January 2016

Relieving India’s cancer burden

Despite the nation’s worrisome cancer statistics, quality healthcare and timely diagnosis can help save lakhs of lives

Over the years, statistics have consistently revealed that the incidence of cancer worldwide is on the rise. Most recently it was estimated that cancer has risen from 700 new cases per million population in 2013 to nearly 1,000 new cases per million people in 2015. Even in India, the trend has been along similar lines.  As per the World Health Organisation, cancer deaths in India alone, were projected to reach 700,000 by the end of 2015, which is the highest annual estimate yet. In spite of technological advances in healthcare, India’s burgeoning cancer burden is fast getting out of hand.

The root cause behind this is likely to be the approach Indians have adopted towards cancer in India- which mostly lays emphasis on ‘cure’ rather than ‘prevention’. The world over, experts agree that if the goal is to decrease the incidence of cancer, the first step must be to increase efforts for prevention, by establishing and ensuring access to screening processes for early detection. Once these processes are introduced, they must also sustain, in order to screen large parts of the population effectively. However, these screening processes present a dual challenge; the first challenge of ensuring these are affordable, accessible and available to the masses; and the second challenge of ensuring that people come forward and utilise them.  

With respect to the first challenge, the government as well as the private sector must look towards the expansion of public infrastructure in primary healthcare. Even the extension of services of trained nurses and health workers can go a long way, especially in conditions like breast cancer, wherein basic screening and examinations conducted by them can contribute to early detection. A study by Tata Memorial Hospital on Clinical Breast Exam also shows that even lesions in the early stages can be detected on examination by trained nurses. Further, the National Cancer Grid, as envisaged by the Tata Memorial Hospital, Mumbai, is an example of a joint effort between the public and private sector. This grid is a network of existing and future major cancer centres in the country that aims to establish a uniform standard for patient care, and promote collaborative research on cancer. Although the Ministry of Health & Family Welfare has allocated Rs.15, 855 crores towards the early diagnosis and treatment of cancer over the next five years, the state governments are yet to submit their proposals to support initiatives like the National Cancer Grid, which aims to promote early detection and awareness. Private organisations and NGOs are also considering cross subsidised models to ensure affordability of basic cancer care. Corporates also can play a greater role through implementing sensitisation programmes, and concentrate their social responsibility efforts towards tackling the disease. Such efforts need to form the core of India’s response to the threat of cancer, and need to be introduced nationwide.

The second challenge of motivating people to come forth for screening, poses greater difficulty in our country. This difficulty becomes further exaggerated if one is to consider the example of breast cancer, owing to the reluctance of women for screening. But while women remain shrouded in this diffidence, they put themselves in danger. It is a medical fact that breast cancer, in stage 0, takes 8 to 10 years to become malignant, post exposure to causative elements. This implies, if more women were screened for breast cancer regularly, we would have greater chances of an early diagnosis during this 8 to 10 year latency period, wherein the damage to the breast tissue would be minimal, survival chances would be nearly 100% and the overall physical and psychological impact on the patient would be minimised.

But breast cancer remains the most common cancer in India. In 2013 alone, breast cancer claimed 47,587 lives, in spite of it being largely preventable and curable in the initial stages.

When detection is delayed it may require surgical procedures. But with early diagnosis, as compared to invasive procedures like mastectomies, the survivor has a greater capacity to preserve the body and self-image of the patient, conserve sexual health, and also leads to lower levels of anxiety. This eventually leads to a better quality of life of the cancer survivor. In a report by the All India Institute of Medical Sciences, it was determined that cancer care at the later stages yield high cost to the patients and their families; the findings revealed that the economic burden of cancer treatment was 20 times the annual income of the family. Consequently, it appears that the repercussions of a diagnosis at a later stage are far more severe than at an initial stage, even fatal. Hence, it is all the more essential to ensure that efforts are made for early detection and diagnosis. 

It also must be taken into account that even if one is unable to prevent the disease, and is diagnosed with cancer, there are ways to ensure a good quality of life. More developed nations are now looking at options like genomic sequencing, and stem cell research as means of effectively curing cancer, and minimising the ill effects of the disease. India has just started to enter the field, and has a considerable way to go. Till these advancements become viable prognosis, India needs to be able to ensure preventive measures like regular screening, early detection, and quality healthcare treatment.