T ABLE OF C O N TENTS 3 . F o r e wo r d 4 . E d ito r ia l Bo a r d I nt roduct ion 6 . A MS A- In tl P r e vious Act ivit ies 1 6 . In fo g r a p h ic s 1 8 . Ar tic le s 3 6 . Ch a p te r P r o fi le 4 0 . Re c e n t Ch a p t er Act ivit y 5 1 . R e c e n t Un iv e rsit y Act ivit y 7 6 . Cu ltu r e Co r n er
8 1 . Ph o to g r a p h y Sect ion 9 4 . Ac a d e mic Q u iz
F O R E W O RD World Cancer Day takes place every year on February 4. It aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease. 6 million people die each year from cancer. That is more than HIV/AIDS, malaria and tuberculosis combined. By 2030, experts project cancer deaths to rise to 13 million. If we don’t act. Well, if we act, more than one third of cancer cases can be prevented. Another third can be cured if detected early and treated properly. In total, we can save up to 3.7 million lives every year. Through raising the public and political literacy and understanding around cancer, we reduce fear, increase understanding, dispel myths and misconceptions, and change behaviors and attitudes. In this edition of the eNewsletter, we have included articles written by AMSA members regarding world cancer day. Next, you will be able to take a look at the excitement that happened at the previous EAMSC Thailand 2019! You can also find beautiful photographs taken by AMSA’s talented members. Don’t forget to check the recent chapter activities section and also offers and opportunities from our sponsors. Last but not least, we have an exciting addition to this tenure’s eNewsletter which is the Academic Quiz! You will find a crossword about cancer at the end of the newsletter. You may fill it in by visiting the website through the available link or QR code. The winner of the quiz will be announced in the next edition of the newsletter and will be given an AMSA International merchandise as a reward. So, don’t forget to join the quiz and win your reward! For more updates on AMSA International, visit our website on www.amsainternational.org, and make sure to follow our social media platforms on Facebook, Twitter, and Instagram! Editorial Board AMSA International eNewsletter 2018/2019
PREVIOUS
AMSA INTERNATIONAL ACTIVITIES
EAMSC 2019
32nd East Asian Medical Students’ Conference: “Diabetes and Obesity: The Unrecognized Burden”
Apiraya Lertviram Secretary of Publications and Promotions EAMSC Thailand 2019
The East Asian Medical Students’ Conference (EAMSC) is an annual event held by the member chapters of AMSA. This year EAMSC was successfully held for the 32nd time in Bangkok, Thailand. The theme for the conference was “Diabetes and Obesity: The unrecognized burden”. It is aimed to raise the awareness of the topic through various sessions in the conference along with creating a global network for medical students.
Sawasdeeka! The first day of the conference started with registration early in the morning until late afternoon. Thailand is known as the land of smiles. Hence we gave our warmest welcome to all the delegates arrived in Bangkok, the capital of Thailand. After checking in to the hotel, the delegates and the staff learned more about one another in icebreaking activity. After that, a welcoming party was held at Twin Tower Hotel. On this special night, the delegates enjoyed authentic Thai food. Moreover, there were two special shows to add to the night. One is Khon, an elegant traditional Thai show and the other is Ramalodies, a chorus from Rama Hospital.
The opening ceremony was held at Phramongkutklao College of Medicine followed by a keynote lecture about diabetes and obesity. The academic session continued on until the afternoon. Half of the delegates went for an academic visit at Chulalongkorn hospital, and the other went to Siriraj hospital. These hospitals are two of the best and biggest hospitals in Thailand. The delegates learned about the health care system in Thailand, took a tour around the hospitals and observed medical students at the schools. After a whole day filled with intense scholastic event, we end our day by relaxing at the Royal Winter Festival. We experienced Thai traditional festival where people dressed up in Thai traditional clothes and walked in a street full of lights and shops.
