Blue

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Exactly one year ago, down to the day – 20 September 2023 – my mother passed away. 

Except there is no way it has been a whole year because it can’t possibly have been that long. 12 weeks? Maybe. But 12 whole months? Come off it, Mr. Dent!

I have no idea why the calendars have suddenly decided to lie, but someone definitely needs to alert the local galactic time council ASAP because time has clearly gone all wibbly wobbly. 

If it had actually been 365 days, surely some of this would have started to make sense by now. But it still makes no sense. None whatsoever. Life itself no longer makes sense. Neither does the universe and everything. What even is the point of all this? Why are we here? Why must we go? Is a hot dog a sandwich? Why a duck? And what do you get when you multiply six by nine?

All valid questions to which I still have no answers. Except the last one, of course, the answer to which is obviously 42. 

But my point is, it still doesn’t feel real, yet it still hurts. Boy does it hurt!

Everything that happened a year ago – allegedly a year ago – keeps going round and round and round in my head. Every detail remains etched in my mind, every recollection stings. A memory can randomly float into my brain and instantly wreck my head. A sight, a sound, a smell, a phrase … anything can trigger an eye-water tsunami. I can go through the five stages of grief, sometimes all in one day, often several simultaneously, and then end up back at square one.

The person who loved me the mostest is gone and there is nothing I can do about it. There is a vacuum where she once was. I want to tell her things; I want to ask her what to do; I want her to hug me and tell me everything will be ok, that I’ll be ok. But she isn’t there. No matter how many times I replay those last few days in my mind and think of how differently things could have gone, I can’t change what happened. Her heart stopped; mine’s still beating. She’s gone; I’m still here. And everything still keeps making my eyes leak. A lot. 

Before my grandmother passed away, she told my mother that “akalmand loag sabar kartay hain, bewakoof loag rotay hain,” [intelligent people have patience, idiots cry] in response to which my mother promptly informed her that Mom fell in the second category. By grandma’s metric though, I am clearly bewakoofoon ki sardar [emperor of idiots]. Like, if crying was an Olympic sport, Pakistan would have had not one but two gold medallists this year. Imagine the glory I could have brought to the country and go petition the IOC to hold crying competitions henceforth. At this point, I can confidently assure you I will deliver.

As cool as being a champion crier may sound though, I realize this is, in fact, a very uncool admission. For our #HumbleAndBlessed generation, the show of any kind of weakness – emotional or otherwise – is frowned upon. But our manicured appearances and curated profiles are only leaving us feeling isolated and disconnected to the point that we end up collectively trauma dumping on a Muppet who just happened to ask how everybody is doing. 

Because it’s so hard to tell someone around you how you are doing. 

It’s hard to find people. The right people. The ones who actually care. The ones who will answer your blubbering phone calls in the middle of the night, who will hear you whine about the same things over and over and over, and who will not judge you when you are a complete and utter mess. 

But bless their hearts, they exist. They are there. And through all my crying, I have been fortunate enough to – more often than not – have a shoulder to cry on. From the lovely cousin whose literal shoulder became the receptacle for my tears minutes after my mother’s passing (and who very patiently pretended like my incoherent babbling was making perfect sense), to the bestest of buds who have offered virtual and real company at the worst of times, I’ve been getting by with more than a little help from my friends. 

Has it still sucked? Very much so. But just being able to tell someone how much it sucks has taken away some of the inherent loneliness that comes with an experience like this. 

Losing a loved one is the hardest thing you will ever go through. And it will be awful. Super hella awful. If you have never experienced it, I wish I had something more profound to say that could reassure you, but I have nothing. Mostly because there really is nothing profound to say. The only advice I have for you is: just be lucky. Be lucky enough to find the right people who will help you get through this awful time. The people you might feel you don’t deserve but who are still there for you anyway for some reason. The kind who never leave a message unanswered and never tell you you’re a burden; the ones who will send you food to make sure you eat, and bake you a water lily birthday cake in reference to your mom’s name, honouring her memory. Better still, be that person for someone else. Help them through the crap life throws at them, and do it without judgement. Don’t deride others for being a mess. And feel free to be one yourself. Be ok with not being ok. It’s fine. How you feel is valid.

Different people grieve differently. A dear friend’s partner went to work the day after his father died. Another friend teared up telling me about his mother’s death, 30 years after she passed away. There is no “one size fits all” approach to coping with grief. And there is no timeline; don’t let anyone pressure you into thinking there is. Just do you.

