Fighting cancer head-on

'If you get rid of factors that cause preventable cancer, such as tobacco, a poor diet and the lack of physical activity, you reduce the risk of cancer by one-third or half,' says Dr Teo Soo-Hwang.

Most people are decidedly nonchalant when it comes to cancer research, but here's something that might grab your attention: It is currently estimated that one in four Malaysians will develop cancer in their lifetime.

To put it simply, cancer - once thought to be a rare disease - is now more likely than ever to rear its deadly head among your friends and family. Even you may not be spared.

Professor Dr Teo Soo-Hwang, chief executive officer of the Cancer Research Initiatives Foundation (CARIF) says an unhealthy lifestyle contributes significantly to the elevated cancer rates.

"One of the top risk factors for cancer is definitely tobacco," Dr Teo notes. This is followed by a combination of poor eating habits and a lack of exercise.

"A national morbidity survey conducted by the Health Ministry found that about 90 per cent of adult Malaysians do not eat enough fruits and vegetables, which is probably why the rate of colorectal cancer is increasing rapidly."

Being a sluggish couch potato makes up the other half of the unhealthy equation.

"About 20 per cent of Malaysians are obese and I think this number is increasing at an alarming rate. It is not just weight that is the problem; we have many Malaysians who are skinny but do not exercise. They would rather go on crash diets which are detrimental to the body," she says, adding that it is important to get vaccination against viruses like hepatitis and cervical cancer.

"If you were to get rid of these factors that cause preventable cancer - tobacco, a poor diet and the lack of physical activity - you reduce the risk of cancer by one-third or half," says the professor at Carif's office in Sime Darby Medical Centre, Subang Jaya, Selangor.

The bad news is, not all cancers are preventable. Genetics also plays a large part in determining one's risk of developing the disease, Dr Teo says. For example, being Chinese automatically predisposes you to nasopharyngeal cancer (which affects the throat) more than any other population in the world. "In other words, in order to have nasopharyngeal cancer, you have to have some elements of Chinese, East Asian or Mongoloid genes in your genetic make-up. The cancer is almost exclusive only to the Southern Chinese," Dr Teo elaborates.

The foundation, which has collaborated with research centres in the United States, Britain, Japan and Australia, currently aims to develop new targeted therapy with fewer side effects for cancers that are more common in Asians. They include nasopharyngeal and oral cancers.

"We focus on why our Asian genes cause us to develop certain cancers and why we respond differently to treatment compared to our Caucasian counterparts."

According to Dr Teo, people of Asian descent may not respond as well to existing cancer treatments as they are targeted mainly at the Caucasian population.

"We know that Asians make up about 60 per cent of the world's population and that means that six out of 10 of the seven billion in this world is an Asian. But at this moment, less than 5 per cent of Asians take part in genetic studies," she points out.

"So for example, if you look up on any scientific discoveries, you'll find that less than 5 per cent of the studies are actually conducted in Asia.

"Our research is important because we know that the genes we inherit influence the risks we have towards a disease as well as our response towards a treatment," Dr Teo adds.

Currently, about 80 per cent of nasopharyngeal and oral cancer patients are Asians. In Malaysia, half of the oral cancer patients die within the first two years. Meanwhile, nasopharyngeal cancer patients often develop metastatic diseases (when the disease spreads from one organ or part to another non-adjacent organ or part) or recurrent diseases and treatment for such diseases is not very effective for both cancers, Dr Teo notes.

To make matters worse, very little research has been conducted on both cancers as they are perceived to be "low to middle income cancers" as well as cancers that are "taking place in Asia," says Dr Teo.

So far, Carif has registered three patents on new treatments for oral and nasopharyngeal cancer and hopes to conduct clinical trials within the next few years.

"We have found proteins in cancer cells that are not present in normal cells and these can be targeted to treat cancer.

"So far, we have developed new cancer cell lines from Asian patients that are being used all over the world to help us find cures for these cancers," she explains.

