Cancer has become the second most common cause of death in India and globally and its prevalence is still increasing. More than one third of cancer cases can be prevented, another third can be cured if detected early and treated properly. By implementing resource-appropriate strategies on prevention, early detection and treatment, we can save up to 3.7 million lives every year in the world.
World Cancer Day
World Cancer Day celebrated on 4 February, started in 2020, is led by the Union for International Cancer Control. The objective is to raise awareness, educate public and catalyze personal, collective and government action to prevent cancer deaths and equal access to life-saving cancer treatment and care for all. The aim is to unite everyone, everywhere under one voice to face one of our greatest challenges in history and reduce the impact of cancer. This day celebrates the anniversary of the signing of the ‘Charter of Paris Against Cancer’ in Paris. This year’s World Cancer Day’s theme, ‘I Am and I Will’, is about commitment to act, as together we can reach the target of reducing the number of premature deaths from cancer and non-communicable diseases by one third by 2030. Our time to act is now.
Burden of Cancer in India
According to World Cancer Report 2020, One in ten Indians will develop cancer in lifetime and one in 15 will die of it. In 2018, the country had estimated 1.16 million new cases, estimated about 570,000 in men and 587,000 in women, with 784,800 deaths. A report of the National Institute of Cancer Prevention and Research (NICPR), states an estimated 2.25 million people in India live with cancer and more than 1,157,294 new cancer patients are registered every year. In 2018, 7,84,821 people (4,13,519 men and 3,71,302 women) died of cancer.
Burden of common Cancers in India annual
|Common Cancers||Among Men||Among Women||Total|
Trends of various Cancers in India
The incidence of colorectal cancer is increasing in the most developed states in India and in urban populations. “There is a clear increasing trend in the incidence rates of breast cancer across the country, with an annual percentage increase that ranges from 1.4 per cent to 2.8 per cent and is more pronounced in urban areas than in rural areas. Incidence rates are also increasing for cancer associated with overweight and obesity and lower levels of physical activity, such as colorectal cancer, uterine cancer, ovarian cancer and prostate cancer.” The report noted that there is a clear decreasing trend in the incidence rates of cervical cancer in most regions in India (annual percentage change, -2.0 per cent to -3.5 per cent.
Causes of Increase in Cancers in India
Tobacco is number one cause of cancers in India: There are currently 164 million users of smokeless tobacco, 69 million smokers, and 42 million smokers and chewers in India. More than 90 per cent of patients with oral cancer have low or lower-middle socioeconomic status. Tobacco-related cancers account for 34–69 per cent of all cancers in men, they constitute 10–27 per cent of all cancers in women in most regions in India.
Life Style Factors: Overweight, obesity, inadequate physical activity & sedentary lifestyle contribute to increase in cancers such as Breast and Colorectal cancers.
Evidence that Cancers can be reduced:
Increase in life expectancy: The prevalence of cancers increases with age. Life expectancy in India has increased by about ten years since 1990. It is expected to increase further. Hence it is important to further strengthen cancer prevention and management strategies as elderly population is increasing.
There is Evidence that Prevention Interventions Work
IARC Director Elisabete Weiderpass observed that high-income countries have adopted prevention, early diagnosis and screening programmes, which together with better treatment, have contributed to an estimated 20 per cent reduction in the probability of premature mortality between 2000 and 2015, but low-income countries only saw a reduction of five per cent.
Global evidence suggest that cancers can be controlled by preventive actions, early detection and prompt treatment. Cancers related to infections such as Cervical Cancer and Liver cancer can be prevented by HPV vaccine and hepatitis B vaccines. Early detection of pre-cancerous conditions and their management, and timely treatment can cure many cancers.
Elimination of Cervical Cancer has been targeted by 2030 globally. The three objectives laid down in this programme include, (i) fully vaccinating girls with HPV vaccine, (ii) Screening of 70% women and (iii) Treatment is provided to 90% women with cancer. India accounts for about one fifth of the global burden of cervical cancer, though incidence rates are decreasing in the country. Elimination of cervical cancer in India will have a major impact on global elimination of the disease as a public health problem. Cervical cancer disproportionately affects women with lower socioeconomic status, who are at a considerable disadvantage in the availability of and access to public health services for prevention and early detection, and therefore this is also an equity issue.
Strengthening Clinical Care
Every cancer and every patient of same cancer is different and needs personalized attention. Precision Medicine in cancer treatment has emerged as an important approach taking into account each patients variability in genes, environment, and lifestyle and family support for each person. This approach helps in identifying most effective, minimally toxic treatment suitable for each patient. The availability of oncology consultations can also be augmented through tele consultations, tele radiology and tele pathology including access to specialized diagnostics through hub and spoke network linking peripheral health institutions to specialized centres.
Access to Health Care in Cancer
The cancer care in India has received government attention since mid-1970s. National Cancer Control Programme was started in1974-75, revised in 1984-85 and in 2010 it was integrated with National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Other related national programmes are National Tobacco Control Programme, National Programme on Health Care for Elderly, National Oral Health Programme and National Program for Palliative Care.
The diagnosis and treatment of cancer is expensive and its lack of affordability is a reason for delay and incomplete treatment. Ayushman Bharat-PMJAY covers about 60 Crore population in India. The approach under PMJAY needs to address prevention, early diagnosis and prompt treatment. With focus on early detection and prompt treatment, cure rate will improve and mortality will come down. Engaging ASHAs and ANMs at grass root level based in health subcenres and the 125,000 Health and Wellness Centres being established by upgrading subcentres under Ayushman Bharat-PMJAY for screening three common cancers (oral, cervical and breast) will also help early detection and treatment. As cancer treatment is evolving fast, there is also a need for inclusion of more oncology medicines in National List of Essential Medicines and review emerging medicines and treatments on a regular interval.
The way forward
Cancer is the second commonest cause of death and it is on the rise. It has recently received political attention at global level and government in India is committed to achieve the globally set prevention and treatment goals to address cancers. This momentum needs to be capitalized by the government to engage all stakeholders in raising awareness, facilitate early detection, diagnosis and prompt treatment. The technology is evolving rapidly to detect and treat cancer cases early. The government needs to ensure that diagnosis and treatment is available at affordable prices. The private sector and civil society organizations such as Indian Cancer Society needs to be fully engaged in the government plans. World Cancer Day gives us an opportunity to mobilize resources, stakeholders and public to address the cancer problem effectively.
(Written by Dr Sanjiv Kumar
MEMBER GOVERNING BOARD, NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE, MOHFW, GOI)