Prof. Dr. S. H. Manzoor Zaidi is the Medical Director at Baqai Institute of Oncology. He was recently interviewed by Muhammad Fareed, Publisher & Managing Editor, Medical Review, in which he briefly spoke about various aspects of cancer. Following are the excerpts of the interview.
Q1 – Please tell us something about yourself.
Ans – I am Dr. Prof. Dr. S. H. Manzoor Zaidi working as a Medical Director at Baqai Institute of Oncology, which is a specialized centre in the treatment of cancers in private sector. It is a non-profit institution that is dealing with a large number of poor patients.
I was the Professor of Radiotherapy and Oncology at Jinnah Postgraduate Medical Centre for 37 years. Currently I am working in Baqai Institute of Oncology since 1993 after retiring from government service.
Over a long span of over 60 years, I have been involved in the management of different cancer right from the beginning of my carrier. The field of Oncology has seen a lot of development in these years and there has been tremendous progress and development. Despite that, there is need for more improvement and more expansion and a lot of things have to be done as far as cancer diagnosis, treatment and management is concern.
Q2 – What are the different cancers your encounter and which are more prevalent.
Ans – The majority of cancers that are seen in Pakistan are related to some sort of tobacco smoking and chewing. Unfortunately, the trend of tobacco smoking and chewing is increasing and naturally the numbers of cancer patients are constantly increasing. If we cut down tobacco use, the incidence of most common cancer, i.e. head and neck cancer, lung cancer and cancer related to tobacco smoking and chewing will be decreased. The aspect of prevention requires education of professional people as well general public.
Oral cancer is very common cancer which is mainly caused by pan and gutka. There is constant increase in the number of patients of oral cancer. Youngster are often seen chewing supari, betelnuts, tobacco and all kind of sweet supari and pan masala extensively which are smuggled from abroad. This is a serious matter and need full attention. These people are very susceptible in developing mouth cancer. If these cancers are not detected at early stage than it results in incurable stage.
There is need to emphasize and to make all out efforts to reduce the maximum number of patients with the help of prevention of these bad habits.
Q3 – What is the incidence of breast cancer. Is there institutional record to know more about the incidence.
Ans – Breast cancer is the most common cancer in women in Pakistan. It has been estimated that breast cancer is very high in Pakistan and it is higher in younger age group in Pakistan. Unfortunately, we encounter breast cancer at late stage which makes the management and treatment difficult and unsuccessful besides the cost being higher than what it will be in early stages.
In the case of breast cancer, women should be aware of the need for early detection and prevention. Early detection and diagnosis is necessary that results in cure. There are certain things which need to be mentioned about prevention of breast cancer. Breastfeeding is the natural way of prevention of breast cancer. Women who breastfeed their children are less likely to get breast cancer than who does not breastfeed. Child birth at late age and no breastfeeding make the women more susceptible to breast cancer.
It is very important that one should realize that breast cancer is a condition which can be picked up at early stage. The most important person to detect the breast cancer at early stage is the woman herself. Women must be aware of the fact that self examination of the breast at regular interval, carefully and properly can detect breast cancer at early stage. Self examination by women herself in between every two menstrual cycle from the age of 25 upward is the cheapest method of detecting breast cancer at early stage. No doubt, anything that is suspected by the women herself, needs further confirmation and diagnosis and investigation by specialist. Something abnormal in the breast in the form of thickening or lump and nipple discharges if noticed by women, then she must consult the specialist and then investigation like ultrasound, mammography, biopsy is done to confirm the diagnosis of breast cancer.
By adopting these procedure, a very large percentage of patients which are on stage3/4 would come down on stage 1/2 thus resulting in better results.
Q4 – What is the level of treatment of cancer and breast cancer. What further facilities are needed to improve treatment.
Ans – Despite, a number of new centres that have been established. There is shortage of facilities of cancer treatment in Pakistan because cancer treatment is based on three main forms which include Surgery, Radiotherapy and Chemotherapy.
Surgery is very highly specialized field i.e. Surgrical Oncology. Specialized training has to be done and specialized centre should be available to do cancer surgery. Routine cancer surgery can be done in any hospital but when we talk about specialized surgical techniques required for the treatment of cancer, there is need for specialized surgeons for Surgical Oncology.
Radiotherapy is related to the availability of machines which are very expensive machines. Atomic Energy Commission has been very helpful in establishing a large number of radiotherapy centres all over the country, but there is need of more centres and equipment to be established at different cities where the facilities should be fully utilized.
Chemotherapy is another form of treatment of cancer. In this medicines are required for the treatment of cancer. Unfortunately, the medicines are very expensive and are beyond the reach of Pakistani patients. There is need for the support of government in the form of relief of the cost in cancer drugs is concerned and there is also the need of indigenous development of drugs which are of low cost to make it available and manageable by Pakistani patients.
Breast cancer treatment consists of surgery with or without radiotherapy and chemotherapy depending upon the stage of breast cancer.
The type of surgery at early stage is done in which only a part of the breast is removed which is less disturbing to the woman who undergoes surgery followed by Radiochemotherapy. But, if detected at later stage, then the whole breast has be to be removed.
Q5 – There is need of awareness campaigns. In which areas and ways it can be arranged.
Ans – There is need for awareness of medical professional and general public. If we curtail the use of tobacco and such substances than the number of cancer patients will be reduced.People need to be made aware of signs and symptoms of cancer.
Q6 – What is the role of pharma companies in creating awareness.
Ans – Pharma companies are already playing their role. Particularly in breast cancer, there are number of companies who are involved in providing leaflets, arranging lecturers and demonstration. There is still need to give more attention to breast cancer and lung cancer.
Q7 – Have awareness been introduced among women for breast cancer.
Ans – There is need of establishing detection centres and detecting facilities for women of breast cancer one they have been made aware of this disease as suspicious case have to be rule out as well.
Q8 – How is hormonal therapy effective in breast cancer. When is preference given to hormonal therapy for breast cancer treatment.
Ans – Not all breast cancer are hormonal sensitive. There are about 30-40% that have benefited from hormonal therapy. When breast cancer patient is operated, the breast tissues are examined for hormone dependence. If they are hormone dependent then they are given anti-hormonal treatment as hormonal management.
Q9 – Are the students is medical colleges are getting sufficient teaching in the subject of Oncology. If not then what do you suggest in improving the teaching standard.
Ans – There is enough basic idea of oncology in the subject, but the detail and development which are taking place are not incorporated in it. There is need for more exposure. There is need for special lecture to be taken by oncologists. There is also need for a lot of introduction especially about sign, symptom detection, prevention, awareness etc., that can be incorporated in all medical studies so that the students should have proper knowledge.
Q10 – The GPs have the role of referring cases to cancer hospitals when patients come to them. It is general impression this they do not effective follow this practice. Do you agree and what can we do about it.
Ans – Family Physician are the most important person for early stage diagnosis. If they are conscious and aware of the type of the disease than they can refer the case to the hospital. Family Physician have to play their active role in referring the patients to the right place. It is very important part they can play in the management of patient’s health and treatment.
Q11 – Anything you wish to add.
Ans – The use of tobacco form should be discouraged and controlled which will results in the improvement of health of very large number of peoples.