Cancer, no doubt, is a dreadful disease. According to a report, 10 million people died worldwide due to cancer in 2020. As per a WHO report, approximately 400,000 children and adolescents of 0-19 years old develop cancer every year. According to the National Cancer Registry Program (NCRP), in India, cancer is rapidly emerging as a matter of public health concern. More than 40 lakh cancer cases were reported and 22.54 lakh people died of the disease between 2018 and 2020 in India. As far as the number of cancer patients is concerned India occupies the third position among all nations in terms of the highest number of cancer cases. As per the recent report of the Indian Council of Medical Research (ICMR), there will be a 12 percent rise in cancer cases in India in the next five years.
This is quite alarming news!
There are 5 types of cancer named after cells, tissues, organs, and glands it originates from and which are affected by cancer cells
- Leukemia is a blood cancer
- Carcinoma refers to cancer of organs like breasts, pancreas, lungs, stomach, etc, and glands such as salivary, thyroid, adrenal, and pituitary glands.
- Lymphoma is cancer of the lymphatic system, a part of the body’s immune system
- Melanoma is a type of skin cancer
- Sarcoma is a cancer of the connective tissues such as bones, muscles, etc.
Oral cancer, breast cancer, and cervical cancer are the most common forms of cancer prevalent in the Indian population. Cancer may develop anywhere in the body and symptoms may not occur. If there are symptoms, they vary widely. Some cancers spread too far in the body, therefore their early diagnosis means that treatment is more likely to be successful which may increase the chances of survival.
What actually happens in cancer?
Our body is made up of trillions of cells. The old and damaged cells die and are replaced by the new cells formed by the process of cell division or multiplication. There are genes that control the growth and division of the cells. In cancer, this genetic control over the growth and division of cells is lost as a consequence of which there is unchecked growth and multiplication of some of the body’s cells. The uncontrolled growth of the cells forms lumps of tissues known as tumors. There are two types of tumors benign and malignant. The latter one also known as cancerous tumors move to nearby or distant tissues in the body thereby causing the formation of new tumors. This is how cancer spreads in the body. This process is known as metastasis. Cancer cells are transformed and altered cells. They are recognized by the body’s defense network of the immune system as non-self cells. The main and the only job of the immune system is to destroy and eliminate anything which it perceives as non-self such as microbes, toxins as well as cancer cells. Therefore cells of the immune system known as B and T lymphocytes ( B and T cells), Natural Killer (NK) cells and macrophages, etc make all efforts to kill and eliminate cancer cells. But cancer cells develop the ability to dodge the immune system and escape the killing.
The increase in cancer cases in India at an average annual rate of 1.1- 2 percent and the increase in death rate at an average rate of 0.1-1 percent from 2010-2019 have been reported. An analysis by the Institute for Health Metrics and Evaluation (IHME), University of Washington School of Medicine published in JAMA journal on December 30, 2021, showed these growth rates among the global highest. IHME study pointed out that globally the picture is not very different.
It’s worth mentioning that the COVID-19 pandemic considerably hindered the work of registration of new cases of cancer and also heavily affected the follow-up actions in case of previously registered patients who needed cancer surgeries, chemotherapies radiotherapies, etc. The routine cancer screening was plummeted. Overall there was a disruption in the cancer care system in India.
What can be done to improve the cancer care system to reduce the cancer burden in India?
Keeping in view the high burden of cancer and the fact that the majority of patients are being diagnosed at the advanced stage of cancer in India, it’s imperative that the focus should be on the early detection of the disease which greatly increases the chances of successful treatment. The screening which is an important component of early detection of cancer consists of testing healthy individuals to identify those having cancers before any symptoms appear. As per one report Ayushman Bharat – Health and Wellness Centres (AB-HWCs) under the Ayushman Bharat scheme of the Central Government of India, launched in 2018, have carried out screening for three common cancers which include oral cancer ( 5.08 crore screenings), breast cancer (2.64 crore screenings in women) and cervical cancer ( 1.79 crore screenings in women) across the country till April 2021. This is a good initiative and must be continued in a way to overcome the disruptions caused by Covid 19. The reports have been published in journals about the success of mobile phone-based ( the mHealth approach) screening of cancers. The effectiveness of this approach can be determined by prominent health agencies in India.
The workforce associated with AB- HWCs can be trained to educate the people about the harmful effects of a sedentary lifestyle, obesity, alcohol, and tobacco consumption which have been implicated in the rise of cancer cases.
Basic cancer care mainly because of high-cost cancer treatment is not affordable to the majority comprising of the rural population ( 70 percent of the total population of India) most of whom are economically and socially marginalized people in India. Chemotherapy, Radiation Therapy, Surgery, and advanced therapies like Immunotherapy for the treatment of various types of cancer are administered in cancer centers, over 95 percent of which are located in urban areas which are not accessible to rural populations. Therefore it’s mandatory to improve the workforce and infrastructure of AB-HWCS in rural areas to detect cancer at the earliest curable stage. This will definitely help to reduce the cancer burden in the rural populations. Another scheme known as Pradhan Mantri Jan Arogya Yojna (PMJAY) covers the treatment of cancer. Under this scheme health insurance cover of Rs. 5 lakh per family per year is provided for secondary and tertiary care hospitalization. Under this scheme over 4.7 lakh cancer cases have been treated till 15 December 2019. In addition to PMJAY, the Swasthya Sathi Scheme of West Bengal, the Chief Minister’s Comprehensive Health Insurance Scheme of Tamil Nadu, and the Cancer Cure Fund of Non-Governmental Organization (NGO), the Indian Cancer Society helps underprivileged patients to get good-quality cancer care. Other schemes of several states and NGOs are extending help to poor people to cope with cancer.
As a nation having a vast network of educational and research institutes and fast growing economy, the integrated efforts can be made by Central Government of India (GOI) to create collaboration among government funding agencies, top class research institutes and universities, private sector life sciences companies, private philanthropic organizations, national and foreign financing institutions in a highly professional way to advance and produce innovative indigenous technologies for the detection, diagnosis and treatment of cancer. There must be focuss on patenting the discoveries. In future this will open up the avenues to save money by way of curtailing the import of foreign technologies and drugs needed for cancer care in India. It may reduce the cost of cancer treatment and may attract more cancer patients for treatment in India. It’s a recognized fact that India offers cheaper cancer treatment than many advanced countries including USA, without compromising on quality of treatment. It’s likely that export of our indigenous cancer care technologies and drugs may turn out to be huge source of earning money. If this strategy proposed above is taken to its logical end will undoubtedly create employment opportunities for young people. It will also be a step forward towards self sufficiency which is a hallmark of GOI policies.
Dr. Aqueel Khan
Former Professor and Head,
University Post-Graduate Teaching Department of Biochemistry,
RTM Nagpur University, Nagpur, Maharashtra,
Mobile No.: 9890352898