The 3rd day started with one of the most anticipated events of this conference which is the scientific paper and public poster competition. The academic delegates did their best presenting their months of work in this session. After that, the delegates went to the fascinating Grand Palace where the kings and royal families used to live. They also visited the magnificent Emerald Buddha temple at Wat Phra Kaew. To end the evening, EAMSC Thailand committee presented a Siam Niramit show which is a Thai cultural show that they present beautifully.
The 4th day began with the exciting white paper competition and scientific poster competition followed by a panel discussion. In this unique opportunity, the delegates enthusiastically exchanged ideas with medical professionals from many specialties about diabetes and obesity. Next was the international booth, where every delegate and staff indulged themselves in a culturally rich environment. There were food, music, and dance performance. It was very interesting to see people from different cultures had a great time together. After that, the delegates were given free time to enjoy the night with their GMs!
The last day of the conference started with community service which the delegates collaborated to create projects that would give back the community. To make the event more exciting, the Thai Health Promotion Foundation awarded the delegates with the best project. Then, it was time for the closing ceremony which included the thrilling academic awards announcements. Then, there was a cultural workshop for the delegates to have handson experience in Thai culture. In the evening, cultural night and farewell party were held at Baiyoke Tower, which is one of the tallest skyscrapers in Bangkok. The delegates had a chance to appreciate the scenery of Bangkok’s night sky and enjoy the international buffet while enjoying the performance from each chapters.
After five days, the conference had come to an end. However, AMSA Thailand would like this EAMSC to be one of everyone’s most memorable experiences. Months of hard work had paid off with the smile of the delegates. AMSA Thailand hoped that this will be one of the events that inspire people of tomorrow from different cultural backgrounds to come together to create a better world.
“The conference really help me to get an overview of the leading NCD, diabetes, and Obesity. It made us more updated about the current situation and the interventions used to treat the illness. I was really grateful to be a part of this conference.” - Chetali Sharma
THANK YOU EAMSC 2019 “A well-made schedule by warm-hearted people. It was an experience that satisfied both my knowledge and heart. It’s something that I can surely recommend to others” - DaHye (Sally) “EAMSC provides an excellent platform for medical students from all over Asia to connect and work towards the topic of diabetes. It also provides a chance for participants to learn about the difference in the teaching of other medical schools.” - Koh Yu Rui
Supathida Jiamsawad GM of Group 1 EAMSC 2019 Chulabhorn International College of Medicine Thammasat University
IMPRESSIONS FROM A GROUP MANAGER “Guys, let’s get on the bus now!” “Is everyone here yet? Did I miss someone?” “Are you guys hungry?” These are some popular sentences I repeatedly used throughout EAMSC Thailand. On the other side, it was a whole week of traveling, presenting, exploration, confronting new challenges and basically getting lost in EAMSC-Thailand. Well... thank god everyone was found safely at the end.
from a local restaurant or a stall with little or no food nutrition information provided at all, unlike the packaged food in the supermarket that calories, sugar, sodium, and carbohydrates percentages are labeled in details. Sometimes, we need someone else to act as a mirror to reflect ourselves. Sometimes what we do just become normal in our everyday’s life and become unnoticeable until it is called out by others.
Throughout the 5 days of academic presentation and cultural exchanges activities, lots of things happened. On the staff and GM sides, there are so MANY unexpected things happened such as terrific traffics and insufficient food supplies. Some staffs were running around day and night to make a final touch of changes. For GMs, counting 1 to 20 was an every-5- minute routine, making sure that all delegates were not lost (however, most of the time we didn’t count to 20 ;)). Prior plans were made to make the event run as smooth as possible, but unpredicted things kept coming; for example, the booked laboratory for rare disease exploration became unavailable. Sometimes, adaptation, commitment and problem-solving are the most important skills needed to overcome obstacles.
EAMSC was a frame of jigsaw puzzles. Coming together was the beginning. Keeping up together was progress. Working and adapting throughout event together was a success. Talking about the ‘behind the scenes’ was not a pathway full of roses. Sure, I would like to thank the chairperson, all the staffs and group modulators for their commitment and hard work through the year for this special event. However, the event could not have been this successful without all the contribution of the delegates and the alumni. There was a Mongolian delegate from my group who spent 3 days on planes and trains to get to Thailand. 72 hours for a first-year student traveling alone to transit at 3 different countries before reaching Thailand was challenging. I’m sure that every delegate has their own astonishing stories.
