(NewsUSA) – Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia. Last year, the American Cancer Society estimated that nearly 16,000 Americans were diagnosed with this disease.

Jason Whiting, Sr. never imagined he would be one of them.

Several years ago, 36 year-old Jason, a Baltimore-based father of two, visited his doctor to see why the lymph nodes in his neck were enlarged. He was immediately referred to Dr. Stephen Noga, director, medical oncology/hematology at Alvin & Lois Lapidus Cancer Institute, who completed blood and bone marrow tests, which confirmed that Jason had CLL. with the diagnosis came mixed emotions — fear, shock and relief that it was detected early.

Given the early-stage diagnosis, Jason experienced minimal symptoms, and he and Dr. Noga decided to initially take a “watch and wait” approach to treatment — a common practice for CLL patients. Over the next several years, Jason had blood tests and CAT scans to monitor his disease progression.

In may 2009, Jason experienced discomfort in his chin and neck, and a CAT scan showed that the cancer had spread to lymph nodes in his abdomen and chest. both Jason and Dr. Noga agreed — it was now time to begin treatment and the fight against cancer.

“It was important that Jason be comfortable with his treatment approach, and we spent a lot of time discussing options,” said Dr. Noga.

Dr. Noga prescribed TREANDA, and after six cycles of TREANDA, Jason has achieved partial remission.

Jason didn’t fight this battle alone. Throughout his treatment, Jason relied on the support of his family and his coworkers.

“When I was diagnosed, I made a decision to beat CLL,” said Jason. “I knew I had to stay positive and motivated so the cancer would not get the best of me. I am thankful for everyone who supported me through the experience.”

Grateful to have achieved partial remission, Jason can be found practicing martial arts and spending time with his children — something that he never takes for granted.

Individual results may vary.

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“The body is made up of small building bricks called cells. The cells have been programmed inherently, that they must grow to a certain age and size and they must die. These cells either by an infection or genetic mutation begin to grow the wrong way. Ultimately, this cell will grow without stopping or dying and continue to accumulate and eventually form into a tumour.” This is the layman definition of cancer by the Specialist Medical Oncologist at the Uganda Cancer Institute (UCI) Abrahams Omoding.

Dr Omoding says that for some cancers like that which affects the skin, it could take up to 10 years for the disease to manifest itself into a tumour, in most cases presenting itself when already in late stages.

For other cancers like Kaposi’s Sarcoma, prostrate, cervical and Burkitt’s lymphoma, much as signs and symptoms may present themselves a bit early, the doctors at the UCI collectively attest that up to 80 per cent of patients come in their late stages of the disease and can hardly get cured, hence eight in 10 patients diagnosed with cancer die of the disease because of late diagnosis.

And this is the disease that is slowly eating up the Ugandan population, with at least one in every 500 people suffering from a cancer, the Head of UCI, Dr Jackson Orem, said. that figure is rather worrying. Statistics, doctors say, have shot up recently due to many factors ranging from an increase in infectious diseases in the region, changing lifestyles and perhaps an increase in awareness among the population who can now report cases at the hospital rather than die unnoticed in shrines and the like.

“Because we are in the tropics, it is an infection epidemic region and majority of the cancers are infection related like Kaposi’s Sarcoma, Burkitts Lymphoma, Cervical cancer and cancer of the liver. most infections are potentially preventable through vaccination but we do not have a robust vaccination programme.

“We do not have a robust screening programme that rolls out screening. Screening plays a vital role because it enables one to detect the disease early,” explains Dr Omoding.

Burkitt’s lymphoma and Kaposi’s sarcoma are for instance 90 per cent associated with the HIV/Aids virus. Cervical cancer is associated with the Human Papilloma Virus, which is also sexually transmitted. Cancer of the liver has everything to do with Hepatitis B, which is an infectious disease.

Even then, not all cancers are infection-related. Worse still, Dr Omording says, some cancers like prostrate, liver and breast tend to occur at a younger age in blacks and progress faster compared to the whites.

“There are speculations of genetic differences, environmental differences and too many infections. it is possible our immune system is weakened by these infections like malaria so we develop the cancer earlier,” he says. with all these risk factors, the county’s readiness to combat Non Communicable Diseases (NCDs) or even handle cancer as a serious ailment remains questionable, with the population largely unaware of this growing epidemic, which combined with other NCDs like heart ailments, diabetes and chronic chest diseases constitute 60 per cent of the total deaths in a year.

