According to a World Health Organization report, premature deaths by non-communicable diseases is one of the highest in India. Of all the other non-communicable diseases like cardiovascular ailments, chronic respiratory problems and diabetes, cancer is a major public health concern.
The cancer burden in developing countries is reaching pandemic proportions. Cancer is one of the leading causes of death in India, with about 2.5 million cancer patients, 1 million new cases added every year and with a chance of the disease rising five-fold by 2025. Indian Council of Medical Research (ICMR) has urged the Government of India to make cancer a notifiable disease. There is a high probability of treating cancers if detected early -- in Stage I or Stage II.
As per a Boston Consulting Group study, 70-80% of cancer patients are diagnosed late when treatment is less efficient and 60% of them do not have access to quality cancer treatment. Out of 300+ cancer centres in India, 40% are not adequately equipped with advanced cancer care equipment. This study further suggests India will need at least 600 additional cancer care centres to meet the requirements by 2020.
A report quotes Dr Pankaj Chaturvedi of Tata Memorial Hospital as saying that annually, nearly 5 lakh people die of cancer in India. As per WHO Report 2005, this number is only expected to rise to 7 lakh by 2015.
Globocan 2008 report shows that in India, cancers of lung and mouth in men and cervix and breast in women are the biggest killers.
Estimated age-standardized incidence and mortality rates: Men
Estimated age-standardized incidence and mortality rates: Women
Source: Globocan 2008 (ASR - Age-standardized rate)
The causes of such high incidence rates of cancer may be both internal (genetic, mutations, hormonal, poor immune conditions) and external or environmental factors (food habits, industrialization, over growth of population, lifestyle-related).
Ignorance among public, delayed diagnosis and lack of adequate medical facilities has given cancer the dubious distinction of being a ‘killer disease’. However, fact remains that if cancer is detected in its early stages, it can be treated and individual can lead a healthy life.
To fight cancer, governments in many countries maintain population-based cancer registries.
Cancer registry in India
Cancer registration is a mechanism to collect and classify information on all cancer cases in order to produce statistics on the occurrence of cancer. It also helps in assessing and controlling the impact of cancer on the community.
In many developed countries and in some states of USA, notification of cancer cases is compulsory for every hospital. This facilitates collection of data for population-based cancer registries.
In areas where notification is compulsory, hospitals retrieve information from the patient records on a specified proforma and send it to the registry. (This is called the passive method)
A report on cancer registration in India says, "In areas where trained staff for abstracting the records is not available with the individual hospitals or notification is not mandatory, the workers from registry scan through the patient records in different hospitals, clarify incomplete or contradictory information, and abstract data." This method is known as active method.
National Centre for Disease Informatics and Research, a dedicated government institute which collects cancer data, operates through 219 centres across India comprising 28 population-based cancer registries which have 250 major institutions contributing to data base.
Cancer scenario in India
The following figure shows how cancer cases have been progressively increasing from 2004 to 2010.
Source: Year wise total cancer prevalence in India [ICMR, 2006; ICMR, 2009]
Based on the data from 2004 to 2010, predictions have been made for cancer cases in 2015 and 2020. With the numbers seen as increasing, the battle against cancer in the future is only going to get more and more monumental.
In an interview, global cancer policy expert, Prof Richard Sullivan, is quoted as saying, "We need to recognize that the challenges India faces in delivering equitable, quality and affordable cancer care to all is a huge challenge."
High treatment costs are one of the main reasons why cancer care is out of reach for millions of Indians. If detected early, treatment is effective and cheaper. However, if detected late, it is more expensive (can even lead to bankruptcy) and also reduces chances of survival.
A skewed doctor-to-patient ratio only worsens the situation. Our health ministry is working towards achieving the target doctor-patient ratio of 1:1000 by 2021, which at present is 1:2000.
If we have to detect cancer early, we should also have skilled manpower across the country, which is disproportionate. Access to cancer detection technologies -- quality pathology labs, imaging equipment, especially PET/CT or molecular imaging that can detect cancer at least 5 years earlier than any other technology -- needs to be improved. India needs at least 500 PET/CTs to manage the present cancer incidence and 1000 units by 2020. India has a population of approximately 1,200 million with a requirement of more than 1,200 Radiation Therapy (RT) machines. At present, there are just 400 RT machines that are available for cancer treatment.
However, the government is taking steps to improve the state of cancer care in India. Last month, the Cabinet Committee on Economic Affairs (CCEA) approved a scheme for strengthening tertiary care cancer facilities at a cost of Rs 4,697 crore.
The central government will help the state and union territory governments in setting up State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC).
The plan will help in increasing oncology-related facilities in underserved areas and bed capacities for in-patient treatment will also increase. It is only with such dedicated and concerted efforts that India can battle the terror of cancer.
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