Colon cancer comes third in ranking as the third most common type of cancer across the globe. It accounts to 10% of all cancer cases worldwide. It is prevalent in developed nations though a few nations in Latin America such as Uruguay, Brazil, and Argentina are increasingly approaching the incidence levels observed in the developed nations. Colon cancer is on the rise in Brazil and new research reveals that there is a significant correlation between pesticides and rise in colon cancer in Brazil. According to the International Agency for Research on Cancer, pesticides has been found to be one of the several hazardous and carcinogenic factors causing malignancies. The study in Chemosphere found that the rise of pesticides sales to 476 tons between 2000 and 2012 correlates the rise of colon cancer. Simultaneously, the deaths from colon cancer increased to over 1 million, regardless of the advances in cancer detection and treatment (Uyemura, Stopper, Martin & Kannen, 2017).
Background on the Disease
Colon cancer occurs mainly occurs and affects the large intestine. It begins as noncancerous tumors known as adenomatous polyps that establish themselves on the inner walls of the colon. The cancerous cells may spread from the noncancerous tumors through the lymph and blood systems to other body parts. The growth of these cancer cells attack the healthy tissue close by and across the body, through a process referred to as metastasis ( Singh, Sharma, Parween & Patanjali, 2018).
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Colon cancer has multiple potential risk factors and thus the exact causes are unknown. However, studies have found that environmental factors may serve as a risk to colon cancer. Studies have indicated that pesticides could play a critical role in the etiology of this cancer. Since agriculture is the one of the Brazil’s economic backbone, it has become the leading consumer of pesticides in the world. The burden of colon cancer is also growing in the country. The excessive amounts of pesticides applied on crops in Brazil are contaminants to water and food consumed by people and livestock. Transmission of Colon cancer can be through food containing high amounts of pesticides. According to the Brazilian National Health Surveillance Agency, about 20% of the food samples examined between 2013 and 2015 were found to be unfit for human consumption because of the presence of high levels of pesticides. Incidences of high pesticide levels in breast milk have been reported to increase over the last years. In addition, the pesticide residues in bovine milk have been found to exceed the safety standards in some regions in Brazil ( Singh, Sharma, Parween & Patanjali, 2018). Therefore, evidence has revealed unsafe levels of pesticides in foods and bovine and breast milk.
Global burden of Colon cancer / Burden of the disease in Brazil
Colon cancer is categorized as the third most deadly type of cancer that affects women and fourth type that affects men in Brazil. In America, colon cancer is the second most deadly disease. It is the fourth leading cause of cancer death worldwide, with new cases accounting to approximately 1.4 million and over 700,000 deaths. In 1990 and 2015, approximately 487, 860, deaths estimated were because of colon cancer. Simultaneously, in Brazil, the deaths from colon cancer were found to be 21, 419. From the period of 1990 to 2015, the levels of mortality rate have increased more in Brazil than other parts of the world. Therefore, Brazil has a higher mortality burden from colon cancer worldwide ( Gibbon, 2018).
Common Medications and/or other forms of treatment used for Prevention
Cancer prevention is crucial and occurs in three phases. The first is the primary cancer prevention that focuses on minimizing the risk of cancer development in an individual through utilization of surgical removal of vulnerable organs, avoiding exposure to environmental carcinogens, and chemo preventive agents. The second phase is secondary cancer prevention that focuses on screening measures and early detection to identify the early stage tumors that are often respond to treatment than when tumors in the late stage. The third phase is the tertiary cancer prevention popularly known as cancer control focuses on minimizing risk of recurrence, preventing second primary cancers, reduce metastasis risk, and prevent other complications associated with cancer ( Kim, Kabir & Jahan, 2017).
Other forms of treatment include use of natural products such as vitamins to treat cancer. Ascorbic acid is an important micronutrient for health of humans and it is used as an antitumor agent. It has an antioxidant activity and takes part in the production of serotonin, norepinephrine, and collagen. This is obtained from ingestion of plants such as vegetables (broccoli and tomatoes) and citrus fruits such as orange and lemon ( Kim, Kabir & Jahan, 2017). Therefore, supplementation of vitamins can promote improved quality of life and benefits of cancer patients.
Barriers to treatment and/or prevention
The barriers to treatment and prevention of colon cancer in Brazil include lack of strict pesticide legislation policy. The existing policies do not adequately regulate use of pesticides in farming, which has contributed to rise in colon cancer, making its prevention a challenge. Another challenge is inadequate levels of knowledge among physicians and nurses affects the colon cancer screening. In efforts to enhance colon cancer screening and prevention, improving knowledge about screening should be taken into consideration. Furthermore, lower screening rates among underserved populations such as racial/ethnic minority groups, recent immigrants, and uninsured populations has increased the burden of colon cancer ( Rahman, Suresh & Waly, 2018).
Role of the Primary Care Provider
Primary care providers play a critical role in managing cancer patients and reducing colorectal cancer associated with mortality and morbidity. Also, they work with oncologists in delivering and coordinating care among cancer patients to improve their wellbeing ( Rahman, Suresh & Waly, 2018).
