Concerns have been raised that that cancer among children in Sri Lanka is on the rise.
The Sunday Observer spoke to Consultant Community Physician of the National Cancer Control Program ( NCCP) Dr Suraj Perera to define what childhood cancer is.
He said, “Childhood cancer is defined as cancers occurring between 0-19 of age, according to the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO). Although, compared to the incidence of adult cancer, the occurrence of cancer before the age of 20 is rare, it nevertheless remains as a leading cause of death among children and adolescents worldwide.”
Asked to give us an update on the latest figures of the number of childhood cancers reported in hospitals islandwide, he said, citing figures from the National Cancer Registry Sri Lanka, that that an average of 700 childhood cancers have been detected per year.
Pressed for further details and the current ranking of childhood cancer among other cancers in Sri Lanka, and the ratio between men and women, he said, “According to the latest data in 2019, 31,834 new cancer cases have been detected and 778 cases are below age 19, making it 2.4 percent of all cancers. Among all childhood cancer cases reported in 2019 in Sri Lanka, 51.4 percent are males while 48.6 percent are females.”
Causes
He said, “The exact causes for most of the childhood cancers are unclear.” However, he listed probable causes from many studies. They include: inherited genetic conditions, exposure to ionizing radiation and infections (such as Epstein Barr Virus, HIV and Herpes Simplex) may have contributed for occurrence of childhood cancers. Only a few childhood cancers are caused by environmental or behavioural risk factors and hence, prevention of childhood cancer has become a difficult task,” he said.
On diagnosis and treatment, he said that even though most of the childhood cancers cannot be prevented or screened, with the modern multi-model treatment, many childhood cancers can be cured through early diagnosis and effective treatment.
“Treatment for childhood cancers is selected based on the type and stage of cancer at the point of diagnosis. Each cancer requires a specific treatment regimen that may include surgery, radiotherapy and chemotherapy. Children and adolescents with cancers should be treated at specialised paediatric oncological treatment centres by a multidisciplinary team including paediatric oncologists, surgeons, radiologists, radiation oncologists, paediatricians, pathologists, microbiologists, experienced nursing officers and social workers,” he said.
Public health priority
In 2017, the World Health Assembly identified the childhood cancer as a public health priority and proposed to act immediately. As a result, WHO summoned the first consultation on childhood cancer in Geneva in 2018 and organised the Global Initiative on Childhood Cancer (GICC). The goal of initiative is to reach at least 60 percent survival rate for children with cancer by 2030, while reducing suffering and saving an additional one million lives. To attain this goal, it was recommended to increase the capacity of all countries to approach safe and quality care for children with cancer, he said.
He said that on par with global initiative, Sri Lanka was further strengthening childhood and adolescent cancer care according to the National Policy and Strategic Framework on Prevention and Control of Cancers. “A National Strategic Plan on Childhood Cancer Care for 2021-2025 is also being developed. We are encouraged that Sri Lanka was selected as a model demonstration site for childhood cancer care through the WHO initiative,” he said.
Asked about how the NCCP was setting about the task of increasing the survival rates of childhood cancers in Sri Lanka, he said that “Gaps / barriers are being identified and are addressed.” Delayed diagnosis and initiation of definitive treatment, obstacles to accessing care, abandonment of treatment, death from side effects and higher rates of relapse are some of them, he said.
Rape, domestic violence among leading causes for suicide – Study
Compiled by Carol Aloysius
As suicide cases continue unabated across the country, despite a drastic plunge in recent years, a study has found that rape and domestic violence are some of the leading causes that drive this disturbing trend.
The Sunday Observer contacted Emeritus Professor of Forensic Medicine and Toxicology, University of Colombo and the Founder Head of the National Poisons Information Centre of the National Hospital of Sri Lanka, Dr Ravindra Fernando for more information on research on suicide he has done over the years. In how many cases had he found sexual abuse to be directly or indirectly linked in suicides and attempted suicides gender wise and age wise?
In reply, he said, “In my study, 151 deaths from suicide were documented, of which 93 (62 percent) were men. More women attempt suicides but always more men succeed. The majority (47 percent) were aged between 20 and 29 years.
This is the commonest age group to commit suicides in almost all studies.” Asked for reasons leading to suicides, he said, “In a study in 2006, the commonest reason for suicide was dispute with the spouse/marital disharmony (30 percent). Other reasons were dispute with parents (eight percent), financial matters (seven percent), organic diseases (seven percent), alcoholism (seven percent), psychiatric illnesses (six percent) and disputes in love affairs (five percent). In 29 cases (19 percent), no definite reason for the suicide was evident.”
Asked if he saw a new trend in these causes in recent years his reply was in the negative.
Being a Toxicologist, we asked what toxic methods were most frequently used in cases of suicide and attempted suicides in Sri Lanka. According to him, in 2020, out of 3,074 (2484 men and 590 women) who had committed suicide in Sri Lanka, 672 died from pesticide poisoning, 28 died by drinking acids. Plant poisons, such as yellow oleander, were responsible for 58 deaths.
On over prescription of medicinal drugs recently highlighted as a common cause, he said that “Only 20 died from drug poisoning and that the commonest medicinal drug consumed for suicide was Paracetamol.” Asked if the Covid-19 pandemic had aggravated the problem, he said that there was no evidence that Covid-19 has worsened the problem. “But I did hear a recent report of a patient being treated for Covid-19 and allegedly suffering from cancer and depression jumping to death from the fifth floor a state hospital in Kandy,” he added.
He said, “Some of those who survive, suffer from the late or prolonged effects of the toxic substances consumed. They need prolonged psychiatric support.”
On Domestic violence as contributory cause, he said “The commonest reason for suicide was dispute with the spouse or marital disharmony (30 percent). Some of these can be related to domestic violence.” Commenting on recent interventions by the Ministry of Health and Presidential Task force to prevent and reduce suicide in Sri Lanka, he said that the Presidential Task Force appointed in late nineties had made important suggestions that helped to reduce suicide.
The restriction of the availability of highly toxic pesticides was one useful recommendation, he said, noting that the Pesticide Technical Advisory Committee of the Ministry of Agriculture of which he was a member, had banned a useful weedicide, Paraquat, in 2010 which had been responsible for about 300 deaths annually.
He considered empowering people to manage anger and conflicts and recognition and treatment of alcoholism and psychiatric illnesses as “useful and timely steps forward.” He said, “It is sad that some young people attempt suicide for trivial reasons. Last week a 15-year-old boy committed suicide because mother did not give him the mobile phone. Whatever the reason, suicide is not the answer,” he said.