# RKS: CANCER SCOURGE - The Silent Lurking Life's Game-Changer

  

# RKS: CANCER SCOURGE 

THE SILENT LURKING LIFE'S GAME-CHANGER

1st June 2023

THE NITROSAMINES COULD BE THE CONCERNING ENEMY

BEWARY OF WHAT YOU CHOOSE TO EAT & DRINK

Dear Reader,

How many of us have lost a near and dear one because of cancer? Many of such 'victims' were leading a 'pious' life sans vices. When even no family history of malignancy, then why would cancer strike?

There are over 200 types of cancers known and over 185 countries in the world have recorded cases of malignancies (synonym for cancer). One crore or 10 million (mn) die of cancer each year, and the disease is responsible for 1 in 6 deaths globally. Cancer is never determined by only one, precise factor, but instead by epigenetic (changed genes) meaning outcome of  interaction between genetic and environmental, dietary and lifestyle circumstances. 

Can we arrest the tide of cancer is the moot question. For this one needs to take cognisance of ground realities and re-assess our lifestyle and choices. 

SOME FACTS ON CANCER

The International Agency for Research on Cancer (IARC) has classified substances and chemicals depending on basis of cancer-causing (carcinogenic) potential as:

Amongst the items encountered daily by humans, tobacco, alcohol, aflatoxins contaminating foods, as well as bottled drinking water containing leached arsenic are Group 1 carcinogens.

CONTRIBUTORY CAUSES FOR CANCER

GENES

Bad genes per se are only responsible for 10% of the cancer cases. Hence, 90% cancer risk has been a man-acquired catastrophe, be it the environment or lifestyle. Carcinogens factors are 3: 

1. Biological Carcinogens
2. Physical Carcinogens
3. Chemical Carcinogens

What is not important is which carcinogen is more carcinogenic, but which one is someone is most exposed to in day-to-day living.

VIRUSES - BIOLOGICAL CARCINOGENS

Viruses account for 12-20% of cancers. These are mainly 7:

1. Epstein-Barr virus - causes cancer of lymph tissue which helps in immunity build up
2. Human papilloma viruses - causes cancer of female and male participating sex organs
3. Hepatitis B & C viruses - cause liver cancer
4. Human herpes virus-8 - associated with HIV (human immunodeficiency virus) that causes AIDS (acquired immunity deficiency syndrome)
5. Human T lymphotropic type 1 - cancer of T-cells which are the body's defence mechanism
6. Merkel Cell Polyomavirus - skin cancer
7. Kaposi’s Sarcoma-Associated Herpesvirus - causes lung cancer in AIDS patients 

Besides viruses, there are 119 substances and circumstances that have been proven to be responsible for occupational cancer. 

ENVIRONMENT - PHYSICAL CARCINOGENS

Ultraviolet (UV) rays of sun have been classified as a 'complete carcinogen' [cancer causing as well as promoting its proliferation (vs 'incomplete carcinogen - only increases spread but cannot CAUSE cancer per se)] and is responsible for 7.5% of skin cancers in the Capital of Skin Cancer i.e. United States (US).

About 1% of the global population develop cancer as a result of natural background radiation at some point in their lifetime. Although up to 5,000 mrem (50 mSv)/year is safe, exposure of general public should be limited to 100 mrem (1 mSv)/year.

1 mSv (millisievert) is the dose produced by exposure to 1 milligray (mG) of radiation. One X-ray is exposure to 0.0002-1.8 mSv, one CT (computerised tomography) scan is 1.2->32 mSv and one nuclear imaging / cardiac stress testing is 40.7 mSv. A single X-ray or CT does not usually cause cancer but a lifetime of exposure exceeding 1,000 mrem (50 mSv) could cause cancer in one out of 100 individuals.

Good news is that MRI (magnetic resonance imaging) is a different type of scan that doesn't use ionising radiation and hence is not carcinogenic. Thus, if given a choice, opting for the more expensive and medically fact-revealing MRI should be preferred over the CT scanning.

AIR POLLUTION

Air pollution can be quantitatively represented as Air Quality Index (AQI). 

5 major air pollutants include ground-level ozone, particle pollution [also known as particulate matter (PM), including PM2.5 (fine particles smaller than 2.5 microns such as smoke from industrial plants and vehicles) and PM10 (larger inhalable particles such as dust from roads and construction sites)], carbon monoxide, sulfur dioxide and nitrogen dioxide. Both PM2.5 and PM10 pollutants are carcinogenic.

DIET - A CONTRIBUTORY CHEMICAL CARCINOGEN 

The everyday and lifelong consumed cooked / processed foods contain a nitroso compound called NDMA (N-Nitrosodimethylamine). This is a Group 2A carcinogen meaning that it is one of the current 94 substances in the list that could PROBABLY cause cancer. Hence, although the body is exposed to 14-17 ng/day of NDMA, and drinking water has a 10-20 ng/L content of this nitrosamine, there has been no much hype regarding this till today what-so-ever.