Predict of the Disease/Situation in the Future
It is projected that by 2030, the global problem of colon cancer will rise by 60% to over 2.2 million fresh cases and 1.1 million deaths. In future decades, the number of patients with colon cancer is expected to increase if the targeted resource-dependent actions are not implemented. It is important for improvements in accessibility and treatment options be put in place. Moreover, prioritization of early detection and primary prevention is vital alongside with their incorporation into the existing healthcare plans ( Dhanker & Kumar, n.d).
Type of Health Care System currently in Place
In Brazil, healthcare is a constitutional right. It has a National Healthcare System referred to as Unified Health System that provide public healthcare to all residents and foreigners within Brazil. The vision of the healthcare system is “health for all” meaning healthcare is universal and free to everyone. Therefore, despite the various challenges, the public health system in Brazil is revamped to deliver quality health care to millions of poorer inhabitants who could not afford basic care. The healthcare system was established under a decentralized universal access to deliver comprehensive and free health care to every person in need. The federal and state government funds the public healthcare system. Presently, primary health care is still one of the major pillars of Brazil’s public health system. The cornerstones of the public health system include tackling serious diseases, treating the injured and sick, preventing sickness and promoting health ( Nedungadi, Jayakumar & Raman, 2018).
Major Medical/Medication issues
The healthcare system in Brazil does not cover some of the therapies required for colon cancer treatment because of the high costs involved. Examples of the therapies not covered include the chemotherapy regimens mFOLFOX6 and FOLFIRI and monoclonal antibody therapies for colon cancer. These treatments exceed the monthly reimbursement amounts offered by the healthcare system. However, despite the challenges, the government covers XELOX regimen as an alternative for colon cancer treatment, which fits within the healthcare budget considering the economic limitations in the current society (Reji et al., 2018).
The intrinsic and political problems also pose significant impact on colon cancer medication in Brazil. Limitations in the economy and the lack of establishment of effective policies in the political realm has hindered the implementation of the new precision medicine for treating colon cancer. Brazil lack full awareness regarding the benefits of precision medicine. Various challenges need overcoming in the economic and political realm, the austerity policies, and structural weakness to facilitate effective implementation of the new precision medicine. There is need for Brazilian government and stakeholders to have comprehension of the value of the new medicine as well as how it can minimize the burdened health-care system. In addition, there is need for establishment of a more efficient system to approve and make the new diagnostic tests and drugs more available and accessible. Furthermore, there is need for development of essential multidisciplinary teams and related infrastructure. All these things are currently lacking in the Brazilian healthcare system thus poses major medical issues (Reji et al., 2018).
The Underserved Population in Brazil
Despite Brazil having a unified healthcare system that provides healthcare for all, there exist significant gaps that contributes to health inequalities among populations in the country. The lower socioeconomic population groups and the poorer regions are the most disadvantaged groups. The existing huge regional disparities in access to health outcomes and healthcare services causes these populations to be underserved. The incomplete health reforms in Brazil failed to address the structural weaknesses in the healthcare system adequately such as inadequate allocation of resources, poor financing, and challenges at the state government level. Additionally, political and economic crises have increased demand for social protection programs, reduced funds for health services, and increases unemployment and poverty. Persistence of these events lead to health inequalities, changing the healthcare service use, behaviors, and health needs (Gupta et al., 2016).
The government has attempted to address these challenges by expanding the universal care to cater for the needs of this population. Initially, the expansion of the universal care was hindered by the inadequate financial facilitated by political crisis and economic instability issues as well as the weak technical capacity of the lower levels of administration and the federal government. The government focuses on addressing the issue by investing in the Universal care and establish an inclusive decision-making at different levels of government to ensure equitable distribution of health resources to all population. This action has allowed the government to reach out to the underserved population and make healthcare available to them (dos Santos et al., 2017).
Effects of Culture on Healthcare in Brazil
Cultural aspects are recognized as relevant in different factors of healthcare. Culture influences health in vast ways. For instance, it affects the way individuals perceives illness and expression and experience of pain, their preference of the types of treatment, approaches to health promotion, beliefs regarding causes of diseases, and the views on death, illness, and health (Looi, Greatbanks & Everett, 2016). This suggests that approach to culture and health care should be done in a mutually integrated manner from the viewpoint of benefiting individuals (Alden et al., 2015). Therefore, evidence suggests that cultural practices and beliefs should be integrated in the health of an individual to provide culturally competent care that help to meet the needs of individual patients.
Conclusion
Colon cancer is a prevalent problem in Brazil. Studies have associated its prevalence to the immense application of pesticides on agriculture. Excessive utilization of pesticides contaminates water bodies and food obtained from these plants. Humans and animals consume these foods and water, which are toxic to the body. Exposure to these chemicals has been found to contribute to the prevalence of colon cancer and related deaths on Brazil. Therefore, the government should put strict legislation to regulate the use of pesticides on agriculture and to establish effective reforms in the healthcare system to effective prevent and manage colon cancer.
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