Longevity is a game of compromises

“Cancer” is a dreaded word – and few of us would not have encountered it in our lives. Few would not have lost a dear one to the disease. I too have – father in 1992 and husband exactly 10 years later. However, it is not the most common cause of death, cardiovascular disease exceeding it by far in all parts of the world. Its only that as you live longer, the odds shift in favor of cancer. In this context I found the article “Why everyone seems to have cancer. ” in the New York Times fascinating reading

As I slowly but surely edge towards the 8th decade of life and care and support my mother in her 9th decade, I often wonder at the desperate striving for longevity that I see around me. While the life expectancy for women in this country was <50 years when I was a medical student in the late 60s,  I am now at the exact age when I should drop dead – in other words the life expectancy stands around 66 years today.  And so here onwards every year is a bonus – and I have no issues with that as I have led a pretty full and good life,  contributed my bit to the society and even more importantly not done too much harm!!

During my training years, conveying news of terminally fatal illness like heart disease  (pre-by-pass days) and cancer to anyone over 60 years was not considered too disastrous (overall life expectancy was <50 years) –  anyone ‘less than 50 years’ was considered young.  When my father had his myocardial infarction in 1971 (he had been a heavy smoker), it was diagnosed with only an ECG, and all that happened was that he was told to stop smoking and be moderate in his habits. I was doing internship at the time, and the association of coronary disease with lipid profiles and central obesity was yet to happen. Although he went on to have a by-pass surgery in 1986, we eventually lost to him to a lymphoma in 1992. He was short of his 73rd birthday – and we all felt that we had lost him too early, especially since his parents had both lived into their late 80s and longevity was in the family. But on the whole, 70s was not was not “Oh by Jove” early – the life expectancy for males at the time stood at 58 years. And,  cancer was considered a sentence without hope.

Much has changed since then. Coronary artery disease is detected earlier and earlier, and much is known about the pre-disposing factors. Blocked coronaries are opened up (angioplasty), not once but twice and thrice – and finally replaced (bypass surgery, which my father had). Tools to detect cancer earlier and earlier are being discovered and fairly good treatment is available for many of them (including the lymphoma that killed my father).

How do these diseases affect the nation as a whole. Authentic data on the cause of death is lacking in our country, since only a small fraction of the 9.5 million annual deaths in India occur in hospitals and only less than 0ne tenth of deaths are registered.   We have some indicators on the common causes of mortality from the  Special Survey of Deaths which was was carried out between 2001-03. It covered all deaths  in a sample of approximately 6.5 million and used Verbal Autopsy methodology. The general perception that cardiac disease was the leading cause of death was strongly substantiated, with it accounting for a quarter of the deaths.  This was followed by chronic pulmonary disease, tuberculosis  and cancer, placed at No 4  (approx 10% each).

So, as people strive to live longer, they have to be lucky not to have any major cardiac problem or diabetes or for the large numbers who have one or the other or both, be damn good in keeping these under control. The author ends the NYT article “Maybe someday some of us will live to be 200. But barring an elixir for immortality, a body will come to a point where it has outwitted every peril life has thrown at it. And for each added year, more mutations will have accumulated. If the heart holds out, then waiting at the end will be cancer.” But I guess each of us has to live out the time that has been issued out to us and longevity is a game of compromises.

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