More people just means more perspectives. There was a community service session where delegates were given a task to come up with a prototype project for a diabetes prevention plan. It was ironic that international delegates who only spent 3 days in Bangkok brought up amazing aspects of diabetic facts in Thai community, that even someone like myself who grew up in Thailand for 21 years did not even notice. He brought up the fact that Thai people usually buy their food
At last, I would like to thank everyone for building this memorable event together. Although each delegate came from various places with different cultures, beliefs, and languages, everyone shared something in common: the kindness, warm-hearted and most importantly the sense of belonging to AMSA family. The memory is yet to be the end, see you again at the next AMSC Singapore. :)
THOUGHTS AND OPINIONS ON WORLD CANCER DAY Cancer: An Articulation Of Pain And Hope By Mr. Arul Anand, Fourth Year Shri Sathya Sai Medical College & RI AMSA-INDIA The lusty growth of cells, Lurking in stealth on my inside, Rings louder with each passing day, The threat of the final mortal eventuality! Surging levels of tumor markers, Takes me in levitation towards the good heaven, Zodiac signs have never been my muse, But now, look at where it has taken me to! The dread is for real, Yet I’m not going easy on this I would renounce my inherited doom and, I will rise breaking the shackles of pain and fate! An articulation of pain and hope
AMSA-India
“Pappa, what’s a
”
meth-ast-tha-sis-ed cancer?
1.
Srinidhii Murugappan Shri Sathya Sai Medical College & R I.
METASTASIS times, and yet he was uncomfortable as to what was about to follow. He held a file with numerous reports of the recent investigations and he looked into the man’s eyes and asked gently, “What’s on your mind about your condition?”. The man replied, “I don’t think I expect much positivity...” but his wife interrupted him saying, “I think my husband will be perfectly alright in a while, Doctor!” The Doctor glanced sympathetically at the little child and his wife, and continued in a On a cold winter morning, I was soft tone, “I am afraid you wouldn’t want walking down the narrow corridor to hear this but, it has metastasized to the of the surgical ward, when a little girl liver and the lungs, we will try our best ran to her parents with a copy of and put you on a rigorous regimen.....” a leading daily in her hands. She had as anticipated, the doctor’s voice was a curious and a puzzled expression on drowned in the wails and screams of the her face demanding an explanation. wife as she cursed man, medicine and God. The newspaper headline on the front page was, “I have been diagnosed with a But, the husband who was frail and metastasised cancer” and had a picture worn-out, looked calm and had a gentle of the yester-year leading actress Sonali smile on his face. Looking at the events Bendre. The five-year old asked with that unfolded the little girl asked, “Pappa, inquisitiveness, “Pappa, what’s a meth-ast- is this what you meant that the family will tha-sis-ed cancer?” be in more pain than the patient?” The father who was lying on the hospital bed slowly looked up to see the little child’s face and said, “It means that their family is in great pain than the patient!” Still perplexed, the little girl continued, but her mother nudged her to be quiet while her father lay still and quiet. A little while later, a staff nurse escorted their family to the attending physician, who was a man of knowledge and compassion. He took a deep breath, he had done this many
TO MANAGE CANCER PAIN, TO BATTLE AGAINST CANCER Pain is a common and burdensome symptom of cancer with a prevalence of 53% in all stages of cancers and 64% for advanced/metastatic/terminal cases. [1] We have seen an elevation of the percentage of patients with cancer pain who got cancer pain management. However, according to a meta-analysis, nearly 43% of the patients with cancer pain were left undertreated. [2] Factors related to cancer pain undertreatment were countries with a gross national income per capita <40 000 per year and a care setting not specified for cancer.
1.
