LettersWhy lifestyle medicine belongs in Asia’s nasopharyngeal cancer conversation

Feel strongly about these letters, or any other aspects of the news? Share your views by emailing us your Letter to the Editor at letters@scmp.com or filling in this Google form. Submissions should not exceed 400 words. The end of April marked the end of Head and Neck Cancer Awareness Month, offering a reminder that one disease deserves greater attention in Asia: nasopharyngeal carcinoma (NPC), a type of head and neck cancer. NPC has a strikingly uneven geography. It remains endemic in East and Southeast Asia, where the majority of cases occur. The regional burden is easy to see. In Hong Kong, the Centre for Health Protection recorded 700 new NPC cases in 2023, 549 in men and 151 in women. According to the International Agency for Research on Cancer’s recent estimates, Indonesia recorded 18,835 new nasopharyngeal cancer cases in 2022, also with a particularly heavy male burden: NPC was the fourth most common cancer in men, accounting for 14,497 new cases or 7.7 per cent of all new male cancers. These numbers reflect a cancer burden that merits wider awareness and discussion. That is why lifestyle medicine belongs in the NPC conversation, as evidence-based support for prevention, treatment tolerance and survivorship. In NPC, three pillars of lifestyle medicine stand out most clearly. First, avoiding risky exposure: smoking and prolonged and high intake of Chinese-style salted fish are established risk factors for NPC. Hong Kong’s own NPC-specific recommendations, thus, explicitly emphasise avoiding smoking and Chinese-style salted fish. Indonesia, meanwhile, continues to face a heavy tobacco burden: according to the 2023 Indonesian Health Survey, an estimated 70 million Indonesians are actively smoking, which is often perceived as a cultural practice. Second, nutrition matters. In NPC specifically, recent clinical data suggests that individualised nutritional interventions during radiotherapy can improve quality of life and nutritional status, while other investigations likewise show the value of evidence-based nutritional support during treatment. Third, physical activity is an important aspect of NPC care, particularly because it has been shown to support treatment tolerance, physical function and quality of life. The other three pillars – sleep, stress management and social support – also matter in NPC; they may play a role in symptom experience and coping with a condition that can affect multiple aspects of daily living. This is why lifestyle medicine deserves a place in Asia’s NPC conversation. Lifestyle medicine is not meant to replace modern oncology but to serve as an evidence-based complement to it. It is important to consider the modifiable factors that influence risk, treatment experience and survivorship, from smoking and diet to physical activity, sleep, stress and social support. NPC care is about radiotherapy, chemotherapy and other advances as well as the everyday factors that matter before, during and after diagnosis. Dr Daniel X. Zhang, senior lecturer, Hong Kong Metropolitan University, and Dr Arcita Pramudita, social services committee member, Indonesian Cancer Foundation Hormuz crisis a warning for Asian cities The opinion article, “Hormuz crisis a chance to spur Asia’s shift to clean, secure energy” (April 12), is right to argue that the crisis in the Strait of Hormuz should accelerate Asia’s shift to cleaner and more secure energy. The case is even stronger when viewed from the level at which these shocks are actually lived: the city. When supply routes tighten and fuel prices rise, the effects do not stay in energy markets. They move quickly into commuting costs, freight bills, food prices and household budgets. In that sense, the lesson from Hormuz is not only that Asia needs more renewables. It is that Asia’s cities need to be designed for lower fossil dependence overall. Electrified transport, more efficient buildings, distributed power and stronger public transit are often framed as climate measures. They are also resilience measures. The more daily urban life depends on imported fossil fuel, the more every distant geopolitical shock becomes a local economic burden. Asia should read this moment not as a temporary disruption, but as a warning that secure energy and secure urban futures now depend on the same transition. Dr Zaheer Allam, Hermitage, Mauritius EU needs referendum on Ukraine war After European Commission President Ursula von der Leyen met Ukrainian President Volodymyr Zelensky on April 23 she wrote on social media: “Ukraine’s brave resistance against Russia is unwavering. So is Europe’s support.” There is nothing brave about Europe’s support; it is involved in the war against Russia without any casualties other than the economic consequences to its people. Von der Leyen and other leaders are never going to suffer from rising prices and taxes. It is time for European Union countries to organise a referendum to establish whether their citizens support the war. Michel Demuynck, Discovery Bay

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Readers discuss a form of cancer endemic to East and Southeast Asia, the impact of the disruption to oil supply on Asian cities, and EU support for Ukraine

Readers discuss a form of cancer endemic to East and Southeast Asia, the impact of the disruption to oil supply on Asian cities, and EU support for Ukraine