Cancer continues to take thousands of lives in India. A non-communicable disease, it accounts for over 42% of all deaths in the country. Every year two million people suffer from cancer. This year, so far 14.5 lakhs cancer cases were reported and over 7.36 lakh people succumbed to cancer. It is expected that by 2020, the numbers of cancer cases will rise to 17.3 lakhs, while mortality rate is likely to shoot up to 8.8 lakh people.
However, there has been limited data on the overall cancer cases and deaths in the country, to identify the extent of cancer in the country, the National Cancer Registry Programme (NCRP), a flagship programme of the Indian Council of Medical Research was set up. A country-wide study was conducted in various population-based and hospital-based cancer registries.
Through cancer screening in various states at the districts level, risk factors were identified along with regional differences in cancer cases.
These steps generated data on the magnitude and patterns of cancer in different regions like North East, Central, Western states and Southern States.
Off all the cancer cases, Breast, Lung and Cervical cancer have topped the list of new cases.
While new cases in Delhi have increased rapidly since 2008-09, the burden in northeastern states is also high. Cancer cases in India are expected to jump from around 14 lakh in 2016 to over 17.3 lakh by 2020. Deaths due to cancer are projected to go up from 7.36 lakh to over 8.8 lakh in the next four years.
Over 1.5 lakh new breast cancer cases were estimated during 2016, which is over 10% of total cases. Cancer of the lungs is second with estimated 1.14 lakh new cases (83,000 in males and 31,000 in females) during 2016.
Incidence of breast cancer is projected to go up to 1.9 lakh by 2020, whereas new lung cancer cases are likely to increase to 1.4 lakh cases in the next four years. Data also revealed that only 12.5% of patients come for treatment in their early stages.
While there is huge regional disparity, the northeast reported the highest number of cases in both males and females. Aizwal district in Mizoram recorded the highest number of cancer cases among males while Papumpare district in Arunachal Pradesh reported the highest rate of the disease among women.
Through resource allocation and cancer screening in various states at the village level, the risk factors and pattern and magnitude of the disease were identified along with regional differences in cancer cases. These steps generated data on the magnitude and patters of cancer in different regions like North East, Central, Western states and Southern States.
Based on the Cancer Registry data it is estimated that there will be about 800,000 new cancers cases in India every year. According to the NCRP report, this year, 14.5 lakhs cancer cases were reported and it is expected that by 2020, the numbers will rise to 17.3 lakhs.
There are multiple types of cancer such as Lung cancer, Oral cancer, Breast Cancer, and Cervical cancer.
Epidemiological studies have shown that 70-90% of all cancers are environmental.
The most common cause of cancer is tobacco smoking, which infects the lung, pharynx and esophagus. According to the cancer registry, 48% of cancers in males and 20% in females are related to tobacco use.
Apart from lung cancer, smokeless tobacco like Gutka also represents a substantial health risk. The carcinogen in Gutka causes cancer of the mouth, tongue and lips. The systemic effects of smokeless tobacco may increase risks for other cancers. Esophageal cancer is also linked to carcinogens in tobacco.
Just like tobacco, extensive alcohol drinking poses another threat to people since it increases the risk of cancers of the oral cavity, pharynx, larynx, esophagus, and liver, colon and breast cancer. The risk of cancer is related to the amount of alcohol consumed. If any person drinks alcohol in large numbers then the risk of cancer increases.
Cancer of the uterine cervix is the most common cancer among women in India. However, Breast Cancer is a rising health risk for women across the country.
Breast Cancer is emerging as the leading cancer in women. One in 44 women were found to have breast cancer. What puts women at risk are early menstrual cycle as well as late pregnancy.
Cervical cancer was also found mostly in women, which is caused by Human Papilloma Virus (HPV).
Cancer also has a close link with Genetic Factors. Familial aggregation has been found in cancers of the breast, colon, prostate, retinoblastoma and lung. Many women inherit breast cancer from their mothers or sisters. However, women themselves are a very good way of detecting breast cancer in early stages. However, the study showed that 20% of women come for early detection while 80% does not, which puts them at risk.
In West Bengal and Bihar, arsenic was found to be the cause of cancer.
The other cause of cancer is linked to diets. Food additives and contaminated food is associated with cancer. If the diet is high in fat, there is an increased risk of breast cancer. Dietary fat is also associated with colon, prostrate cancer.
The risk of cancer increases also due to weight gain. An association is possible also for gallbladder and colon cancer. Obesity increases the risk of endometrial cancer and Postmenopausal breast cancer and kidney cancer.
Similarly Stomach Cancer occurs due to high consumption of salt and salted foods, which causes infection in the intestine.
There are numerous other environmental factors such as air and water pollution, and pesticides in their vicinity, which are related to cancer. However, most of these conditions are not addressed on time, therefore the infected patient is at high risk of cancer and death is not treated on time.
Methods to control and prevent cancer
To prevent and control cancer, it is imperative to create awareness in the public domain.
While the mainstream population has better access to information, in rural and sub-urban setting, each household should be informed about how to identify the symptoms of the disease as well as share the methods of preventing cancer.
Primarily Lifestyle related factors are the most important and preventable among the environmental exposures.
The key elements in households, especially in rural and suburban settings are Cleanliness, hygiene and proper sanitation which can prevent them from being exposed to cancer.
Besides, avoidance of all forms of tobacco and alcohol is the most important preventive action against mouth, throat and lung cancers. Control of tobacco smoking will also help reduce exposure to occupational and environmental carcinogens (in particular indoor pollution).
Early detection is the prime method of preventing cancer. Regular breast self examination by women themselves is a very good way of detecting breast cancer in early stages. Mammography in women older than 50 years is useful in early detection of cancer.
If treated on time, 60% of cancer cases are preventable. In those who are affected due to tobacco usage, 40% cases were preventable.
Healthy lifestyle can also help in controlling cancer. In terms of food, a healthy diet rich in Fruits and vegetables and unprocessed food has a preventive role. Besides, reduction of high calorie food especially fat, increase in fruit and vegetable consumption and physical activity is preventive.
A diet rich in green and yellow vegetables and proper oral hygiene has been shown to offer protection against oral cancer. Cancer of the oral cavity can be detected early and every opportunity in which a health care person interacts with a tobacco user should be able to detect pre-cancerous conditions or cancers of the oral cavity.
To prevent and control cancer it is important to avoid tobacco and alcohol, ensure regular physical activity and identify the warning signs of cancer such as a lump or hard area in the breast.
Avoidance of solar exposure, especially in childhood, is the only primary way to prevent skin cancer. Also, since exposure to sun causes cancer, reduction of sun exposure through use of protective clothing and changing patterns of outdoor activities can reduce the risk of cancer in patients.
Besides, it is imperative that early diagnosis is done which helps in preventing and control cancer. Many women prefer not to go for testing on time, which puts them at risk. One prime reason is financial. The cost of treatment and care is often prohibitive which stops the patient from approaching hospitals.
At any given point there is likely to be 3 times this load, which is about 24,00,000 cases. Unless steps are taken to prevent and control cancer at the onset, thousands of live will be lost.
(Mohuya Chaudhuri is a senior journalist and researcher)