Despite the neglection of cancer pain by some patients and physicians, cancer pain is actually challenging the cancer treatment in many ways. It frustrates and even depresses both patients and their families, and interferes with their quality of life. Whatâ&#x20AC;&#x2122;s worse, in some cases, it resulted in giving up on the treatment and even suicide. In a word, cancer pain is so damaging that it worth our attention. Considering the low rate of cancer pain management provided, we offered the following suggestions for an improvement in the management of cancer pain.
First, patients should report the pain problem to their doctors or nurses, to get help for the relief of pain and to provide information about the extension of cancer. Patients, their families, physicians and nurses should be fully informed that cancer pain without treatment can cause bad consequences and that cancer pain can actually be treated effectively in most of the cases. People may tell the cancer patients to be tough and to live through the pain caused by cancer. But this is actually misleading since cancer pain is actually treatable.
Second, a simple pain intensity scale reporting the level of pain is highly recommended. It helps monitoring the severity of cancer pain and the effectiveness of pain management. Moreover, it is also useful in helping establish pain control goals for the individual patient. Third, pain relief can be provided by a range of medications prescribed by the physician, with Aspirin-like drugs, Paracetamol and Opioids, such as codeine and morphine included. Some people respond better to certain pain-killing medications than others. So, treatment is always individual, according to their sensitive drugs and the score on the pain intensity scale. Last but not least, if the cancer pain is so severe that it cannot be relieved by drugs, other types of treatments can often be used, such as surgery, nerve block, spinal analgesia, epidural and so on included. Cancer pain management is an important part of the effective cancer therapy. To battle against cancer and improve the quality of life of the patients, weâ&#x20AC;&#x2122;d better pay attention to pain management.
AMSA-China
“nearly 43% of the patients
with cancer pain were left undertreated.
”
2.
Jiayi Shen
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China 1. Beuken-van Everdingen, M. H. J. van den, J. M. de Rijke, A. G. Kessels, H. C. Schouten, M. van Kleef, and J. Patijn. 2007. “Prevalence of Pain in Patients with Cancer: A Systematic Review of the Past 40 Years.” Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO 18 (9): 1437–49.
2. Deandrea, S., M. Montanari, L. Moja, and G. Apolone. 2008. “Prevalence of Undertreatment in Cancer Pain. A Review of Published Literature.” Annals of Oncology: Official Journal of the European Society for Medical Oncology / ESMO 19 (12): 1985–91.
AMSA-Malaysia
â&#x20AC;&#x153;Now as a medical student
and the future of our nation we carry a big responsibility to raise public understanding regarding cancer.
â&#x20AC;?
3.
Kirthiga Sri Ravindran Universiti Malaysia Sabah, Malaysia
I AM A MEDICAL STUDENT, I WILL INSPIRE THE PUBLIC day 2019. This include world cancer submits, cancer leadership campaign, walks, runs and rides in the name of world cancer day.
‘Health is Wealth’ is one of the most common proverbs uttered by everyone as their life goals. I agree with this proverb, but let’s think about people who have a disease like cancer. They were not blessed with a healthy life like most of us do. This does not mean that they had lost their wealth of being a human. It does not mean that they were cursed to leave us soon. In accordance to create solemnness on cancer and to eradicate stigma on cancer, world cancer day was founded by the union for international cancer control to support the goals of the world which was cancer declaration written in 2008. February 4 was declared to be World Cancer Day (WCD). The primary goal of WCD is to significantly reduce illness and death caused by cancer and is an opportunity to rally the international community to end the injustice of preventable suffering from cancer. The theme for 2019 world cancer day celebration is ‘I am, and I will’. 2019 marks the launch of the 3-year theme I am, and I will campaign. This theme inculcates everyone to give personal commitment and represents the power of individual action taken now to give a better future. This multiyear campaign can be useful in creating a long-lasting impact among people and more opportunities to create global awareness and impactdriven action. Many activities were organized by people around the world in conjunctions with world cancer
