Few diseases possess the power to frighten us as much as cancer does. Even the word itself, made up of two sombre little syllables, is often delivered in muted tones – “The doctor says it’s cancer” – as if saying it aloud risks drawing its malign attention. Tuberculosis, smallpox, plague … all have surrendered their crown to cancer, which persists in its fearful resilience even as we find cures and treatments for many other conditions.
That fear came calling to my family in 2021 when my father was diagnosed with colon cancer. “Your Dad has cancer” – a few little words that, like a bucket of cold water right in the face, very quickly focus your attention and help you, if nothing else, appreciate what really matters in life.
Oncologists and public health figures, more so this month, have been calling for people – particularly those at particular risk of developing the disease – to get screened. March is colorectal cancer awareness month and calling for screenings is responsible and right, but issuing the call and getting people to heed it are two different things.
For millions of people around the world, the opportunity to be screened simply does not exist. If someone lives in a part of the world that has an inadequate and fractured healthcare system, acute medicine is the priority and preventive testing is often at the bottom of the list.
Many other people struggle to pay for early or regular screenings, or are fearful about how much treatment will cost if a cancer diagnosis is made. Research published by the US Centres for Disease Control and Prevention last year found that although testing was the main reason for the steady decline of colorectal cancer in the past 10 years, “screening rates are generally low among people with low incomes or who lack health insurance”.
Another US study in 2022, this time on cervical and breast cancer, found that common barriers to screening included a “lack of cancer knowledge, cost/inability to pay, lack of health insurance coverage, cultural perceptions, fear, language difficulties, and transportation and time constraints”.
In the GCC too, there are challenges to cancer screening. A 2019 paper published in the European Journal of Cancer Prevention found that breast and cervical cancer screening in the UAE, Saudi Arabia, Oman and Kuwait was generally low. Again socio-economic factors were at play, with the research claiming that “marital status, wealth, education, nationality and place of residence are associated with screening uptake, with the lower educated, poor and unmarried having the lowest percentages of uptake".
Even in countries where screening is available and affordable, many people are not getting themselves checked out, or are waiting until they feel unwell before doing so. A report from researchers at the University of Chicago last December found that just 14.1 per cent of all cancers detected in the US were found by screening. The rest were identified after patients reported to doctors with symptoms or were tested for other conditions.
This hesitancy, whatever its causes, can have dire consequences. According to Dr Stephen Grobmyer of the Oncology Institute at Cleveland Clinic in Abu Dhabi: “When it comes to the importance of early cancer screening, you only need to look at the numbers to see just how crucial early detection is.
“If identified early, over 90 per cent of people with some types of bowel, breast and ovarian cancer will survive for at least five years compared to those identified at later stages.”
Despite the advances made in medical technology, some forms of cancer screening remain a challenge. Tests can be invasive, uncomfortable and time consuming. Taking time out of our busy lives to go through this, especially when we have no current health problems or symptoms, is something often relegated to the bottom of the to-do list.
This is where the role of family comes in. Quiet and respectful conversations from those closest to us can tip the balance in favour of taking one morning off work to go to the clinic. Research published in the journal Cancer in 2015 has found that "shared decision-making is an important component of patient-centred care and is associated with improved outcomes" and that "physicians should consider eliciting patients' preferences for family involvement".
Coupled with this is the need for direct and clear advice from doctors. A National Colorectal Cancer Roundtable action plan for US physicians from 2008 put "communication" at the heart of improving screening rates, warning that patients often waited on a recommendation from a health professional before going to get checked, or had to receive several persistent reminders before getting screened.
If there is a way to overcome this reluctance to get screened, it is perhaps in the power of our imagination. Not picturing the worst – itself a major factor that deters people from getting tested – but in imagining a longer, healthier life shared with our loved ones who would like us to stick around for as long as possible.
My father fought hard after his diagnosis. He endured sickening chemo and painful radiotherapy before going through surgery. But with the help of his family, some exceptional nurses, oncologists and surgeons – and no little grit on his own part – he made a full recovery. We were lucky in myriad ways, and not everyone is so fortunate.
Had he been screened years before, perhaps the cancer could have been found sooner and his treatment may have been shorter and less gruelling. One outcome is that I am now a prime candidate for screening, having had a first-degree relative develop colon cancer.
Sadly, it took my father’s disease to make me sit up and take notice of the calls to get screened. No one really wants to think about those two little syllables. But if we can improve access to screening, make it more affordable, develop quicker tests and demystify the process, perhaps more of us will live longer.
