The number of cancer patients is set to rise dramatically throughout the entire Gulf region. This is simply because of changes in the age of its population.
Cancer can, of course, occur at any age but it predominantly occurs in older people. In the UK, 25 per cent of the population is now over 60 compared to only 3.6 per cent in the UAE. The number of new cancer patients in this region per million people is currently less than half that in Europe. But this is set to change rapidly with a much more European age pattern coming to all GCC countries.
The risk factors for cancer due to age are already locked-in, so a health crisis is inevitable.
There will be a significant rise in both incidence (the number of new cases) and prevalence (the number of patients living with cancer). The World Health Organisation predicts a more than doubling of both in the GCC region by 2050. The “big four” cancers are those arising in breast, colon, lung and prostate, which make up 65 per cent of diagnoses.
Each cancer has its own age profile and causation. As breast cancer starts rising in women in their forties, it is unsurprising that we are already seeing a huge increase. The other types will surely follow in the next decade.
But a real puzzle is emerging. Over the past 20 years, we have seen a dramatic increase of certain cancers in the 30-50 age group globally. This trend started in the 1990s, so has nothing to do with Covid-19 or its vaccines. Lymphoma, melanoma, head and neck as well as the big four cancers are all involved.
What is going on and what can we do about it?
We know that age is the biggest risk factor and we just cannot stop the clock. But changing lifestyles are definitely involved too. The interplay of diet, exercise and obesity can alter the hormonal balance in the body. How we work, play and relax now is different from the past. Only three generations ago, the Gulf was a land of nomadic tribesmen with a healthy lifestyle. Subsequent generations now sit in smart high-rise offices, often with sedentary lifestyles and a diet heavy with processed food. But why is this increasing the risk of cancer?
Our lifestyle contributes to the composition of the microbiome – the bugs that colonise our intestines breaking down potential carcinogens and toxins. Powerful data-mining artificial intelligence programmes are being used to study the huge number of variables involved. Within five years, it is likely we will understand more clearly the factors causing defects in cell growth control that allow rogue cells to emerge. These become the enemy within – the cancer. Greater understanding will allow specific tailored cancer prevention advice to individuals. Prevention and screening messages are always far more powerful if individualised.
Risk-based screening for common cancers will be revolutionised by multi-cancer early detection tests, or MCEDs. These pick up abnormal DNA fragments released by tiny early cancers which circulate in the blood. Although there are several on the market, they produce too high a false positive rate to be used on everyone. They can make the worried well even more worried. Eventually, a reliable, self-administered finger prick sample will be enough to diagnose cancer accurately, but we’re just not there yet.
Technology will allow us to diagnose cancer in its very early stages where outcomes are best. The Gulf is well provided with increasingly sensitive diagnostic scanners, both MRI and CT. And molecular analysis of biopsies from cancers will provide far more personalised individual drug and radiation combinations. The future physicians’ laptop will not only choose the optimal therapy but also predict probable unpleasant side effects. AI will be used extensively to understand individual interactions to treatments – both good and bad allowing perfect personalisation.
The Gulf has many excellent cancer treatment facilities. But there are few effective networks allowing the combination of international expertise bringing multi-disciplinary opinions for patients and yet delivering care close to their homes currently in place. Treating cancer effectively is no quick fix, often taking several months of frequent hospital visits for radiotherapy and chemotherapy. The medical tourism model used for elective surgery is not feasible.
The increasing cost of optimal cancer care is driving government health bodies globally to reduce the wide inconsistencies in treatment protocols. Networked care from a mixed economy of public and private providers is very much the future. It allows the development of a financially sustainable model adapted to a country’s overall wealth.
Increasing financial investment into an individuals’ cancer care obviously increases the benefit to the patient. But there is a limit – a therapeutic plateau – where further spending brings no benefit for the patient. Poorer countries such as those of middle Africa operate well below it; most of Europe and Asia is comfortably at its beginning but the US is far along it, spending vast sums of money for no gain in the last few months of a patients’ life. Networked care is the solution to providing the best individual treatment and yet minimising its toxicity both for the patient and financially for the payor. Coupling the intellectual power of a large central university hospital with skilled technical care close to home is what families want.
Currently we cure over 90 per cent of patients with early-stage cancer. When the disease has spread outside its organ of origin, this figure drops dramatically. So, the emphasis has to be on streamlining the diagnostic phase and fast-tracking treatment. The current emphasis is very much on maintaining the best quality of life both during and after therapy. We are now far more honest with our patients and try to manage their expectations with frankness. Breakthroughs appear in the media regularly driven by commercial interests from biotech and pharma companies and their investors. Their hyped-up message can often raise false hope.
Public education and better screening lead to earlier diagnosis and better outcomes. Understanding the reasons that cancer arises at a molecular level will lead to both better prevention and more effective treatment strategies. But oncologists need to steer a delicate path between hope, hype and reality for this increasingly common disease.