And do yourself a favour and accept the fact that it will probably always suck. Time’s healing powers have been greatly exaggerated. You will adapt to the loss, sure, but it will randomly punch you in the gut whenever the hell it feels like it. It will suck when you lose someone close to you. It will suck a year later. It will suck 30 years later. As it should. Because the foundation of grief is love. And even though your person is no longer there, your love for them will live on in this realm till the moment you take your last breath. 

- By Sameen Amer

Us Magazine, The News - 20th September, 2024 *

Lights, camera, action!

cinema scope

A celebration of stunt work and those who perform it, The Fall Guy thoroughly entertains with its action and wit

The Fall Guy

Starring: Ryan Gosling, Emily Blunt, Aaron Taylor-Johnson, Hannah Waddingham, Teresa Palmer, Stephanie Hsu, and Winston Duke

Directed by: David Leitch

Hollywood loves making movies about itself, but such films often have the tendency to come off as self-important or pretentious or indulgent (or all of the above). The Fall Guy is quite the opposite. The latest offering by David Leitch is a love letter to filmmaking that is just a whole lot of fun with no pretentiousness in sight.

Inspired by the ‘80s television series of the same name, the film pays homage to action flicks and tips its proverbial hat to the stunt performers who make these movies possible.

The plot revolves around Colt Seavers (an incredibly charming Ryan Gosling), a down-on-his-luck stuntman who withdraws from the industry after a stunt goes wrong, abandoning both his career and his ladylove, camerawoman Jody Moreno (the lovely Emily Blunt), along the way.

A year and a half later, Colt is approached by producer Gail Meyer (Hannah Waddingham) to once again work as the stunt double for famous actor Tom Ryder (Aaron Taylor-Johnson), who is now starring in a sci-fi epic that is being directed by Jody.

Under the impression that his ex-girlfriend wants him to join the production, Colt arrives on set in Sydney, only to realize that Jody never asked for him and is still fuming over their breakup. It soon becomes obvious that our hero has been lured to the set under false pretences. Embroiled in a conspiracy, Colt must figure out what’s actually going on and save Jody’s directorial debut.

The absurdly entertaining ridiculousness that ensues is simply a lot of action-packed fun. 

The film references and meta humour are bound to amuse movie buffs. The action is thoroughly entertaining, and you can tell that the set pieces have been shaped by someone who clearly revels in and appreciates the intricacies of the craft; Leitch’s work as a stunt performer makes him the ideal choice to helm the vehicle. The cast is terrific; everyone is so committed to the zaniness of the premise, it's glorious.

Ultimately, its story might not be exceptionally clever and your mind might need to skirt a few plot holes along the way, but The Fall Guy is still a very enjoyable popcorn flick with an excellent cast and crew. Filled to the brim with entertaining action, built around a gentle romance, and wrapped in complete and utter silliness, the film is likely to leave you with a grin on your face (and a Phil Collins song stuck in your head!)

Rating: 4 out of 5

- By Sameen Amer

Us Magazine, The News - 14 June, 2024 *

May flowers

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April showers famously bring May flowers, and what a blessing that is! The bright, cheerful blossoms are such a joy to behold, and spending some time in their company is a great way to lift the mood. From the colours they sprinkle on nature’s canvas to the fragrance they spread and the pretty birds and butterflies they attract, flowers give us so much to be grateful for and also gently remind us that all will be well.

As spring gives way to summer, we take a look at some of the lovely blossoms that are currently dotting the gardens of Lahore…

Marigold

Marigold is such a popular blossom and can bring a bright pop of colour to any flowerbed. Available in a range of yellows and oranges, these annuals come in many varieties, including two-toned French marigolds with brilliant shades and striking petals.

Some types of marigolds are used as a source of essential oil, perfumes, and flavourants, and the flowers also make an ornamental appearance in functions in South Asia.

Gazania

Native to Southern Africa, the gorgeous Gazania is a stunning annual that is perfect for adding colours to sunny borders or containers. The blooms come in shades of yellow, orange, red, and white, often with two or more colours in each flower. Oh and they love sunshine! When the sun goes down, the flowers tend to close up.

Gazania is a gorgeous presence in the spring/summer garden, and to places like South Australia and New Zealand that have declared it a weed, all we can say is: how rude!