Now as a medical student and the future of our nation we carry a big responsibility to raise public understanding regarding cancer. First and foremost, in my rosy view of opinion, we can start up with our university people. We can organize a tour to each faculty and residence to give out brochures and discussion about cancer. We can educate them on how to motivate cancer patients. This act will yield more benefits as well-educated generation like those in the university are more trustworthy in passing a message on cancer awareness to current society. We can place posters regarding the responsibilities of students in fighting against the stigma of cancer. Besides that, we can reach out to public by putting on the current progress of cancer research in social media. In today’s world, social media had been one of the basic needs of humankind. Hence, it can help us to educate them on cancer treatment and preventions. We can also organize health promotions to shine a light on this matter among public. Other than that, we can have booths on cancer in crowded areas like hospitals, shoping malls and school. In a nutshell, there are many ways for us to create awareness on cancer treatment and prevention. We, as a medical student and future pillars of our nation, should take a step ahead in making these campaigns a success. “I am a medical student and I will inspire the public”
A PARADIGM OF LOOPHOLES “To me, death came every day, until it convinced my body to let go.” A 34 year old vibrant architect, was diagnosed with stage 4 breast carcinoma after about a year of suffering and negligence. As she lays grieving in pain, the night before her departure; the only thought that gnawed through her soul was..’IF ONLY..’ Despite of all the unswerving efforts of medical professionals and humongous investments made by healthcare institutions to achieve optimal awareness among the populace; Cancer still continues to swiftly pave its way towards becoming the leading cause of morbidity and mortality across the world. The patient, aforementioned, was well aware of the disease and its repercussions, then what caused her to die? Was it just the disease? I’m afraid not. Just like in about 30-40% of cases (or even more!) IF ONLY had the following measures been taken, she might have been able to win that battle.
spine. (Yet, a CT scan wasn’t done until other signs of the cancer became obvious).
In-depth history - About a year before her death, she had
Line of treatment - Cancer is a devil you combat
1.
visited her physician with complaints of chronic backache and episodic blackouts. Since the complaints seemed trivial initially the physician didn’t bother to take her family history (Her maternal aunt had had breast carcinoma)
Frequent screenings - Given the embarrassment and
vulnerability associated with breast cancer, the aunt had never revealed it. By the time the family came to know of it, she had already undergone treatment and recovered. So other members of the family never bothered to undergo a screening, considering it embarrassing and pessimistic ( even though well educated!). Also, “How can someone as young as 34 ever get breast cancer?!”
Optimal diagnosis - The doctor had concluded that the back aches were the result of poor sitting posture at work and the blackouts were a result of stress. Failure of mild analgesics lead to the presumptive diagnosis of vitamin D deficiency and its appropriate treatment. REAL REASON- The carcinoma had metastasized to her
Nurturance (palliative care) “YOU CAN’T ADD DAYS TO THEIR LIFE, BUT YOU CAN ADD LIFE TO THEIR DAYS.” Hospice care is undervalued as much as it is important. Was she provided with it? If Only.. against using another devil -- chemo and radiotherapy. Many terminal patients prefer to die of cancer than suffer the complimentary agony that comes with its treatment. Whereas for the early detected cases, it is essential for the doctor to make the right call, either to treat it surgically and medically.
Your will power - At last it all comes down to ‘miracles’.
The Human Psyche has this unfathomable ability to get you past any obstacle in the labyrinth of existence. It blesses but a very few with its company… These loopholes, seemingly nominal, were capable of taking a person’s life. And hence, as the doctors of tomorrow, the IF ONLY paradigm demands from us, not only theoretical expertise but also vigilance and prudence. The battle has just begun!
AMSA-India
“IF ONLY had the following
measures been taken, she might have been able to win that battle.
4.
Khushi Desai
Shri M.P. Shah Gov. Medical College, Jamnagar, India
”
AMSA-Thailand
â&#x20AC;&#x153;Spreading awareness is a slow but steady process. â&#x20AC;?
5.
