Cancer in 2025: No, We Are Not Winning the War
Cancer prevention must become the cornerstone of our strategy
Cancer Crisis
I frequently face two common questions: “Why did you choose this specialty?” and “Why is the number of cancer patients increasing?” My answer to the latter is: “More of us live longer—increasing age, smoking, alcohol, sedentary lifestyles, and urbanization or western lifestyles all contribute.” Often, I add, “We really do not know.”
In front of me sat a young woman in her early twenties, who had recently completed treatment for breast cancer. Her treatment involved breast-conserving surgery, removing only the diseased part of the breast. While one might expect her primary focus to be on her recovery, her thoughts were instead consumed by the potential reaction of her future in-laws to her diagnosis as her marriage approached. Survival, surprisingly, was not her foremost concern. Survival was nowhere in her thoughts. She was the fifth breast cancer patient under 30 years of age had seen that week.
It has been more than 50 years since the declaration of the “War on Cancer” and the passing of the National Cancer Act in the USA, which transformed the fight against cancer. Since then remarkable progress has been achieved. The identification of cancer genes and cytogenetic abnormalities in the 1980s was followed by the Human Genome Project (1990-2003) and the launch of the Cancer Genome Atlas in 2005. Our understanding of cancer biology, the discovery of its hallmarks, the identification of mutations in cancer cells, the immunological environment of cancer, and the development of effective therapies have all made headlines.
Hence precision medicine, driven by genomic profiling, has enabled tailored therapies targeting specific molecular abnormalities in tumors. For instance, genomic profiling allows oncologists to identify unique mutations or genetic markers in a patient's cancer cells, enabling the selection of therapies most likely to be effective. This approach is exemplified in the treatment of non-small cell lung cancer, where specific genetic mutations like EGFR or ALK can guide the use of targeted drugs, significantly improving patient outcomes. Immunotherapy, including immune checkpoint inhibitors and CAR-T cell therapy, has revolutionized the treatment of several cancers, offering durable responses in once untreatable cases. Advances in minimally invasive surgical techniques, targeted radiotherapy, and artificial intelligence in diagnostics have enhanced precision and outcomes while reducing side effects. Additionally, improved supportive care and novel drug developments have significantly boosted survival rates and although some advanced cancers have seen therapeutic improvements, many new treatments offer only marginal survival benefits, often measured in mere days or weeks. Compounding this challenge is the skyrocketing economic burden of these innovations, which severely limits access for economically disadvantaged populations. Since the passing of the Cancer Act in 1971, billions of dollars have been funneled into cancer research. Global spending is projected to reach $307 billion by 2026, supported by both public and private investors. Alarmingly, approximately 93% of this funding is directed toward treatment and cure, with only a mere 7% allocated to prevention. For instance, spending on cancer medicines alone reached $196 billion in 2022 and is expected to soar to $375 billion by 2027, with the top 38 drugs consuming 80% of total expenditures. In 2023, three pharmaceutical giants collectively generated over $45 billion from several top-selling anticancer drugs.
Indeed, overall death rate for all cancers in adults has declined by 32%. Nearly 80% of children with brain and blood cancers survive today. However, this decrease in cancer mortality is largely attributed to early detection and a decline in smoking, which has reduced lung cancer and other tobacco-related cancers in men, accounting for nearly 35-45% of the total decrease in mortality in the USA, Europe, and Japan.
Yet, in 2025, cancer remains a leading cause of morbidity and mortality worldwide.
I recently saw a couple from rural north Kashmir. The young woman had completed treatment for her rectal cancer. Their primary concern was whether the “patchi ras” (local term) was the cause of her diarrhea. Fortunately, she had been blessed with two children, the younger being three years old. Losing her fertility as a result of her treatment or her premature menopause did not worry them. She was also fortunate not to need a stoma. Like many others I’ve seen, she was in her early 30s.
Another patient, a young man in his early twenties, accompanied by his younger brother, a budding doctor, had metastatic adenocarcinoma, a type of lung cancer. He said, “I eat well, I never smoked, I never drank alcohol, I always exercised—but I still developed cancer. Why?” He indeed was a fit-looking young gentleman.
Living a healthy life is important, but it is misleading to tell people they can avoid cancer entirely by doing so. We cannot control all the factors we are exposed to daily. Cancer results from an interplay of nature, nurture, and fate.
What is disturbing is the increasing incidence of some cancers, particularly in younger individuals. This trend, increasingly recognized in the West, is now evident in Kashmir as well. Over 75% of cancers becoming common in young people involve the bowel, stomach, pancreas, and breast in females. Greater awareness, wider screening, or increased genetic predisposition do not fully explain this trend.
Why are so many young people getting cancer? This is a matter of concern.