Carif is also researching over 5,000 species of local plants for anti-cancer compounds. Malaysia boosts a large chemical diversity of flora and fauna that may be developed into clinically useful drugs. Realising this potential, Carif has tapped into the country's natural resources, researching the use of plants, mushroom, seaweed, swamps, streams and oceans.

"We are focusing on natural compounds that kill cancer cells but are not toxic to normal cells. This will help avoid the side effects of chemotherapy," says Dr Teo. "Recently, we found a number of promising candidates with anti-cancer properties and we have filed a patent for one of these."

The foundation, which has been conducting patient-oriented research and awareness campaigns for the past decade, is also focused on finding genes that cause breast cancer and on dissecting these to find out how they can cause cancer.

"Currently, we know that up to 15 per cent of cancer patients - regardless of the type of cancer - develop cancer because of the genes they inherited from their mother or father.

"If you can identify all these individuals ahead, you can then target them for screening and hopefully pick up the cancer earlier when it is more easily treated. And hopefully, these individuals don't have to die from the cancer," Dr Teo explains.

For instance, while it is generally recommended for all women over the age of 40 to have a mammographic screen, some women may actually require a screening from as early as age 25 because the genes they inherited put them at a higher risk of developing cancer.

"Our genetic technology allows us to identify these genes faster, so we can stratify the risks. Knowing our genetic make-up helps doctors and researchers target screening and prevention for women who need it most. Knowing the genes also helps us develop better treatments for these cancers," she says.

In its efforts to raise awareness on breast cancer, Carif also launched the second phase of its More Than A Mammo programme in May and hopes to recruit up to 3,000 women for a mammogram at a subsidised rate of RM50 (S$20). Targeted at educating women on the importance of early breast cancer detection, the programme drew more than 1,000 participants within six months last year.

"Last year's participants contributed to a study conducted in collaboration with the Karolinska Institute, Sweden. Through that research, we hope to develop better ways to detect breast cancer in Asians," she says.

Carif celebrates its 10th anniversary this year. Dr Teo, who has been onboard even before the foundation's launch in 2002, speaks fondly of their achievements. "Before Carif existed, there was no other non-profit cancer research organisation in Malaysia."

As a non-profit organisation, Carif relies entirely on public donations to sustain its long-term cancer research and nurture young talents for the cause. Currently, the foundation is supported by Yayasan Sime Darby and the Sime Darby Group of Companies, Petronas, Yayasan Lim, Lembaga Totalisator and the Selangor Turf Club, Joseph Eu Foundation and Eu Yan Sang, and Yayasan Al-Bukhary.

"We started off with a lab of just 700sqft and six scientists. Now we have two different labs, each about 2,500sqft and we are probably the best research facility in the country," she says. Currently, the research facility is provided by the Sime Darby Medical Centre.

Dr Teo says the foundation has also put Malaysia on the map for cancer research studies through its collaborations with top medical research centres like the University of Cambridge and the US National Institutes of Health.

The foundation, which depends solely on sponsorship and donations, is also seeking to engage the public to join them in their fight against cancer by participating in their Community Champion campaign. Marathoner and cancer survivor Frank Chong became their first community champion last June when he took part in a 90km run at the Comrades Marathon in South Africa. He raised about RM14,000 for cancer research through the campaign.

"There are many ways that the public can contribute to the cause. The campaign is one way. Volunteerism has a very important role among Malaysians," says Dr Teo.

On their slogan, Hope Lives Here, Dr Teo explains that it encapsulates their belief in their ability to make an impact in combating the disease. 'It is also our call to action. One in four Malaysians will get cancer in their lifetime and unless we do more about it now, I'm going to be really worried, not just for those in my generation, but also my children's generation," says Dr Teo, a mother of two. She is determined to tackle the challenge head-on.

To quote the former Prime Minister Tun Dr Mahathir Mohamad, who attended Carif's launch as well as their 10th anniversary gala, Dr Teo concluded: "Research is risky; we might never achieve anything in our lifetime but if we don't try, we definitely won't achieve anything."

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