Gerbera

A lovely member of the daisy family, the gerbera finds beauty in simplicity. One of the most popular cut flowers in the world, gerberas are cherished for their decorative value. Each bloom is usually one solid colour – white, yellow, orange, and pink are common – but some plants can have flowers with petals of several different colours. And since it’s a perennial, you don’t need to grow a new plant every year. Expect to see blooms throughout the year, especially during warmer months.

Verbena

With its beautiful clusters of bright purple flowers, verbena – also known as vervain – blossoms really stand out against a background of green foliage and grass. Another perennial, verbena can attract butterflies and hummingbirds, and is used in perfumery and herbalism.

Lantana

The Lantana shrub yields clusters of small aromatic flowers, making gorgeous, often multi-coloured umbels, and is useful as a honey plant and in butterfly gardening. The plants are, however, somewhat toxic and are even considered noxious weeds in some regions, but they have been put to good use in South Asia, with Indian craftsmen creating sun, rain, and termite-resistant furniture using their hard but bendable stems.

Coral tree

The dramatic blossoms of the coral tree are so stunning that they practically demand you stop whatever you’re doing and spend at least a moment taking in their beauty. The distinctly-shaped bright red nectar-rich flowers are borne in elongated clusters at the tips of the branches and are a magnet for certain birds, like drongos and mynas.

Chaste tree

Chaste trees produce butterfly-attracting midsummer purple flowers that grow on elongated spikes. The flowers are pretty, while the plant has been used in traditional medicine. The leaves and fruits also yield essential oils.

Daylily

Daylily is also known as ditch-lily, but it is neither a lily, nor does it specifically grow in ditches. Each of its flowers does, however, only last a day, which is so unfair given how pretty the blooms are. A daylily flower has three petals and three sepals (collectively called tepals), and the ones you can commonly see around Lahore these days are mostly orange and/or yellow. (The genus is toxic to cats so is best kept out of reach of your feline children.)

Rangoon creeper

You can see the Rangoon creeper vine cascading down walls as you walk down the streets of Lahore, and it’s always a joy to see the gorgeous pink bunches that adorn this perennial evergreen. The fragrant flowers become brighter – from white to pink – as they age. And bees and birds are drawn to these lovely blossoms. 

Plumeria

Beautiful flowers with a beautiful fragrance, plumeria – or frangipani – blossoms are cherished around the world. They come in many colours – pink, red, white, yellow, orange – and sometimes have two colours in the same flower. They grow in clusters, have a lovely scent (popular in incense), and are widely used for ornamental and decorative purposes. 

Oleander

An evergreen shrub, oleander produces vibrant blooms in clusters. The five-lobed flowers are usually white or pink and peak during summer but grow year-round. All parts of the plant – leaves, flowers, stems, roots – are toxic though, so it must be used with utmost care.

Pansy

Our pansies are still blooming and they are such a delight! The plant takes its name from the French word pensée, which means "thought", as the flower was considered a symbol of remembrance.

With five polychromatic petals, the pansy comes in all sorts of vibrant shades and colours, and is ideal for spring and summer pot arrangements.

Petunia

If only we knew what went through the mind of a certain bowl of petunias, the universe might make a lot more sense. Still, existential quandaries aside, we can continue to enjoy the beauty of the mighty petunia, even if we aren’t privy to its many secrets.

And of course we also have rose, hibiscus, jasmine, sunflower, periwinkle, and all kinds of other gorgeous flowers around us. So take a moment to revel in their beauty. No matter where you are, just spend some time acknowledging the blessings of nature and embrace the joy they bring.

May all your April showers yield the loveliest May flowers.

- By Sameen Amer

Us Magazine, The News - 24th May, 2024 *

Strong female character in distress

cinema scope

Damsel

Starring: Millie Bobby Brown, Ray Winstone, Nick Robinson, Shohreh Aghdashloo, Angela Bassett, and Robin Wright

Directed by: Juan Carlos Fresnadillo

Tagline: This is not a fairytale.

Subverting fairytale cliches and turning the princess from a damsel in distress to the hero of the story is such an intriguing, empowering idea. But it’s an idea that no longer seems novel. There is no shortage of strong female characters in everything from ‘80s sci-fi to the latest Disney adventures. Which is why just this idea alone cannot sustain an entire movie, especially in the absence of an interesting, intricate plot and a strong script. This is the predicament that befalls Damsel, the new Netflix fantasy that clearly means well but doesn’t seem to have much to offer beyond this narrow premise.