Benyapa Wongsaravit Rangsit University, Thailand
WHAT CAN WE DO TO RAISE PUBLIC UNDERSTANDING OF CANCER Another method where medical students and those in the healthcare field can be a part of the cancer awareness campaign is by organizing support groups for individuals who are affected by cancer. Cancer is a very broad term and it is important that we set up specialized support groups such as As medical students with a prospective career
support group designed from those with breast or lung cancer.
in the healthcare field, we have an important role to raise
Through these support networks, participants are
public awareness and understanding
more likely to connect with others where they can
to the general public. Since cancer is a prevalent issue in Thailand, it is important
establish a small close-knit community that can be beneficial in the long term of their treatment.
that we put in a lot of effort to understand the nature of the disease and think about what can we
Spreading awareness is a slow but steady process.
do to prevent it.
Currently, the National Cancer Institute of Thailand is efficiently promoting awareness on early
Currently, there are various methods that we,
detection of cancer within the local communities
as medical students, can spread to raise public
of Thailand. I believe that medical students have
awareness about cancer and contribute to society.
the power to continue the effort from previous
For instance, we can host a campaign marathon
generations on the topic of cancer awareness.
run like HIV-Run where the community can come
Hopefully, one day, with all of our united effort,
together and participate in the event. The cancer
cancer will no longer be a prevailing issue in our
campaign run has many incentives since not only
society.
we are raising money to donate to those who are affected by cancer, but we can also publicize the topic of cancer through the news, social media or conversational means.
TURNING TODAY’S MULTIDISCIPLIN INTEGRATION INTO TOMORROW’S C CARE: TREATMENT MODEL FOR ESOPHAG PULMONARY CARCINOMA AS AN EX An 81 years old gentleman endorsing progressive swallowing difficulty for the recent 3 months visited our hospital. He complained dysphagia with postprandial vomiting. Body weight loss was, however, denied. He admitted 10 pack-year smoking history and extensive alcohol consumption. Physical examination was otherwise noncontributory except for a mass palpated in the supraclavial. Under the impression of esophageal neoplasm, the patient underwent UGI endoscopy, which showed a 3-cm ulcerative tumor at 29-32 cm from incisors. A biopsy was completed and squamous cell carcinoma (SCC) was reported. Chest CT and whole-body PET exhibited metastatic lung nodule, yielding cT3N1M1, stage IV. In response, laparoscopic feeding jejunostomy and port-A were inserted by a general surgeon, and definitive CCRT was initiated by a medical oncologist. Nevertheless, worsened dysphagia and retrosternal dull pain onset 6 months later. Repeat UGI endoscopy demonstrated esophageal obstruction, favor recurrent SCC. The patient pursued palliative surgery over enrolling in immunotherapy trial. Under single-lumen endobronchial narcosis developed by anesthesiologist instead of double-lumen for better radical lymph node dissection, subtotal esophagectomy, cardiectomy, gastric tube reconstruction, and thoracoscopic RUL wedge resection were performed. Nutritionist and respiratory therapist were consulted post-op for diet modification and breathing exercise, respectively. The patient is currently in stable condition.
pneumolysis. Since the position of the later nodule was difficult to assess, perioperative real-time electromagnetic localization via endotracheal injection of contrast medium was suggested by a radiologist. The patient stood the whole procedure well and was discharged three days later.
1.
Another case is a 79 years old male with underlying hepatic flexure colon adenocarcinoma, pT3N1bM0, stage IIIb, s/p right hemicolectomy. During outpatient follow-up, chest CT incidentally revealed a speculated nodule at LUL and a cavitary lesion at RUL. Several ground-glass opacities were also observed bilaterally. After primary cancer under control and metastatic pulmonary lesions resectable, the patient agreed to receive surgical intervention. Uniportal Video-Assisted Thoracic Surgery (VATS) RUL lobectomy was executed by chest surgeon, followed by LUL wedge resection with
Reviewing the present two case reports, the structure of the multimodal program was contoured. While a plethora of studies investigated how to utilize various tactics, the optimal treatment combination remained controversial and highly context-dependent. For instance, neoadjuvant CCRT followed by the operation was once well-established to be the gold standard for esophageal cancer. The necessity of esophagus and/ or neighboring lymph node resection had recently been challenged. The individualized extent of tissue preservation without hampering pathohistologicallyfree and achieving satisfactory disease control envisions patient- centered primary care. Besides, intraoperative tumor localization expanded surgical benefit by minimizing unnecessary resection range and avoiding pain prior to surgery. Despite more experience should be accumulated to refine the protocol, such concept of “single-surgeon for single-disease” must be revisited. Our model demonstrated the advantage based on participation of multidisciplinary tumor board. Teambased effort accelerates the advancement of cancer treatment and would eventually realize quality care upon disease itself as well as the patient.
