Cancer in India

Cancer in India

News: A new report says Cancer deaths in the US have declined by a third over the past three decades. What is the situation in India, and what will it take to replicate the success in the US? We discuss here.

Background:
• Even with improvements in treatment, both the incidence of cancer and mortality continue to rise in India.
• Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body.
• According to a report by the American Cancer Society, deaths due to cancer have declined by 33% (translating into 3.8 million fewer deaths) in the United States since 1991. This success is mainly due to early detection, lower rates of smoking, and improvements in cancer treatment.

What is the incidence of Cancer and mortality in India?
• According to an ICMR study, one in nine Indians will develop cancer during their lifetime. One in 68 men will develop lung cancer and one in 29 women will develop breast cancer.

Why are some Cancers declining?
• The incidence of cervical cancer has dropped in India over the last 50 years from 45 to 10 per 100,000 populations. The decline is because of late marriages, fewer children, better hygiene, and vaccination (human papillomavirus vaccine (HPV)).
• At the same time, there is an increase in rates of breast cancer, especially in urban centres (45 per 100,000 in Hyderabad). This is because of the same reasons (which resulted in cervical cancer decline) – late marriages, having the first child at a later age, not breastfeeding, and a high protein diet.
• Unlike cervical cancer, there is no specific intervention for breast cancer other than screening because what causes it is unknown.
• The rates of tobacco-related cancers (oral, oesophageal) are also coming down, largely due to tobacco laws that have brought down smoking in public places.
• Lung cancers, however, remain a cause for concern. It is caused not only by smoking but also by pollution. For example, lung cancer rates are high in Arunachal Pradesh because they light fires indoors in winter. The survival rate for lung cancer is not very high and it is mostly diagnosed in the late stages.

Have there been improvements?
• Yes, as the cure rate for various cancers is rising. For example, The cure rate for pancreatic cancer has doubled from 3% to 6% in the last 50 years. Prostate cancer has gone up from 60% to 100% and Breast cancer has improved from 50% to 90% with newer treatments.

What must be done to bring down overall mortality like in The US?
• The first intervention has to be screening. Screening for the three most common types of cancer — breast, cervical, and oral.
• Next, Screening must lead to treatment. However, the treatment has to be accessible and affordable.
• Coordination of different government programmes is utmost important. Presently, they are working in silos and independently. 
• There must be many more cancer care facilities. 
• We have one comprehensive cancer care centre for every 5 crore population. There are seven pillars of cancer care — prevention, surgery, chemotherapy, radiotherapy, imaging, laboratory diagnostics, and palliation. 
• “The WHO says there should be 1 radiotherapy machine per million population in developing countries, so for our 1.4 billion people we need 1,400 machines, and we have only 700.