The titular damsel here is Elodie (portrayed by an enthusiastic but one-note Millie Bobby Brown), the princess of a struggling kingdom that is in dire straits. When a proposal arrives for Elodie to marry the prince (Nick Robinson) of a prosperous realm, she reluctantly accepts, hoping the union will help the impoverished people of her land. Little does she know that her fairytale wedding is about to turn into a nightmare. 

Turns out that Elodie is nothing more than a sacrifice, the latest in a series of offerings to a dragon (voiced by Shohreh Aghdashloo) meant to repay a centuries-old debt. But our protagonist has no intention of being devoured by a fire-breathing giant lizard. Instead she must MacGyver her way out of her predicament and get revenge on the people who put her there.

Damsel’s heart is in the right place and its premise does have potential, but its half-baked plot and dull script keep the adventure from giving us anything exciting or inventive. A whole chunk of the movie is just Millie Bobby Brown making her way through a cave survival movie with a conveniently useful dress and perfect makeup, and while there is no shortage of acting talent in the film’s cast – the terrific Angela Bassett plays Elodie’s stepmother and Robin Wright appears as the evil queen responsible for condemning Elodie to a dire fate – most of the actors aren’t given much to do here.

All in all, Damsel is too corny to really connect with viewers who have seen other movies explore similar ideas but with more nuance or at least woven into more exciting tales. 

Rating: 2 out of 5

- By Sameen Amer

Us Magazine, The News International - 29th March, 2024 *

The tale of a tuatara

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Leo

Starring (voices): Adam Sandler, Bill Burr, Cecily Strong, Jason Alexander, Sadie Sandler, Sunny Sandler, Rob Schneider, Jo Koy, Allison Strong, Jackie Sandler, Heidi Gardner, Robert Smigel, and Nick Swardson
Directed by: Robert Marianetti, Robert Smigel, and David Wachtenheim

Too many cooks may spoil the broth but it turns out that three directors can, in fact, make a fun movie, at least if Leo is anything to go by. The film sees comedy stalwart Robert Smigel teaming up with W/M Animation’s Robert Marianetti and David Wachtenheim (the latter two in their feature directorial debut) for some heart-warming drama peppered with silly humour and warm musical moments.

The animated adventure is the latest offering from the partnership between Adam Sandler’s Happy Madison and streaming giant Netflix, and finds the actor voicing a grumpy old lizard who stumbles into an existential crisis.

A 74-year-old tuatara, the titular Leo (Sandler) lives in an elementary school terrarium which he shares with his turtle friend, Squirtle (Bill Burr). The two animals have spent many years in the same fifth-grade classroom, learning and growing alongside the pupils but unable to live their free, natural lives.

But when Leo overhears someone say that tuataras have a lifespan of 75 years, the lizard is aghast that he only has one year to live and hasn’t fulfilled any of his goals and dreams. 

When grumpy substitute teacher Ms. Malkin (Cecily Strong) orders that each child must take the class pet home for a weekend, Leo hopes to take the opportunity to escape and accomplish everything he hoped to do in his life. But he instead finds himself bonding with each student and becoming an impromptu therapist to the kids, as each of them learn his secret: that he can actually talk.

A funny, emotional family flick, Leo offers some valuable life lessons for kids. Its musical numbers may be a little slight, but they are often presented in visually creative ways and serve their purpose in the tale. There is a whole lot of warmth on offer here, plus there is plenty of humour – some a tad juvenile, some perhaps a little out of place in a kids’ movie – that will manage to elicit at least a few chuckles. 

All in all, it won’t exactly redefine cinema (nor is it trying to), but Leo successfully delivers some wholesome, feel-good fun. It’s well-animated, the voice cast is solid – I’m not entirely sure if it's a complement that Sandler's voice is well-suited for an aging reptile! – and it leaves you with lessons that will hopefully help kids – and grownups – embrace their quirks and learn to love themselves.

Rating: 3.5 out of 5

- By Sameen Amer

Us Magazine, The News - 22nd March, 2024 *

Mind, heart, soul

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Reading may famously be a dying habit but the crowd at the Lahore International Book Fair seemed to be on a collective mission to prove otherwise. Sure the digital age may have drastically changed how we consume everything from news to literature, but based on the turnout at the 2024 LIBF, there is clearly no shortage of people who still love books.

