmission, associated cancers, and the vaccine.” Journal of Cancer Education (2022): 1-9.

Rubino, Roberta, et al. “Mediterranean Diet as a Supportive Intervention in Cancer Patients: Current Evidence and Future Directions.” Current Oncology 29.10 (2022): 7579-7582.

Sajid, Taskeen Zahra, et al. “Association of low birth weight with environmental tobacco smoke (ETS) exposure among pregnant women.” The Professional Medical Journal 29.04 (2022): 448-458.

Zhang, Yan-Bo, et al. “Combined lifestyle factors, incident cancer, and cancer mortality: a systematic review and meta-analysis of prospective cohort studies.” British journal of cancer 122.7 (2020): 1085-1093.

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. This type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.

Types

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.

Risk factors

The risk of hepatocellular carcinoma, the most common type of liver cancer, is higher in people with long-term liver diseases. It’s also higher if the liver is scarred by infection with hepatitis B or hepatitis C. Hepatocellular carcinoma is more common in people who drink large amounts of alcohol and who have an accumulation of fat in the liver.

Diagnosis

Tests and procedures used to diagnose hepatocellular carcinoma include:

• Blood tests to measure liver function
• Imaging tests, such as CT and MRI
• Liver biopsy, in some cases, to remove a sample of liver tissue for laboratory testing

Treatment

Which treatment is best for you will depend on the size and location of your hepatocellular carcinoma, how well your liver is functioning, and your overall health.

Hepatocellular carcinoma treatments include:

• Surgery. Surgery to remove the cancer and a margin of healthy tissue that surrounds it may be an option for people with early-stage liver cancers who have normal liver function.
• Liver transplant surgery. Surgery to remove the entire liver and replace it with a liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.
• Destroying cancer cells with heat or cold. Ablation procedures to kill the cancer cells in the liver using extreme heat or cold may be recommended for people who can’t undergo surgery. These procedures include radiofrequency ablation, cryoablation, and ablation using alcohol or microwaves.
• Delivering chemotherapy or radiation directly to cancer cells. Using a catheter that’s passed through your blood vessels and into your liver, doctors can deliver chemotherapy drugs (chemoembolization) or tiny glass spheres containing radiation (radioembolization) directly to the cancer cells.
• Radiation therapy. Radiation therapy using energy from X-rays or protons may be recommended if surgery isn’t an option. A specialized type of radiation therapy, called stereotactic body radiotherapy (SBRT), involves focusing many beams of radiation simultaneously at one point in your body.
• Targeted drug therapy. Targeted drugs attack specific weaknesses in the cancer cells, and they may help slow the progression of the disease in people with advanced liver cancers.
• Immunotherapy. Immunotherapy drugs use your body’s germ-fighting immune system to attack the cancer cells. Immunotherapy may be an option for treating advanced liver cancer.
• Clinical trials. Clinical trials give you a chance to try new liver cancer treatments. Ask your doctor whether you’re eligible to participate in a clinical trial.

Symptoms

Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools

When to see a doctor

Make an appointment with your doctor if you experience any signs or symptoms that worry you.

The International Agency for Research on Cancer (IARC) has classified outdoor air pollution as a Group 1 carcinogen. Increasing evidence has suggested that the association may not be limited to lung cancer, but also cancer of other sites.

Indoor emissions from the household combustion of coal are a Group 1 carcinogen. The household combustion of biomass fuels and emissions from high-temperature frying have been concluded to be possibly carcinogenic to humans by the IARC. It is estimated that 3.8 million premature deaths (8% from lung cancer) are attributable to household air pollution from cooking with kerosene or solid fuels each year.

The Global Burden of Disease Study also suggested that indoor air pollution is associated with the risk of esophageal squamous cell carcinoma. The forgotten 2.6 billion people who have less access to cleaner fuels, mostly in low- and middle-income countries (LMICs), Kenya included suffer an increasing cancer burden and are also exposed to a huge amount of air pollution. The vicious cycle of climate change, air pollution, and cancer will keep rolling and provide a devastating cancer burden without intervention.

