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Role of Oncological Terrain in Cancer Prevention.
- Sergio Stagnaro (9 May 2003)
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No unnecessary injections please
- Kamal Kumar Mahawar (11 May 2003)
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Paan chewing is an important risk factor for hepatocellular carcinoma
- Ajit Singh Kashyap, Kuldip Parkash Anand, and Surekha Kashyap (30 June 2003)
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Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio N° 23/8. 16037 Riva Trigoso (Genoa) Italy.
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Sirs. More than half of people with hepatocellular carcinoma (more than 500.000 cases globally annually with a five year mortality exceeding 95%) are notoriously in China. Andrew J Hall and Christopher P Wild state in their article (1): “The causes of most of these cancers are now known, and their prevention is possible”. My first question: “In whom hepatocellular carcinoma primary prevention has to be performed? For instance, in “all” Chinese individuals?”. In additon, the same authors, in agreement with others, continue: “More than 50% of hepatocellular carcinomas are due to persistent (as opposed to transient) hepatitis B infection, and around 25% are due to persistent hepatitis C virus”. It is plain that some, but “not all” subjects , who suffered from such as infectious viral disease, present hepatocellular carcinomas(75% of diseased subjects present HC: it is too much in my 46-year-long clinical experience!). Certainly, I agree with the autors on the fact that “Preventing infection (i.e., Hepatitis B vaccination) with these two hepatitis viruses is one key strategy to reduce the burden of liver cancer”. However, I like to put my third, and least, but not last, question: “Who must undergo to hepatitis – B, C – vaccination in order to prevent cancer?” In my opinion, Primary Prevention of the most common and dangerous human pathologies, including hepatocellular carcinoma, depends mainly by easy and quick bed-side detecting individuals at "real" risk, e.g., of cancer (See www.piazzetta.sfera.it, http://digilander.libero.it/piazzettamedici/professione/professione.htm, as well as http://digilander.iol.it/semeioticabiofisica, Oncological Terrain, Oncogenesis, three articles: Biophysical-Semeiotic Constitutions) (2, 3, 4). To define clinically a particular constitution, which does not exclude the presence of others, it is necessary to think over the current possibility of gathering at the bed-side "biophysical-semeiotic" data, providing biological and molecular-biological information on the various human organs, tissues and apparatus, so that doctor can describe numerous types of constitutions, even from the quantitative point of view. Without any doubt, these data can not be observed at all by the aid of traditional physic semeiotics, unable of carrying molecular-biological events to clincal dimension, which really represents the most original and fertile aspect of Biophysical Semeiotics. In conclusion, we must recognize, at first, individual involved by “Oncological Terrain”, i.e., “Oncological Constitution”, and then localized precisely the real risk of cancer in a quantitative way, so that the prevention can be perform in individuals clinically (i.e., on very large scale) and rationally selected, regardless of the level of country income. Sergio Stagnaro MD.,Member NYAS. 1) Hall AJ., Wild CP.Liver cancer in low and middle income countries Prevention should target vaccination, contaminated needles, and aflatoxins BMJ 2003;326:994-995 ( 10 May ). 2) Stagnaro-Neri M., Stagnaro S. Cancro della Mammella: Prevenzione Primaria e Diagnosi clinica precoce con la Percussione Ascolata. Gazz. Med. It-Arch. Sci.Med. 152, 447-457, 1993. 3) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz. Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28 Settembre-1 Ottobre, Bellagio,1983 4) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una Patologia Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144, 423, 1985 (Infotrieve) Competing interests: None declared |
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Kamal Kumar Mahawar, SHO General Surgery Caithness General Hospital, Wick KW1 5NS
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I agree with the authors that there is an urgent need to control hepatitis B anc C infections to reduce the incidence of hepatocellular carcinoma. (1) The prevalence of hepatitis B infection has reached alarming proportions in many a countries. In India, use of inadequately sterilized needles and syringes has been linked with many a outbreaks.
One important fact to be noted in this regard, which has also been confirmed by studies (2,3), is that many a times these therapeutic injections administered are unnecessary. The advantages of parenteral route have been overemphasized and clinicians everywhere especially the ones in developing countries need to realize the inherent danger associated with each injection. Most common illnesses can be treated by orally administered formulations and the use of parenteral route in these situations does not guarantee much speed and efficacy. Referenes: 1.Hall AJ, Wild CP. Liver cancer in low and middle income countries. BMJ 2003;326:994-995. 2. Singh J, Bhatia R, Patnaik SK, Khare S, Bora D, Jain DC, et al. Community studies on hepatitis B in Rajahmundry town of Andhra Pradesh, India, 1997-8: unnecessary therapeutic injections are a major risk factor. Epidemiol Infect 2000 Oct;125(2):367-75. 3.Singh J, Gupta S, Khare S, Bhatia R, Jain DC, Sokhey J. A severe and explosive outbreak of hepatitis B in a rural population in Sirsa district, Haryana, India: unnecessary therapeutic injections were a major risk factor. Epidemiol Infect 2000 Dec;125(3):693-9 Competing interests: None declared |
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Ajit Singh Kashyap, Reader , Medicine, Armed Forces Medical College, Pune 411 040, INDIA Medicine Department Armed Forces Medical College,Pune 411 040, INDIA, Kuldip Parkash Anand, and Surekha Kashyap
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Sir, We read with interest the excellent editorial on hepatocellular carcinoma by Hall and Wild (1). However the authors do not mention the recently recognised link between widespread habit of paan chewing and hepatocellular carcinoma (HCC) (2). Paan almost always includes calcium hydroxide, areca nut (from areca catechu tree), and betel leaf (from piper betle vine), to this tobacco and other various spices are commonly added. The habit of paan chewing is widespread in south asia, south east asia, and south pacific. . The link between paan chewing and oral cancer is amply recognised (3) In a study from southern Taiwan, J-F Tsai et al (2) report independent, dose dependent association between paan use and HCC (OR 3.49, 95%CI 1.74-6.96). More importantly this study concluded that paan chewers infected with hepatitis B (synergy index 5.37) or C (1.66) were at greater risk of HCC than those were with viral hepatitis B and C alone (2). Paan is a known hepatotoxic agent (4), but exact carcinogen is not known. The possible carcinogens are nitrosamines, and aracholine, a pharmacologically active alkaloid present in the areca nut. Safrole is also present in the betel bud and leaves. Safrole-DNA adducts have been found in oral tissues of users and in the hepatoma cells of one user (5). The exact mechanism of carcinogenicity of paan is yet to be determined. Paan chewing is particularly common in lower socioeconomic members of the society in Taiwan and elsewhere, the groups particularly at high risk of hepatitis. The use and spread of the habit of paan chewing should be discouraged (5). Conflict of interest -none Source of funding-nil *Ajit Singh Kashyap MD Kuldip Parkash Anand MD
Surekha Kashyap MD
References 1.Hall AJ, Wild CP. Hepatocellular carcinoma in low and middle-income countries. BMJ 2003; 326:994-995. 2.Tsai J-F, Chuang J-L, Jeng J-E, et al. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case control study. Br J Cancer 2000; 84:709-12. 3. Gupta P, Mehta H. Cohort study of all-cause mortality among tobacco users in Mumbai, India. Bull World Health Org2000; 78:877-83. 4. Sarma A, Chakrabarti J, Chakrabarti A, et al. Evaluation of paan masala for toxic effects on liver and other organs. Food Chem Toxicol 1992;30:161 -163. 5. Mack TM The new pan asian paan problem. Lancet 2001; 357:1638-1639. Competing interests: None declared |
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