The 37th edition of the yearly exhibition took place at the Expo Centre in Lahore in the first week of February, and while the weather may have been cold and the day overcast, there was still plenty of hustle and bustle at the arena on the cloudy Sunday afternoon when I visited the event. 

Not only was the book fair a chance for bookworms to find just the volume they were looking for and booksellers to reach their customers, but the five-day event gave bibliophiles the opportunity to cherish seeing like-minded people turn up in droves and show their support for printed works.

Books galore

The massive hall was filled with stalls of the various booksellers, offering everything from English content to Urdu literature. Whether you enjoy fantasy, sci-fi, romance, memoirs, real-life adventures, religious books, or anything in between or beyond, you were very likely to find something of interest among the thousands and thousands of volumes on display. 

Much of the exhibit featured new books, some imported, many expensive enough to make you wish you’d win the lottery already and remind you that life is indeed unfair.

A handful of stalls focused on the resale of old book. Among them was Old Books Collection from Karachi. Muhammad Ali Siddiqui, from the aforementioned retailer, seemed pleased with the outcome of the event. “We have a stall at the book fair every year,” he said. “This is our fifth book fair, and the result is good, MashaAllah.” The event, he explained, helped his business reach new readers and customers, and gave him the chance to meet people.

Pre-loved books may not catch everyone’s fancy, but they can be a blessing for those on a budget. Muhammad Abid Siddiqui from Siddiqui Book Centre, another old books business, pointed out their value. “We find and keep second-hand books,” he said. “The price of new books has increased because of the hike in the price of paper, and even slim volumes can cost as much as two to three thousand, so we promote second-hand books.”

Bookworms aplenty

Among the sellers of the pricy new volumes was Liberty Books from Karachi, represented at the LIBF by Rizwan Ahmad, who was more than pleased with the number of people who had turned up at the event. “It’s going really well; the response has been even better than we expected,” Rizwan enthused. He explained that Liberty Books had chosen to step away from the book fair for half a decade because of rampant piracy, and had only just made their return to the event. “We have returned after six years,” he said, “and we re-entered the book fair with limited stock. We left this because of piracy. Now Insha’Allah next years we’ll also come achay taraikay se because MashaAllah the response is very good. It’s going well.”

And while the abovementioned Siddiqui Book Centre’s Abid Siddiqui was, likewise, satisfied with the overall turnout and sees this yearly gathering as a way to help the young generation develop an interest in reading, he did have a few suggestions on how it could be even better. “Our experience here is good, but it is still not at the level that it should be,” he explained. “The reason for this is that a lot of people don’t even know about this [event], and if it was covered by the media and news of the book fair had been spread in Lahore, then even more people would have found out about it.”

Paper power

There is something so heartening about gatherings like the LIBF and how they highlight the value of books. Muhammad Hamza Gaziani, the proprietor of The Book Kingdom, emphasised just how vital this medium is. “I feel like books are very important for everyone as they increase your imagination, your knowledge, your speaking skills – [they have an impact on] each and every thing. 

“Book fairs,” he continued, “are very important so that the people who don’t really know about books can get introduced to them and [can have access to] especially those books which aren’t available online or in physical stores. Some are like mangas – Naruto, comics; these are very rare, and we are the ones who are specially keeping them.”

Azhar, a longtime employee of Readings, also expressed just how important books are for society. “Books are essential for human transformation,” he said. “If I talk about myself, I have been working for Readings for about 16 to 17 years and I feel like I have changed from the person I was back then. I have learned a lot from books. Like everything has an aura, books have their own aura. When a book is in our hands, we don’t get that much time to read but even reading the summaries, even knowing about books briefly, even that brings about a lot of changes in us. If I have changed so much in the company of books, then I feel if everyone stays attached to books, it will not only change them individually, but since individuals come together to develop society, the whole society will change and there will be a positive impact. The nation will develop and perform better.”

Happy with his experience at the LIBF, Azhar was excited to see people showing their love for books. “You can see people are participating in a good way,” he noted. “The impression we were getting that reading habits are declining and people are not drawn towards reading, that impression is being revoked here. There are people here in significant numbers, and from a business perspective, people buy books, that’s how we do business. We import books, and import a lot of books. And this is just the Lahore edition. If this is the situation in one city, then overall the situation is not bad, I feel.