Cancer has become the leading cause of premature death in many countries in recent decades. Previous studies showed plenty of evidence that control of modifiable risk factors would reduce the cancer burden. Since modifiable risk factors could be eliminated by changing the lifestyles of individuals, a greater uptake of modifiable risk factors is critical to reducing cancer burden and inequality in cancer survival.

However, climate change has widen cancer inequities through its complex connections with modifiable risk factors which include; abnormal temperature, UV, air pollution, natural disasters, food (diet), water, infections, and inefficient physical activities.

The associations between climate change and modifiable risk factors have no doubt expanded the inequities. People who face overlapping modifiable risk factors, but who are unable to change or adapt, are at the highest risk in the climate change–cancer linkage. Individual actions to avoid exposure to modifiable risk factors is highly recommended, limited benefits would be achieved unless the nations strive to ensure the basic needs of the people.

Cancer is the second cause of globally ranked premature death after cardiovascular disease and has become the top cause in many countries in recent decades.  Apart from lifestyle factors, air pollution and other environmental risks are also the main factors associated with cancer. The inequality that exists in overall cancer survival between different countries is predominantly due to the disparities in health awareness; early diagnoses; screenings; and accessible, affordable, and high-quality healthcare for patients with cancer.

Data from the United States suggests that 42% of cancer incidence and 45% of cancer mortality were attributable to modifiable risk factors, a kind of behavior or exposure factors related to cancer risk that we could reduce or control, such as poor diet and physical inactivity.5 Findings from a population-based cohort study suggested that modifiable risk factors could explain 46% of inequities in cancer morbidity and mortality.6 Inequities exist in cancer burden because cancer survival and mortality burden are closely related to the treatment ability and care. The reduction of cancer burdens attributable to avoiding modifiable risk factors would provide an equitable strategy for cancer prevention and control. Therefore, it is critical to provide a supportive environment and educational programs on how to avoid modifiable risk factors is critical. However, climate change is challenging this approach and will widen cancer inequality.

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Potential Critical Connections of Climate Change and Cancer Risk

The potential linkage between climate change and factors that can modify cancer incidence and threaten cancer survival are shown in Figure​

Figure1

1. The combustion of fossil fuel seems to be the start of a vicious cycle since it increases greenhouse gas emissions (CO2, CH4, etc.) that aggravate climate change and produce air pollution. According to previous studies, cancers potentially associated with modifiable risk factors are highlighted in Figure​

Figure2

2.

Figure 1

Potentially critical connections between climate change and cancer risk. UV: ultraviolet radiation; the dashed line indicates that high temperatures could amplify, or enhance, the effects of ambient air pollution. Natural disasters include heat waves, cold spells, wildfires, droughts, floods, hurricanes, typhoons, etc.

Figure 2

Potential associations between climate-change-related risk factors and cancer.

The International Agency for Research on Cancer (IARC) has classified outdoor air pollution as a Group 1 carcinogen. Increasing evidence has suggested that the association may not be limited to lung cancer, but also cancer of other sites.7 Increased incidence and shorter survival of cancer affected by air pollution were observed in previous studies.7 In addition to the greenhouse gases emitted by the combustion of fossil fuels contributing to climate change, climate change may worsen air quality by changing the ventilation, dilution, precipitation and other removal processes, and the amplification of atmospheric chemistry.8 Accumulative evidence suggests that climate change is expected to increase particulate matter ≤ 2.5 μm (PM2.5)-related mortalities even under the scenario of a moderate projection of greenhouse gas emissions.9 Though the interplay of climate change and air pollution on health has been well documented, the evidence for cancer warrants investigation.10

Besides outdoor air pollution, household air pollution is also a part of the linkage.11 There are still millions of people who are not able to cook with clean energy, which results in severe indoor air pollution as well as greenhouse gases, that is, the major factor affecting climate change.12 Indoor emissions from the household combustion of coal are a Group 1 carcinogen. The household combustion of biomass fuels and emissions from high-temperature frying have been concluded to be possibly carcinogenic to humans by the IARC. It is estimated that 3.8 million premature deaths (8% from lung cancer) are attributable to household air pollution from cooking with kerosene or solid fuels each year. The Global Burden of Disease Study also suggested that indoor air pollution is associated with the risk of esophageal squamous cell carcinoma.13 “The forgotten 2.6 billion people” who have less access to cleaner fuels, mostly in low- and middle-income countries (LMICs), suffer an increasing cancer burden and are also exposed to a huge amount of air pollution. The vicious cycle of climate change, air pollution, and cancer will keep rolling and provide a devastating cancer burden without intervention.

