17 January 2023

Cancer in India: A status report

GS-3: Science and Technology- developments and their applications and effects in everyday life.

Recently, the American Cancer Society released a “Cancer Statistics 2023 Report”. According to the report, the number of deaths from cancer in the United States has decreased by one-third since 1991. The report credited early detection, a reduction in smoking rates, and advancements in cancer treatment as the reasons for the success. 

The trend has not yet been seen in India, where both the number of cancer cases and deaths are still increasing despite advancements in treatment. Doctors reported that the number of cervical and smoking-related cancer cases has decreased in India, but the number of lung and breast cancer cases has risen.

To decrease cancer deaths in the country, it is essential to have improved screening and treatment facilities, and a more comprehensive linkages between screening centers and hospitals.

Cancer

• Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. 
• It is a genetic disease, meaning it is caused by genetic mutations that regulate the behavior of our cells, particularly their growth and division.
• It is a result of specific alterations in genes, which are the fundamental units of inheritance. 
• These genes are organized in strands of tightly packed DNA known as chromosomes.
• Genetic mutations that lead to cancer may occur due to:

• Errors that occur as cells divide.
• Damage to DNA caused by harmful substances in the environment, such as the chemicals in tobacco smoke and ultraviolet from the sun. rays
• Inheritance from our parents.

• Normally, the body eliminates cells with damaged DNA before they can become cancerous, but this ability decreases as we age. This is one of the reasons why cancer risk increases with age.

Incidence of Cancer and Mortality in India 

• In India, cardiac problems continue to be the primary cause of death, with cancer as the second leading cause.
• According to the National Cancer Registry of the Indian Council of Medical Research (ICMR) data, approximately 14.6 lakh new cancer cases were reported in 2022, an increase from 14.2 lakh in 2021 and 13.9 lakh in 2020.

• The number of deaths from cancer rose to an estimated 8.08 lakh in 2022, compared to 7.9 lakh in 2021 and 7.7 lakh in 2020.
• It is projected that the total number of cancer cases will increase to 15.7 lakh by 2025.

• An ICMR study utilizing data from population-based cancer registries states that one in nine Indians will be diagnosed with cancer during their lifetime. 

• The study also reports that one in 68 men will develop lung cancer and one in 29 women will develop breast cancer.

• The incidence of cancer is higher among women compared to men.
• The most frequent types of cancer among men were lung, mouth, prostate, tongue, and stomach, while for women, it was breast, cervix, ovary, uterus, and lung.

Mixed cancer trends, some decreasing, others increasing

• Over the past 50 years, the rate of cervical cancer in India has decreased from 45 to 10 cases per 100,000 people, thanks to factors such as delayed marriage, reduced number of children, improved hygiene, and vaccination.
• However, there has been a rise in rates of breast cancer, especially in urban centers, which is attributed to similar causes: delayed age of marriage, having the first child at a later age, not breastfeeding, and a high-protein diet.
• Unlike cervical cancer, which can be prevented through HPV vaccination, as vaccines are becoming more affordable, the government plans a campaign soon, there is no specific intervention for breast cancer other than screening, as the cause of the disease is not well understood.
• The rates of cancer caused by tobacco use, such as oral and oesophageal cancer, are also decreasing. 

• This is largely due to laws that have restricted smoking in public places.

• However, lung cancer continues to be a concern. It is caused not only by smoking but also by factors such as indoor fires in winter in Arunachal Pradesh and prolonged cooking on open stoves in Bihar. 

• Air pollution in Delhi is also expected to have a significant impact in the next decade. 
• Unfortunately, the survival rate for lung cancer is low and it is often diagnosed in the advanced stages.

• The cure rate for pancreatic cancer has improved from 3% 50 years ago to 6% currently. 
• For prostate cancer, the cure rate has increased from 60% to 100%, and for breast cancer, it has gone up from 50% to 90% with new treatments. 
• To reduce mortality, it is important to ensure early diagnosis and timely treatment.

Measures to decrease overall mortality rate similar to that of the US

• The initial step must be screening. 

• Through the government's upgraded health and wellness centers, screening for the three most common types of cancer – breast, cervical, and oral – has already begun. 
• This, along with other government programs, has led to patients seeking medical attention earlier.
• Cervical, breast, and oral cancers account for 34% of cancers in India.

• Dual stain testing is the most effective method for cervical cancer screening, and a low-dose CT scan is the best option for lung cancer screening in individuals with a history of smoking. 

• Breast self-examination is not an appropriate standard screening method for breast cancer. 

• In the past, there was an 80/20 rule, meaning 80% of patients presented to the hospital in advanced stages, of which 20% were curable, while 20% of patients presented in early stages, of which 80% were curable.

• However, in the last 10 years, this has changed to a 70/30 rule, with 30% of patients now presenting to hospitals in early stages.

• To show benefits in terms of mortality, it is necessary to improve and refine screening methods and target them more effectively.
• Screening should lead to treatment.

• If people who are likely to have cancer do not have the means to go to a hospital, get tested, and seek treatment, it will be ineffective.  

• Treatment must be both accessible and affordable.
• The government has multiple programs working independently, which should be coordinated to ensure that patients who are screened are able to reach a hospital for treatment. 

• There are pilot districts where screening and treatment are linked, but this should be implemented nationwide.

• There is a need for an increase in cancer care facilities, with one comprehensive cancer center for every 50 million people.

• The World Health Organization recommends one radiotherapy machine per million population in developing countries, so for our 1.4 billion people, we need 1,400 machines, but currently, we have only 700.

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