“This is one event,” he continued. “There should be more events like this in a year so that more people are attached and there is even more awareness. I am not mayoos with respect to books.”

It’s such a good thing that the LIBF has given us optimism when it comes to reading, for what better way is there to nourish the mind, heart, and soul than a good book?

- By Sameen Amer

Us Magazine, The News - 16th February, 2024 *

Understanding cancer

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According to the International Agency for Research on Cancer, in many countries, cancer will affect one in two men and one in three women during their lifetime. The World Health Organization estimates that the disease is responsible for nearly one in six deaths worldwide.

Those are daunting statistics. Yet most of us known little about this malady that can suddenly affect any of our lives.

To mark World Cancer Day, we spoke to renowned consultant oncologist and haematologist Dr. Muhammad Arif – the owner of the Razia Sultana Memorial Cancer and Blood Associates clinic in Lahore – and asked him about the disease, what triggers it, and how to prevent it.

Us: What is cancer?

Dr. Muhammad Arif: Cancer is a disease which involves the abnormal, uncontrolled growth of cells. It eventually becomes visible with testing or even to the naked eye. Cancer can start anywhere in the body and spread to other organs. It can be fatal if not caught and treated early.

Us: What causes cancer?

Dr. Arif: There are a number of theories regarding what causes cancer to develop.

The most widely accepted one nowadays is that the number one reason for cancer is likely to be lifestyle, which includes factors like diet, nutrition, exercise, weight, and stress. It is believed that about 60 to 70 percent of the cancer cases in the world are because of unhealthy lifestyle.

There are also some cancers that are triggered by a gene you get from your parents, but only about three to five percent of cancers in general are inherited. The rest of the cancers are incidental and sporadic.

Cancer starts when a cell changes its behaviour. Usually it starts with a mutation. But first mutation never causes cancer; the mutations accumulate over time.

These mutations are either acquired or inherited.

For instance, in our Pakistani context, we see a lot of hepatitis in the general population, which leads to a very high risk of liver cancer in those patients. In Western countries, it happens because of lifestyle; a condition known as fatty liver leads to a high risk of liver cancer.

Us: What are the most common types of cancer?

Dr. Arif: In women, breast cancer is considered the most common type of cancer. In men, it’s generally lung cancer.

Overall, the most common cancer is skin cancer – like squamous cell carcinoma or basal cell cancer – but most of the time, these are not deadly cancers; they are very easily treatable, so that’s why we don’t hear too much about them. The other skin cancer, melanoma … that’s rare, especially in Pakistan, but that’s actually a very deadly cancer.

In Pakistan, the most common cancers after breast and lung cancer are lymphomas. Then we have a lot of people with blood cancers, like myeloma. In some areas, we have a lot of cancers of the head and neck area – like tongue or mouth – especially in people who chew tobacco or smoke.

Other cancers aren’t uncommon either. We see a lot of stomach, pancreatic, and colon cancer, and liver cancer is among the most common ones in Pakistan because of hepatitis. 

Us: What are the main risk factors for cancer? You mentioned lifestyle…

Dr. Arif: Yes, the number one factor is lifestyle, which includes diet, exercise, weight, and stress.

Eating healthy and getting proper nutrition is essential. The second most important thing is probably exercise and weight management. Exercise leads to a lot of benefits – 30 to 45 minutes of brisk walk or light exercise every day, four to five days minimum per week, can reduce cancer risk by about 20 to 30 percent. So that’s recommended. Exercise also helps to maintain weight.

Third would be stress. Healthy stress, like exam stress or a little bit of competition stress, is ok. But unnecessary stresses – which have a lot of impact on your overall health – should be avoided.

Sleep is another important thing, especially in teenagers and youngsters. People who get a good night’s sleep are generally overall very healthy.

Other risk factors include – particularly since hepatitis is very common here – needle sharing. We should make sure there is no reuse of syringes and ensure that hygiene is maintained during medical procedures.

Us: What are the signs and symptoms of cancer?

Dr. Arif: Most cancers are initially silent, but when the cancer gets to a point where it starts to show symptoms, the most common symptom is a gradual decline in overall health. People might feel fatigue, tiredness; they might start to lose weight or lose appetite; they might notice a change in the colour of their eyes (which could become yellow if somebody has jaundice) or urine; they may become pale; or they might start to feel shortness of breath when they walk.
In practical terms, any symptom – from pain to a lump – which is new and persistent – more than a week or so – should be evaluated. 

