Cancer incidence has emerged as an important lifestyle disease. Conventionally viewed as a rich man’s disease, it today causes more morbidity and mortality in the less affluent societies. Six in every ten cancer patients in the world are from developing countries. These patients rely on a system that is hopelessly stretched. Timely and complete cancer treatment is available to a fortunate few.
Does the medical curriculum pay adequate attention to cancer? Go back to your days as an undergraduate medical student and you have the answer. About 30 years ago I witnessed the shocking site of a patient of left radical mastectomy with a raw wound awaiting a skin graft to cover the defect. The misery of the middle-aged lady with a painful raw wound involving more than half the pectoral region with her hand held against the left flank and the possibility of another month of hospital stay is clearly imprinted on my mind even today. This was about the time that one of the first trial comparing radical mastectomy with a conservative breast surgery was published in a journal I think is subscribed by every medical college. It was also about 5 years after the efficacy of adjuvant chemotherapy for breast cancer had been documented in the same journal. I have attended one of the premier medical colleges and yet this was not thought to be incorrect. I carried this impression for another eight years. Less than half a kilometer away was a completely different world of cancer treatment. I entered that world with a post-graduate degree and came out with my concepts about cancer turned up-side down.
The last I worked in an internal medicine unit was about fifteen years ago. Cancer patients have many age related co-morbidities and this gives me an opportunity to have a glimpse of current treatment of diseases like diabetes, ischaemic heart disease and hypertension. The therapy for these has evolved to well beyond what it was when I was a post-graduate student. About one in eight medical research papers deal with cancer. Oncology has probably changed more than any other medical speciality in complexity of knowledge, available therapeutic interventions and outcomes. This blog captures this change and moves beyond.
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