Cancer in India

chillibreeze writer — Ranjani Mohan

Introduction

Recent times have seen an increase in the incidence of cancer. This is mainly attributed to urbanization, industrialization, lifestyle changes, population growth and increased life span (in turn leading to an increase in the elderly population). In India, the life expectancy at birth has steadily risen from 45 years in 1971 to 62 years in 1991, indicating a shift in the demographic profile.1 It is estimated that life expectancy of the Indian population will increase to 70 years by 2021–25.2 This has caused a paradigm shift in the disease pattern from communicable diseases to non-communicable diseases like cancer, diabetes and hypertension.

Burden caused by Cancer

Cancer is a group of diseases with similar characteristics, which can occur in all living cells in the body and different cancer types have different natural history. The myth that cancer affects people mostly in the developed countries is being broken by the fact that, of the 10 million new cancer cases seen each year worldwide, nearly 5.5 million are in the less developed countries. Cancer is the second most common cause of death in the developed world and a similar trend has emerged in the developing countries too.3

Cancer prevalence in India is estimated to be around 2.5 million, with over 8,00,000 new cases and 5,50,000 deaths occurring each year due to this disease.4 More than 70% of the cases report for diagnostic and treatment services in the advanced stages of the disease, which has lead to a poor survival and high mortality rate.5

The impact of cancer is far greater than mere numbers. Its diagnosis causes immense emotional trauma and its treatment, a major economical burden, especially in a developing country like India.

The initial diagnosis of cancer is perceived by many patients as a grave event, with more than one-third of them suffering from anxiety and depression. Cancer is equally distressing for the family as well. It could greatly affect both the family’s daily functioning and economic situation. The economic shock often includes both the loss of income and the increase of expenses because of the treatment and health care. This disease is associated with a lot of fear and despair in the country.

Distribution of Various types Cancers across the Subcontinent

Among men, lung, esophagus, stomach, oral and pharyngeal cancers are more prevalent, while in women, cancers of cervix and breast are most common, followed by those of stomach and esophagus.

Different cancers occur in different states of our country.6–8

• Esophageal cancers: Southern states of India like Karnataka and Tamil Nadu and also in Maharashtra and Gujarat.
• Stomach cancers: Southern India with the highest incidence in Chennai.
• Oral cancers: Kerala (South India)
• Pharyngeal cancers: Mumbai (Western India)
• Thyroid cancers among women: Kerala
• Gall bladder cancer: Northern India, particularly in Delhi and West Bengal.

Trends in Incidence of Cancer in India

A trend analysis of the data on cancer incidence for the period 1964–96 has demonstrated that the overall occurrence of cancer is increasing with among females. The greatest increase among females was for cancer of the breast and among males for cancer of the prostate. There was an increasing trend for lymphoma, urinary bladder, gall bladder and brain tumors in both sexes. Cancer of the colon was increasing in females and that of the kidney in males. Esophageal and stomach cancers were decreasing in both sexes. Cervical cancer showed a decreasing trend.9

Risk Factors

According to epidemiological studies, 80-90% of all cancers are due to environmental factors of which, lifestyle related factors are the most important and preventable.10 The major risk factors for cancer are tobacco, alcohol consumption, infections, dietary habits and behavioral factors. Tobacco consumption, either by way of chewing or smoking accounts for 50% of all cancers in men. Dietary practices, reproductive and sexual practices account for 20-30% of cancers. Studies have shown that appropriate changes in lifestyle will reduce the mortality and morbidity caused to cancer11. This offers the prospect for initiating primary and secondary prevention measures for control and prevention of cancers.12

Cancer Control in India

India is one of the first few developing countries where a nation-wide cancer control programs were launched. Government of India took its first initiative in 1971. The National Cancer Control Program for India was formulated in 1984 with four major goals 13:

1. Primary prevention of tobacco related cancer
2. Early detection of the cancers of easily accessible sites
3. Augmentation of treatment facilities
4. Establishment of equitable, pain control and palliative care network throughout the country

Cancer Prevention

According to Mayo Clinic, there are 7 steps to prevent cancer.14

• Avoid tobacco use: As already discussed, tobacco is the major risk factor for cancer. Hence, it is important to avoid tobacco in all forms, like both active and passive smoking and chewing tobacco.
• Eat a variety of healthy foods: It is important to consume plant-based foods, rich in fruits and vegetables, reduce the intake of fat and alcohol.
• Stay active and maintain a healthy weight: Regular exercise should be an integral part of one’s daily routine.
• Protect yourself from the sun: Exposure to sun is the major cause of skin cancer. It is important to avoid the sun’s ultraviolet rays, especially from 10 am to 4 pm and applying adequate amounts of sunscreen lotion with a sun-protecting factor (SPF) of at least 15, especially before venturing outdoors during these hours
• Get immunized: Vaccination against Hepatitis B should be regularly administered, as this infection could lead to liver cancer.
• Healthy practices: Sexually transmitted diseases like human papilloma virus infection, hepatitis B and HIV can lead to an increased incidence of various cancers. It is thus important to practice safe sex by using condoms, limit the number of sexual partners, or abstain from sex and never share needles. In case of drug addiction, it is important to seek help.
• Get screened: Regular screening and self-examination for certain cancers helps in early detection of cancer and improves the prognosis.

References

1. SRS based abridged life tables 1990–94 and 1991–95. SRS Analytical Studies, 1998, 1, 3.
2. National Cancer Control Program, India: DGHS, MHF and W, Govt. of India, New Delhi, 1996.
3. Stewart BS, Kleihues P, eds. Cancers of female reproductive tract In: World Cancer Report, World Health Organization, International Agency for Research in Cancer, Lyon, France: IARC Press 2003.
4. Nandakumar A. National Cancer Registry Program, Indian Council of Medical Research, Consolidated report of the population based cancer registries, New Delhi, India: 1990-96.
5. Dinshaw KA, Rao DN, Ganesh B. Tata Memorial Hospital Cancer Registry Annual Report, Mumbai, India: 1999.
6. Cancer Registry Abstract, Newslett. Natl. Cancer Registry Project India, 2001, 8.
7. Parkin DM, Whelan SL, Ferlay J, et al. Cancer Incidence in five continents. IARC Scientific Publications, Lyon, 1997.
8. Population based Cancer Registry Report 1991–95, Regional Cancer Centre, Trivandrum, 1999.
9. Yeole BB. Trends and predictions of cancer incidence cases by site and sex for Mumbai. Indian J Cancer. 1999; 36:163–178.
10. WHO, The World Health Report, Geneva, 1997.
11. Varghese C. Cancer prevention and control in India. Ministry of Health and Family Welfare. Available at: http://mohfw.nic.in/pg56to67.pdf
12. Murthy NS, Mathew A. Cancer epidemiology, prevention and control. Curr Sci. 2004; 86(4): 518–524.
13. Dinshaw KA, Shastri SS, Patil SS. Cancer control program in India: Challenges for the new millennium. Health Administrator. XVII (1): 10–13.
14. Cancer prevention: 7 steps to reduce your risk. Mayo Clinic. Available at: http://www.mayoclinic.com/health/cancer-prevention/CA00024

 

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—About our writer: Ranjani is a medical doctor by qualification, but a medical writer by choice. Her passion for the science of medicine and the language of english, coupled with her urge to write, brought her to this field almost 7 years ago. Ever since, she has been writing; sometimes working fulltime, while at others, as a freelancer.

 

 

 

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