NARY CANCER
GEAL AND XAMPLE
AMSA-Taiwan
“Team-based effort accelerates
the advancement of cancer treatment and would eventually realize quality care upon disease itself as well as the patient.
6.
”
Ting Wei Kao
National Yang-Ming University, Taiwan
AMSA-Thailand
â&#x20AC;&#x153;Spreading awareness is a slow but steady process. â&#x20AC;?
7.
Akrawit Viriyavejakul Thammasat University, Thailand 1. Barnoya J, Glantz S. Secondhand smoke: the evidence of danger keeps growing. The American Journal of Medicine [Internet]. 2004 [cited 23 December 2018];116(3):201-202. Available from: https://www.amjmed.com/article/S0002-9343(03)00693-4/fulltext 2. Ferrea S, Winterer G. Neuroprotective and Neurotoxic Effects of Nicotine. Pharmacopsychiatry [Internet]. 2009 [cited 23 December 2018];42(06):255-265. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19924585 3. Yolton K, Dietrich K, Auinger P, Lanphear B, Hornung R. Exposure to Environmental Tobacco Smoke and Cognitive Abilities among U.S. Children and Adolescents. Environmental Health Perspectives [Internet]. 2005 [cited 23 December 2018];113(1):98-103. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253717/ 4. Fiala C, Kulasingam V, Diamandis E. Circulating Tumor DNA for Early Cancer Detection. The Journal of Applied Laboratory Medicine [Internet]. 2018 [cited 22 December
WHAT ACTION SHOULD BE DONE BY THE POLICYMAKERS TO REDUCE RISK FACTOR EXPOSURES AND TO IMPROVE PREVENTION AND TREATMENT OF CANCER?
For the majority of people, there is no scarier diagnosis than that of cancer. Cancer is often thought as a terminal, untreatable and painful disease. However, this popular view of cancer is exaggerated and over-generalized. Because of this fearsome reputation, cancer is undoubtedly a serious and potentially lifethreatening illness. The first step in tackling cancer is to reduce risk factors that cause it. Simply avoiding smokers will decrease exposure to secondhand smoke, which is the combination of cigarette smoke and smoker exhalation [1] . Major locations of exposure to secondhand smoke include workplaces, public areas such as bars, recreational spaces, and homes. Children in homes are particularly vulnerable because their lungs are still developing and are susceptible to toxins. Unnecessary exposure to respiratory poisons can increase risk of severe respiratory diseases and underdeveloped lungs [2] . Moreover, more than 21 million children are estimated to be at risk of reading deficits because cigarette smoke is neurotoxic even at untraceable low levels [2,3] . The only solution to protect nonsmokers is to eliminate smoking by creating nonsmoking areas and regulations.
The prevention of cancer and the development of effective strategies to detect cancer precursors remain critical goals in early screening. The time from initial exposure to a carcinogenâ&#x20AC;&#x201D;for example, ultraviolet light exposure or tobacco smoking takes decades before progressing to cancer. Then, the malignant tumors shed fragments of cells or intracellular molecules into their immediate environment. Often these substances are detectable in the blood, other bodily fluids, or feces, providing the potential for easier, less- invasive screening methods for early cancer detection. One type of biomarker that has gained attention is ctDNA or circulating tumor DNA [4] . This type of DNA is marked by key mutations or abnormalities found in intact tumor cells. Cancer treatment has seen many advances over the last century in its slow shift towards precision treatment. Surgery is more precise, less invasive and with early detection, it can even cure some cancers such as select breast and colon cancers. Radiation can be designed to an individualâ&#x20AC;&#x2122;s cancer characteristics and can completely cure earlystage cancers. However, elimination of cancer requires hope in the accelerating rate of cancer drug discovery [5] . Some new regimens fuse old therapies for new uses, while others are classed as an entirely new type of drug. One notable new class is targeted therapy drugs that attack cancer cells and will largely leave healthy cells alone [6] . Interestingly, increasing funding and attention from the private sector remain vital to the success of these drugs.
