The Biggest Battlefield Against Cancer Is Not the Hospital, but Beyond Its Walls

Because I treat a relatively large number of neuroblastoma children, I have come into contact with many neuroblastoma families and thus have some understanding of the epidemiology of this disease. Many of the neuroblastoma patients I treat come from my hometown, Huanggang, Hubei.

I have not done a detailed survey in Hubei Province, so I do not know whether Huanggang is the place with the highest neuroblastoma incidence in Hubei, but intuitively there are indeed many neuroblastoma children from Huanggang. For a while, I encountered a neuroblastoma child from Huanggang almost every day, sometimes more than one in a single day.

Some parents told me that at Wuhan Children's Hospital, child tumor patients from Huanggang account for a very large proportion. It is said that about 40% of child tumor patients come from Huanggang, far more than from all other regions of Hubei.

This intuitive impression is not rigorous, but it does reflect a very serious problem: my hometown is indeed "sick," and not lightly.

By my own impression, every year in recent years quite a few people in our village have died of cancer—stomach, esophageal, liver and lung cancers are the most common causes of death. I previously paid little attention to child tumor patients in Huanggang, but now that I encounter more and more Huanggang-born child tumor patients, I have a very direct impression of the problem.

Generally speaking, the following factors are associated with neuroblastoma: premature and low-birth-weight infants; use of sex hormones before or during pregnancy; a daily drinking history during pregnancy; and parents working in electronics-related occupations. The real reason for the high neuroblastoma incidence in the Huanggang area may be that many local migrant workers work in electronics factories.

People from Huanggang are extraordinarily hardworking; I can say without modesty that they are among the hardestworking groups I have ever seen. Even in China, a country known for diligence, people from Huanggang rank at the top in industriousness. Many Huanggang people went out to work in earlier years; more than half of the young people—especially young women—went to electronics factories in Dongguan, Shenzhen and elsewhere. This is not hard to explain as to why neuroblastoma is so common in the Huanggang area.

As for why there are so many lung-cancer patients locally, it relates to the fact that too many people in Huanggang smoke and the air pollution is serious—by my own experience living long-term in both Huanggang and Beijing, I feel the air quality in Huanggang is far worse than in Beijing. In recent years Huanggang's air pollution has been severe; there are few blue-sky white-cloud days all year round, very different from twenty or thirty years ago.

The high local incidence of stomach and esophageal cancers has much to do with the Huanggang habit of eating preserved foods such as cured fish and cured meat. What I found most vexing in my hometown is the question of food; as living conditions have improved, more and more New Year cured goods are prepared, and cured fish, cured meat, cured chicken and pressed duck are very popular. So the incidence of stomach and esophageal cancer in Huanggang is very high; in my village almost more than half of cancer patients have stomach or esophageal cancer.

Liver cancer is related to the prevalence of hepatitis B. At my college-entrance physical, about a quarter of the students in my class were found to have hepatitis B. I still remember that when we were children getting vaccinated, everyone shared needles. The barefoot doctors in the countryside gave us injections, boiling needles in a metal lunch box over an alcohol lamp, and that counted as disinfection. When many children were being vaccinated, it was very slapdash. I am now grateful that AIDS had not yet spread in our area in those days; had it been widespread, vaccinated this way, I do not know how many people would have died unjustly.

Treating one tumor patient takes enormous effort, but preventing cancer from occurring does not require such great effort. It is just that our country has yet to elevate cancer prevention to the level of a national strategy. As Professor Jia Jiafú, director of Beijing Cancer Hospital, has urged, we have indeed reached a stage at which cancer prevention should be elevated to a national-strategy level.

The current incidence of cancer in China is very high; about one in four urban people and one in five rural people will eventually develop cancer, and in some first-tier cities this proportion is even one in three.

The causes of cancer are many: environmental pollution, life expectancy, the working environment, food and water sources, and dietary and living habits may all induce cancer. Cancer places a heavy burden on all of society; many families are impoverished by cancer, and cancer brings a series of social problems. To reduce the incidence of cancer at the root, there is no alternative to a whole-of-nation declaration of war on cancer.

Abroad, many media outlets, organizations and individuals are fighting to prevent cancer, and we are still far from doing enough. The many cancer types I have encountered in practice over these years—such as melanoma, bowel cancer, breast cancer and childhood tumors—can only be described as exploding in growth rate. In the last ten-plus years, the incidence of malignant melanoma has risen more than tenfold, and some rare tumors are progressing at breakneck speed. In the past, a single cancer case caused a sensation; now, with cancer so common, almost everyone has several cancer patients around them, and people have long since ceased to be surprised.

We need a more developed preventive-medicine system—the concept of preventive medicine is very broad, and building a developed preventive-medicine system requires not only doctors and scientists but also the participation of the public.

For example, the relationship between smoking and lung cancer is very close; to control the incidence of lung cancer, the whole nation must ban smoking. On the issue of the smoking ban in the United States, almost the whole nation was in action.

Doctors and scientists provided detailed data proving the relationship between smoking and lung cancer; lawyers sued the tobacco companies; public-service-ad organizations, in the time slots when cigarette ads aired, broadcast ads that smoking causes lung cancer; some well-known journalists and writers became the vanguard of the anti-smoking movement, loudly appealing in the media for everyone to face up to the harm of tobacco.

Through everyone's joint efforts, the wealthy and greedy tobacco companies were finally brought down, advancing the American anti-smoking movement, and the incidence of lung cancer dropped markedly.

Preventing melanoma in the United States was likewise the work of a group of volunteers. On crowded beaches, they popularized for everyone knowledge and tips on preventing melanoma and detecting it early—melanoma is one of the few cancers that can be detected and prevented early. As long as one pays attention to the bordered moles on one's body surface (moles that differ from normal black moles), most melanomas can be detected early, and an early-detected melanoma can be eradicated with just a very small outpatient procedure.

Of course, prevention is even more important. Most melanomas are caused by ultraviolet radiation, so popularizing sun-protection knowledge in places where tourists gather can effectively reduce the incidence of melanoma. The sharp rise in melanoma incidence in our country in recent years has much to do with the rapid growth of our tourism industry.

Propaganda and education can save lives, but in our country few people are willing to devote great energy to this kind of volunteer and popular-science work. Tall hospital buildings rise one after another, more and more patients make the hospitals unbearably crowded, and tumor-ward corridors are filled with extra beds; we are paying a heavy price to treat cancer. Preventing cancer costs far less, but its social benefit is enormous.

I hope that we strong, young and middle-aged people can all become a fresh force in cancer prevention, joining this campaign against cancer. Only by gathering the strength of all sectors of society can the declaration of war on cancer achieve true victory.