Introduction
In a first-of-its-kind cancer registry, the district of Gadchiroli in Maharashtra was found reporting more than 600 cases of cancer a year. As per the Population-based Cancer Registry (PBCR), published in April 2019, about 28 per cent cases are related to oral cancer, the highest number of cases in 2015–16. The PBCR was initiated after a SEARCH study found out that 50.4 per cent of Gadchiroli’s population were tobacco users. The study is a joint initiative by Tata Memorial Hospital (TMH) and Dr Abhay Bang’s Society for Education, Action and Research in Community Health (SEARCH).
Increase in Oral Cancer Cases
The incidence rate of oral cancer in Gadchiroli was 12 per cent per one lakh women and 20 per cent per one lakh men in 2015–16, the highest in the country. More than 600 cases of oral cancer are reported every year with men and women proportion at 40 per cent and 20 per cent, whereas the prevalence of oral cancer is about 10–12 per cent of all oral cancer cases. Oral cancer was the second leading cancer after cervical cancer among women, which is highly unexpected.
Causes of Oral Cancer
Tobacco is the major cause of oral cancer, particularly when it is mixed with flavoured betel nuts, known as kharra or mawa. No awareness campaigns seem to work, be it the television, the internet, newspapers or even pictorial warnings, especially in tribal areas where women give it to their children to stop them from crying, thus making them dependent at a very early age. The rate of incidence of all cancers can be brought down by 50 per cent if tobacco consumption is curbed as the International Agency for Research on Cancer (IARC) lists tobacco and betel nuts as carcinogens.
Cervical Cancer
The second most common cancer among Indian women preceded by breast cancer is cervical cancer. It is declining across the country at an average rate of 1.81 per cent to 3.48 per cent, as per government data. Most Indian women die of cervical cancer than any other country in the world. Official estimates for 2012 show that every year 1,22,844 women were diagnosed with cervical cancer and 67,477 died of it. The WHO estimated 5,30,000 new cases of cervical cancer globally with 2,70,000 deaths. Thus, of all female cancer deaths, 7.5 per cent occurred due to cervical cancer. And about 85 per cent cases of cervical cancer occurred in low- and middle-income countries.
The regional registries, released in 2016, by the Indian Council of Medical Research (ICMR), including Bengaluru, Bhopal, Chennai, Delhi, and Mumbai showed a considerable decline in age-adjusted rate over time. Though this decrease is attributed to an improved living standard of women, experts opine that this incidence could have been underestimated due to under-diagnosis in rural areas. In fact, most of the cases of cervical cancer are detected with regional spread of the disease.
The annual percentage change (APC), estimated for 2012–14, as per the population-based cancer registry by ICMR in incidence of cervical cancer in Bengaluru is at –2.26 per cent, in Bhopal at –1.81 per cent, in Chennai at –3.48 per cent, in Delhi at –2.73 per cent), and in Mumbai at –1.99 per cent.
Cancer Preparedness Index 2019
In 2018, about 9.6 million deaths occurred due to cancer, the second biggest killer. Every year, it creates a burden exceeding $1 trillion. As per the 2019 Index of Cancer Preparedness, 28 countries were assessed for the adequacy of measures to treat and prevent cancer. The preparedness of countries was scored across 45 indicators, categorised under policy and planning, care delivery, health system, and governance. Countries are ranked by their scores on a scale from 0 to 100. India ranks 19 with 64.9 per cent score or 72.8 average overall score.
As for healthcare system, India ranks 25th in the index above only Saudi Arabia, Kenya, and Egypt. As for healthcare infrastructure, it is the second worst in the list. India ranks 20th with a score of 61.3 in its delivery of care. With high standard of guidelines, it falls short on its immunisation, screening, and early detection.
However, with a relatively high score of 80.8, India ranks only 17th overall in cancer planning and policy. Strong cancer research makes India the first, while tobacco control makes the country the third.
Inadequate Treatment Facilities
Another study, ‘History of the Growing Burden of Cancer in India: From Antiquity to the 21st century’, published in the Journal of Oncology, says that Uttar Pradesh, Bihar, Jharkhand, and Odisha, currently passing through huge epidemiological changes, will bear the biggest cancer burden in the next 10–20 years. Owing to a huge gap in demand and supply of treatment facilities, these states will face even bigger challenges if the gap is not immediately addressed. The study was carried out to make it clear whether cancer epidemic in India is due to westernisation or a modern lifestyle, as per Mohandas K. Mallath, from Tata Medical Centre (TMC), Kolkata.
The study found out that ageing, and not civilisation, is the main cause of cancer incidence. As India continues to age, the cases of cancer will double every 20 years. According to Mallath, the lead author of the study, people generally move from a high birth—high death state to a high birth–low death state and then to a low birth–low death state. Since life expectancy increases, degenerative and cancer diseases also start increasing. It is called Epidemiological Transition Levels (ETLs), which are high in Kerala and the lowest in Uttar Pradesh.
However, due to better healthcare facilities and early diagnosis, cancer mortality would be proportionately lower. If tobacco is completely banned, Indians would get 10 more years to live, and get age-related cancers such as breast cancer (women) and prostrate cancer (men). Another important point is the Centre-State concurrent responsibilities due to which patients suffer. Government also should not permit private hospitals to run cancer care programmes as they charge huge amounts of money.
Conclusion
To conclude, India plans to introduce the human papilloma virus (HPV) vaccine by 2020, and has started screening in health and wellness centres under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). The central government should also enforce the age-old Bhore Committee report (1946) and Mudaliar Committee report (1962) recommendations, which include creation of a multidisciplinary cancer treatment unit in all medical colleges and setting up of a stand-alone cancer-speciality hospital.
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