THE ENEMY IS AT THE GATE: WHY THE GRAY AREA OF ONCOLOGY IS STILL SO FAR FROM MANY, ALTHOUGH NOT ONE IS IMMUNE. RUN OR PREVENT? Today, out of all types of pathologies, breast cancer is the most common pathology among women. I used to ask myself a lot -- why so much attention is paid to this category of pathologies? The first time I thought about this was when a charity forum - a marathon called “In the Name of Life”, devoted to the problem of breast cancer, was held. It was the first large-scale event of this kind in Uzbekistan, which took place in the city of Tashkent and united more than 100 thousand people throughout the country. The organizers of the forum were the Fund Forum, the National Association for Breast Cancer and the Breast Cancer Foundation named by Susan Komen (USA). It was a truly large event that brought the whole country together: doctors, athletes, artists and, cultural workers, schoolchildren and volunteers - all those who are not indifferent to the ideas of charity and support for women’s health.
Today, patients with such a diagnosis have a burdened family history. So, let’s ask ourselves, who should be the first to talk about this from the very beginning? We tell doctors to pay special attention to this. We introduced screening throughout the country to detect and prevent cervical cancer. We received good statistics on this type of tumor. However, there are still a lot of questions, and I think that this gray zone of oncology should be kept in everyone’s mind. That is the way our people work, they do not like seeing the doctors. Some people start to panic at the sight of hospitals and any other medical institutions. Perhaps not only the doctors of polyclinics that should deal with the prevention of oncological processes. Because the proper attitude to our health should be in the minds of everyone, regardless of our family history. After 2 episodes of cancer from generation to generation in my family, I realized that. Moreover, what to do with those who, as they might think, is very far from all this? Or maybe we should talk about it from school desks?
1.
I could only answer myself the question of why so many international, national organizations of foundations pay attention to breast cancer only when I faced this problem in my family. I was a 3rd-year student at a medical institute and I still had little idea of the processes that occur in the body when oncology appears. However, for my mom at that time, my knowledge was unnecessary. All that I saw in her eyes is a mad desire to live, to fight for life, to conquer the disease at all costs. My mother bravely accepted everything that she had to go through for recovery. I must say that the therapy and diagnosis of such patients in Uzbekistan comply with world standards. All consultations, therapies, tests, including surgical interventions, are carried out in our country for absolutely free of charge. We have excellent oncologists who always know what to do when we first identify the oncological process. Unfortunately, only when the disease is identified. Without prevention, things are always much worse. We can constantly talk about the problems of today’s oncology, we can write, talk on TV, hold various forums and master classes, but I am sure that there is a very small percentage of people who undergo various examinations and pass the tests for oncology.
Today I can breathe easily because nothing threatens my mom’s life. But not all such stories have a good ending and many will agree with me. I can even say that this is not a happy-ending story at all. This is a job. This is an attentive attitude towards your health and prevention. Mom does it, I do it, and my children will do it. Yes, today a lot of attention is also paid to the aesthetic side of the issue of oncology, especially when it comes to women. It is worthy of respect. Nevertheless, I think everyone, who is getting on the surgical table, thinks that they will not wake up without some part of his body; but first, he will surely wake up without cancer.
AMSA-Uzbekistan
â&#x20AC;&#x153;All that I saw in her eyes is a
mad desire to live, to fight for life, to conquer the disease at all costs.
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Asmik Kostyunina Scientific Research Institute of Pediatrics, Uzbekistan