Everyone talks about tobacco and smoking and environmental pollutants causing cancer. But the individuals who breathe relatively 'pure' air in smaller towns and villages, and are neither smokers nor alcohol-consuming, their suffering from cancer could only be explained on the basis of food and water's content of NDMA. 

NDMA may be present in water, air and soil due to chemical reaction between ubiquitous, naturally occurring precursors classified as nitrosatable substrates (secondary amines) or nitrosating agents (nitrites). For example, NDMA may form in air during nighttime as a result of the atmospheric reaction of dimethylamine (DMA) with nitrogen oxides. Soil bacteria may also synthesize NDMA from various precursor substances, such as nitrate, nitrite and amine compounds. NDMA IS ALSO RELEASED BY USE OF PESTICIDES.

WATER

NDMA, can occur in drinking-water through the degradation of dimethylhydrazine (a component of rocket fuel) as well as from several other industrial processes. It is also a contaminant of certain pesticides. NDMA has recently been identified as a disinfection by-product of chloramination (the reaction of monochloramine with dimethylamine, a ubiquitous component of waters affected by waste water discharges) and, to some extent, chlorination. NDMA can also be formed as a by-product of anion exchange treatment of water. 

As per the World Health Organization (WHO), 2 L of water is recommended for consumption daily. Since the NDMA content of drinking water is 10-20 ng/L, the daily intake of this probable carcinogen from water itself is 20-40 ng/L per each day.

FOOD

Leafy greens like spinach and rocket tend to be top amongst the crops with respect to their NDMA content, with other rich sources being celery and beetroot juices, and carrots. The various food items which contain NDMA are classifiable as below:

1. Foods preserved by the addition of nitrate and/or nitrite, such as cured meat products (in particular, bacon) and cheeses (since these methods of preservation introduce nitrosating species into the food);
2. Foods preserved by smoking, such as fish and meat products (since oxides of nitrogen in the smoke act as nitrosating agents);
3. Foods dried by combustion gases, such as malt, low-fat dried milk products and spices (since combustion gases can contain oxides of nitrogen);
4. Pickled and salt-preserved foods, particularly pickled vegetables (since microbial reduction of nitrate to nitrite occurs); and
5. Foods grown or stored under humid conditions, leading to nitrosamine formation by contaminating bacteria. 

Since pesticides release NDMA, and organic farming does not entail use of pesticides, fungicides, etc., fruits and vegetables organically grown are more safer to consume from the perspective of NDMA content elimination.

In addition, NDMA has been detected in a variety of personal care and cosmetic products (e.g., shampoos, hair conditioners and toners, bath and shower gels, creams and oils, face tonics, cleansers) due to the reaction of nitrosating agents such as nitrite and/or nitrogen oxides, which occur frequently therein.

NDMA & CANCER

Consuming up to 0.096 mcg (microgram) or 96 ng or 0.32 parts per million (ppm) of NDMA per day is considered reasonably safe for human ingestion based on lifetime exposure.

Nitrosamines such as NDMA, once absorbed from intestine via food and water, become highly reactive at the cellular level and alter gene expression with consequent DNA damage. If this carcinogenicity probability has to be minimized, the total intake of NDMA from all sources daily, in an average 65 kg Indian male or 55 kg Indian female, must be limited to less than 1.5 ng/day for a 'he' and 1.7 ng/day for a 'she'. 

CONCLUSION

Australia has the highest age-standardised rate (ASR) of cancer in the world, and New Zealand and Ireland are ranked 2nd and 3rd respectively. Niger, Gambia, Nepal and Bhutan have the lowest ASR which is roughly 5-10 times lesser than Australia. There seems to be a close relationship to incidences of cancer country wise and their NDMA intake everyday as food and water. 

NDMA intake is 400-3100 ng per day for a 70 kg Australian and seems to be highest as compared to US and even most European nations. Food sources for NDMA in US provide up to 1000 ng/day. 

Rampant cancer spread is a reality in the Indian subcontinent. The estimated number of incident cases of cancer in India for the year 2022 were determined as 14,61,427, and one in nine people are likely to develop cancer in his/her lifetime. 

In India, if the NDMA is not to become a concerning carcinogen, it would be best to limit its intake, as well as of all nitrosamines put together, to less than 96 ng/day. Since food per se contributes to >60% of NDMA intake it would be prudent to opt for organically farmed produce and only sparingly enjoy preserved and stored foods especially meats and cheeses. 

It is always wise to remember, especially in the case of cancer ...

PREVENTION is Better than DETECTION.

DR R K SANGHAVI

Prophesied Enabler

Experience & Expertise: Clinician & Healthcare Industry Adviser

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