Carcinogens are substances that cause DNA damage, potentially leading to cancer. While certain carcinogens, such as DDT, Chlordane, and Carbaryl, have been banned, many others remain in use, particularly as insecticides. Additionally, some substances do not directly damage DNA and are not classified as direct carcinogens but still pose significant risks. These substances can disrupt endocrine function, trigger chronic inflammation, or impair the immune system, all of which can indirectly increase the likelihood of cancer development.
The proverb “prevention is better than cure” resonates more than ever, particularly in Kashmir. This region, known for its natural beauty, has witnessed a worrying rise in cancer cases in recent years. Environmental and lifestyle factors, long overlooked, are now critical determinants of cancer risk.
Kashmir’s heavy reliance on agriculture and horticulture has led to widespread use of pesticides and insecticides. While essential for crop protection, their misuse and overuse have dire consequences. These chemicals infiltrate the soil, water, and air, eventually entering the food chain. Farmers, directly exposed to these chemicals, are particularly vulnerable to health risks, including cancers of the skin, lungs, and digestive system.
Substances like per- and polyfluoroalkyl substances (PFAS), commonly known as “forever chemicals,” represent a persistent and silent threat. Invented by Du Pont in 1930s, these synthetic chemicals, more than 12000 in number are widely used in industrial processes and consumer products. These do not degrade naturally, leading to their accumulation in the environment and the human body. Contamination from PFAS is even present in water polluted by electronic waste. Similarly, toxic chemicals are prevalent in building materials such as floor tiles, carpeting, upholstery, insulation, paint, and treated wood. Many of these materials contain harmful substances like asbestos fibers, phthalates, formaldehyde, and chlorinated copper arsenates. These pollutants not only contaminate the environment, including groundwater, but also release hazardous emissions when burned. These chemicals may further exacerbate their impact by entering the food chain. Prolonged exposure to PFAS, in particular, has been strongly associated with several cancers. Other concerns include Bisphenol A (BPA), used to line food cans and commonly found in plastics. BPA exposure has been associated with hormone-related cancers such as breast and prostate cancer. DHEP in plastics is another cause of concern.
Cosmetics often contain harmful chemicals such as parabens, phthalates, formaldehyde, toluene, triclosan, siloxanes, and others. These chemicals are known to disrupt hormones and may contribute to the rising incidence of breast cancer.
A recent study from UK has linked sir pollution, particularly particulate matter less than 2.5 micrometers (PM2.5), to lung cancer in never-smokers and is also suspected of contributing to bowel and other cancers. Major sources include vehicle exhaust and fossil fuel burning.
A study has provided strong evidence linking childhood cancer to exposure to three key categories of chemicals: pesticides, paints and solvents, and traffic-related air pollution. It is important to recognize that children consume more food, drink more water, and breathe more air per kilogram of body weight than adults, leading to higher concentrations of carcinogens in their bodies. Additionally, an increased incidence of caesarean sections has been associated with alterations in the microbiome of children. Factors such as a decline in breastfeeding rates and the use of antibiotics in childhood may further disrupt the microbiome.
What is the way forward:
To combat cancer in Kashmir, prevention must become the cornerstone of our strategy. For instance, successful prevention programs in regions like Scandinavia have demonstrated the impact of reducing environmental carcinogens and improving lifestyle education. These models emphasize community-driven approaches and robust government policies that could inspire similar initiatives in Kashmir. Public awareness about well known carcinogens like smoking and alcohol is a must. In addition a multi-faceted approach is required for the control of other substances related to the increasing cancer incidence:
The government must enforce stricter regulations on the sale and nature of pesticides and insecticides used. Training programs for farmers on safe handling and organic alternatives can significantly reduce exposure. The substances used in building materials, cosmetics, food containers also need to be scrutinized and regulated. Such industries should adopt cleaner technologies and phase out the use of PFAS. Robust environmental monitoring is essential to curb the release of harmful chemicals. Many such actions are already being taken elsewhere after intense public pressure.
Encouraging the use of BPA-free products and launching public awareness campaigns about the dangers of plastic consumption can protect consumers from exposure. Manufacturers should be held accountable for the pollution caused by plastic products.
Developing alternative means of transport for large convoys, improving public transportation (especially electricity-based systems), and reducing fossil fuel use are urgent priorities.
Public campaigns should inform people about the links between environmental toxins and cancer. Schools, colleges, and community centers should play an active role in spreading this knowledge. Organizations like the Kashmir Oncology Forum can play a pivotal role.
Policymakers must prioritize cancer prevention by incorporating environmental health into public health strategies. Providing subsidies for organic farming, offering incentives for clean and sustainable industries, and allocating resources for cutting-edge research are essential steps. With healthcare budgets already under significant strain, failing to address this issue will allow the burden of cancer to grow beyond our capacity to manage it effectively.
Let us focus on prevention, not just treatment, to truly turn the tide in this unrelenting war against cancer.