With the accumulation of greenhouse gases, global warming, and changing meteorological factors, there is an increasing frequency of abnormally hot and cold temperatures, which are the direct expression of climate variability. Although it is not clear whether it is the increased temperature of warm months, carcinomatous meningitis was observed to have a higher incidence in these months.14 Evidence from more studies is warranted to confirm the causal association. The direct effects of extreme temperatures like heat waves may worsen the conditions of cancer patients because of their impaired thermoregulation and immune function.15 Occupational heat exposure, exacerbated by climate change,16 is also associated with several cancers, e.g., female breast cancer.17 The climate-change-induced ozone depletion led to increasing ultraviolet radiation (UV) exposure, which will lead to increased risks of melanoma and other skin cancers (e.g., squamous cell skin cancer).18 In consequence, melanoma survivors have an increased risk of developing second primary cancers, such as prostate cancer.19

The changing temperature and precipitation will also lead to changes in natural disasters and food production, which may increase the risk of cancer indirectly. Take wildfires as an example of a natural disaster that has shown an increasing trend in frequency and duration globally.20 Long-term exposure to wildfires has been suggested to increase the incidence of lung cancer and brain tumors.21 Extreme weather and natural disasters caused by climate change may reduce people’s physical activity by limiting active venues and suitable temperatures. Less physical activity could increase the risks of colon, female breast, and uterine cancers.5 Furthermore, inactivity-induced excess body weight also increases the risk of cancers of the gastrointestinal tract, genital organs, and female breast.

Less food availability and deteriorating food security induced by climate change have been observed. A modeling study revealed that by 2050, the global food availability would decrease by about 3.2%, and a 4.0% fruit and vegetable consumption reduction would be attributable to climate change.22 Parental malnutrition and exposure to air pollution exacerbated by climate change are significantly associated with serious adverse pregnancy outcomes,23,24 which are associated with higher breast cancer risk in early adult life.25 Lower consumption of fresh vegetables and fruit would also increase the risk of cancer from the respiratory and digestive tracts. Polycyclic aromatic hydrocarbons (PAHs) from high-temperature pyrogenic processes and vehicular emissions, which are related to the higher risk of breast cancer and colorectal cancer,27 were also found in commonly consumed leafy vegetables.26 The increase in the temperature led by climate change may increase appetite suppression and reduce conception rate of livestock because of heat stress, as well as reduce milk production.28 Lower dairy product consumption has been observed in line with increased breast cancer and colorectal cancer.27 Temperature and moisture significantly influenced aflatoxin production.29 Aflatoxin B1 production in maize will have consequences on aflatoxin M1 contamination in milk30 and might increase the liver cancer risk.31 Similarly, the diversity, distribution, and biology of fish populations are also affected by climate change. It is estimated that for every 1 °C of global warming, global fish catches are expected to decline by 3 million tonnes.32 Liver and colorectal cancer risks will be increased27 due to the lack and unaffordable fish consumption, especially in low-income countries.33 Climatic variability has always been the main factor responsible for fluctuations in coffee productivity worldwide.34 Coffee consumption is suggested to reduce the risk of oral and liver cancers.27 Apart from food, water quality is also affected. Climate change is likely to exacerbate the increasing bromide levels in public water systems, which would increase the excess lifetime bladder cancer risk35 and the cyanotoxins in drinking water that are associated with liver and colorectal cancer.36

Kidney cancer is cancer that begins in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, with one kidney on each side of your spine.

In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms’ tumor.

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scans are being used more often. These tests may lead to the accidental discovery of more kidney cancers. Kidney cancer is often discovered at an early stage, when the cancer is small and confined to the kidney.

Symptoms

Kidney cancer usually doesn’t have signs or symptoms in its early stages. In time, signs and symptoms may develop, including:

• Blood in your urine, which may appear pink, red or cola colored
• Pain in your back or side that doesn’t go away
• Loss of appetite
• Unexplained weight loss
• Tiredness
• Fever

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.