There is currently no national policy on cancer and its screening like it is with immunisation or malaria and neither are lower health centres and even some district hospitals and their equivalent medical personnel equipped to diagnose the different cancers.

Only the Uganda Cancer Institute is fully equipped to screen for the disease and yet it can only cover part of Kampala in its community screening, leaving the institute stretched beyond capacity with an inflow of patients from all over the country.

In fact, it is not uncommon to find patients camping at the institute for months just to get hold of a doctor and yet when diagnosed, they can hardly pay for subsequent tests of about Shs20,000 each. The minimum cost of treatment is about $500 (about Shs1m), but this could rise to $1,200 (about Shs2.4m) depending on the severity of the cancer diagnosed.The head of the UCI, Jackson Orem, has time and again decried the little funding to the institute which has left many diagnosed unable to complete their doses because neither the institute nor the patients can afford to pay for the expensive medicine.

Indeed, the Principle Medical Officer for Non-Communicable Diseases at the Ministry of health, James Sekajugo, agrees that NCDs and cancer in particular have not yet been fully attended to by the government as they should.

“We are justifiably alarmed by infectious diseases because they kill people at a very high speed. The NCDs are killing one person or two but very steadily, the people who have died of them are more than HIV/Aids, Malaria, TB and maternal conditions put together,” Dr Sekajugo says, adding that NCDs are responsible for 60 per cent of deaths globally.

“As time goes and as the country develops, the intention is to have screening at all health centre IVs and I think we need to now approach the NCDs through prevention.

Posted on: Monday, 13 December 2010, 14:07 CST

Cancer prevention experts have long been frustrated by the lack of a meaningful way to screen women for ovarian cancer. It is a relatively rare disease that often progresses with few symptoms until it is too late for potentially curative treatments, and elevated values of the most commonly used biomarker used in screening, CA125, are also related to other disorders.

Now, scientists at the Duke Cancer Institute say that incorporating the latest information about the biological diversity of ovarian cancer appears to lessen the potential value of screening even further.

"I feel that what this and other studies are telling us is that we will have to do a whole lot more than screening to protect women from this terrible disease," said Laura Havrilesky, MD, an associate professor of gynecologic oncology at Duke and the lead author of the study appearing in the journal CANCER. "we need to work harder to find better approaches to screening and also consider the potential value of preventive strategies."

Until recently, ovarian cancer has been regarded as a single disease. but studies at Duke and elsewhere have shown that it has at least two distinct subtypes, a slow-growing, indolent form, which takes months to years to move into an advanced stage, and a more aggressive variety driven by key gene mutations that gallops through stages I and II in about half that time.

Havrilesky led a research team that used information in the SEER database to create a decision model for screening for ovarian cancer. The SEER database, maintained by the National Institutes of Health, includes information on cancer incidence, prevalence and survival in over a quarter of the U.S. population and breaks out ovarian cancer by type.

They then validated the model using early data from a real-life study, the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), a large, randomized trial that is using CA125 values and ultrasound to screen a general population of post-menopausal women for ovarian cancer.

In conceptualizing ovarian cancer as a single disease, the model predicted that screening women over the age of 50 in the United States could potentially lower cancer deaths by about 15 percent. but incorporating the two subtype concept, the model predicted deaths would fall by only 11 percent.

Havrilesky says it just makes sense: Screening is more likely to pick up a greater number of slow-growing, as opposed to fast-growing tumors, because indolent cancers remain in a more treatable early stage almost twice as long as their more virulent counterparts. "but catching and successfully treating the slower-growing cancers isn’t going to do as much to reduce deaths from ovarian cancer as much as catching the more lethal tumors would do."

In an accompanying editorial, Patricia Hartge, MA, ScD, a senior investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, notes the modest benefit of screening for a general population, but says that screening for women at higher risk of ovarian cancer – those who carry mutations known to be related to the disease or who have a family history of it – presents a more hopeful picture.

But Havrilesky is not so sure. She says screening in even the highest risk population has not yet been proven successful and says other options are under study that may hold merit.

‘We know that women who take oral contraceptives have a reduced risk of ovarian cancer, and the Duke Evidence-Based Practice Center is currently doing a systematic review and model to determine if this might be a reasonable approach for some women."

• Duke University Medical Center

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