Us: But many of these symptoms could suggest a different disease…
Dr. Arif: Yes, definitely. You shouldn’t be scared if you have some lump. It may be something else, like an infection or something benign. Similarly, if you have weight loss, it doesn’t necessarily mean that you have cancer; some people who have thyroid disease start to lose weight. But if the symptom persists, it should be investigated to make sure it doesn’t have a serious underlying cause.

Us: How important is early detection?
Dr. Arif: Early detection is definitely the only way, at present, to cure a cancer. Cancer can be detected early through screening. When the disease has started in the body but you don’t have any symptom and cannot detect it with your eye or by examination, you do these tests, like mammogram, Pap smear, and coloscopy. If the disease is detected early – Stage I and II – and surgery is performed, a majority of the cases are curable.
Take the example of colon cancer. If you diagnose it by screening through colonoscopy that finds a small polyp in the colon and you take it out – that’s all you need, surgery – then you’re cured. About 95 percent people are cured in Stage I colon cancer. In Stage II, it drops by about 20 to 30 points. In Stage III, there’s an about 40 percent cure rate; in the rest of the cases, the disease comes back at some point. Stage IV is not curable. Very, very rarely, if somebody has very limited stage IV and it has not advanced too much, then it might be possible to control with surgery. 

Us: But screening can be expensive…
Dr. Arif: There is cost analysis on that, and if you look at the value of the test, there is a positive correlation – it is very, very cost effective instead of having the disease diagnosed at an advanced, late stage.
Treatments – medicines, surgery – are so expensive. When it’s diagnosed in early stage, most people won’t need very extensive treatments, like chemotherapies and targeted therapies; they might need just a small surgery. Compared to early disease, advanced disease will cost a lot, plus it’s not curable. If you add up these things, it’s very cost effective to do screening tests.
In women, yearly mammograms are recommended after the age of around 40 or 45. Coloscopy is recommended for both men and women who are 50 and above. In men, prostate cancer can be detected early. Similarly, cervical cancer and uterine cancer can be detected by Pap smear which is recommended for women who are married.

Us: Are there any other ways to prevent cancer, like vaccines?
Dr. Arif: Yes. There is, for instance, a hepatitis vaccine which provides almost 80 to 90 percent protection against the disease, so even if someone is exposed to the virus, it won’t cause problems like cancer and liver diseases.
In Western cultures, they recommend cervical and oral cancer prevention with a vaccine that they give to youngsters which has been shown to reduce the risk of cervical cancer.

Us: What are the treatment options available for cancer?
Dr. Arif: The classic three ways of cancer treatment are surgery (if possible), radiation, and medicines called chemotherapy.
Nowadays, there are many new advances, especially immunotherapy and targeted therapies. They are very effective in some people.
For example, five to seven years ago, people with Stage IV lung cancer survived only a year or so; now about 20 to 25 percent people survive over five years. Similarly, the survival rate for myeloma was two years on average a few years ago; now it is about eight to 10 years. 

Us: Why is there no actual cure for this disease?
Dr. Arif: By its very nature, in cancer, there are some cells that mutate all the time. Once that process starts, you treat one type of cell, it changes into a different type of cell and becomes resistant to the treatment you are using. So it continues to progress over time. Although you may be able to control it for a long time, eventually it is not possible [to stop it].
Still, there are, say, on average about 30 percent people who are cured of their cancer. It’s getting better – from zero percent to 30 percent – but there’s obviously still a long way to go.
We are hoping that cancer eventually becomes a chronic disease, like other incurable conditions such as diabetes and heart disease; people get long-term treatment for it, but it is no longer an automatic death sentence. That will be a great success, I think.

Us: Do you have any recommendations for the readers?
Dr. Arif: I would say that prevention is probably the best strategy. Be proactive about your health – think about your well-being, make sure what you put in your body is not harmful, do not abuse your body, exercise, sleeping well, avoid unnecessary stresses. Don’t get exposed to risk factors which you can avoid, like hepatitis, unnecessary radiation exposures, unnecessary medications.
The next best strategy is that when you are in the appropriate age range, get screening done so that even if you develop cancer, it is caught early, treated promptly, and you hopefully get rid of the disease for good.

- By Sameen Amer

Us Magazine, The News - 2nd February 2024 *