Will India Win The Cancer Battle?
It is everybody’s right guess that cancer is now quite significantly prevalent in India. In fact according to scientists from Tata Memorial Centre and All India Institute of Medical Sciences (AIIMS), India is on the verge of another epidemic – the cancer epidemic.
Apparently India reports close to 1 million new cases every year, which is 15% higher than the number, reported in the United States. This number is expected to double by 2020. According to the GLOBOCAN project of IARC, which records the cancer statistics in 184 countries, about 7 lakh people died in India because of cancer in 2012. According to a study of 26 million cancer patients over 15 years, the cancer survival rates in India is significantly low and these numbers are either stagnating or moving very slowly.
Some more statistics to support India’s looming cancer epidemic are as follows:
- 1 in 8 Indian women will suffer from breast cancer by 2020
- 5-10% patients die within 2 months of diagnosis
- 70% abandonment rate at govt. hospitals which treat 85% of patients
However, the extent at which cancer exists in India presents a certain anomaly, which has been tough for our doctors to explain. In the western world, 50% of cancers occur in people beyond the age of 70. This can be explained by a simple fact that life expectancy has increased and cancer is often something that affects the older population.
However, 70% of Indian cancers occur in the age group of 30-69. In fact smoking contributes to 25% of cancer in Indian males according to reports in 2011. While it might seem like an indication towards altered lifestyles and cancer contributing habits, the reasons are still not completely documented and supported by statistics.
Is Prevention a Possibility?
The key to preventing cancer is to focus on educating the masses about a better lifestyle. This includes education about tobacco-use, healthy living and eating. In India, at the national level several steps have been taken to implement an operational strategy to reduce tobacco use. These include warning signs of packages, public service announcements, and ban on advertising and increased tobacco taxes. However, the warning signs on packages are so small and ineffective, it is almost negligible.
There are also several statewide and nation-wide initiatives to check obesity and alcohol abuse. However, there is no data to support how well these initiatives have done WRT the curbing of incidence of cancer.
However, national immunization programs against HPV and Hepatitis B, two of the most important to prevent cervical cancer has not been effective. The Hepatitis B vaccination coverage in infants is placed at 67%, while the coverage of HPV vaccination (which can be administered until the age of 26) is almost negligible.
Late Detection of Cancers in India
The fundamental focus on any cancer treatment is early detection. While prevention is largely stressed upon, early detection adds to treatability of any cancer. This year’s World Cancer Day stressed upon the importance of early detection.
However, in India 80% of cancers are detected too late, i.e., in Stage 3 or Stage 4. The average detection rate in the west is Stage 2 where the cancer can still be treated.
The fact is that some states such as Tamil Nadu and Kerala implemented opportunistic programs to push for early detection of cancer. However, these programs met with minimal success owing to non-availability of human resources (Pathologists) absence of integration with multicultural groups.
Though the public primary level healthcare centers have access to certain kinds of basic screening such as for cervical cancer and breast cancer, these have not been seriously implemented to a wider population. However, our public primary healthcare system does not offer any screening facilities for colorectal cancer, which is strictly suggested by the American Gastroenterological Association for men and women starting at the age of 50.
Lack of Access to Treatment Facilities
In India, there are exactly 210 cancer hospitals, which offer comprehensive treatment. But, 60% of these centers are located in 6 metro cities. This means that though people in rural and urban areas are affected by cancer, they have to travel all the way to any one of these 6 metro cities in order to access treatment. Whether this treatment is affordable is another question altogether! Apparently cancer patients outside these big cities, spend close to 40-60% of their total expenses just on travel.
Also, there is a severe lack of any professional bodies, which offer objective advice with regards to cancer in India. The western world is full of such professional associations & societies, which have now broken down to focus upon the different varieties of cancer, thus improving the focus on all of these.
Poor Affordability of Treatment Facilities
The average cost of cancer treatment for a period of 6 months is Rs. 2.5 lakh. This number can significantly vary depending upon the kind of cancer and stage at which it is diagnosed. It could even go up to Rs. 20 lakh with targeted drugs and treatment. While Rs. 2.5 lakh is affordable for India’s middle & upper classes, the lower economic class is the one that gets majorly handcuffed while requiring treatment.
Some of the most advanced facilities are available in the cancer hospitals in our cities; however, this is out of reach for most of our population owing to the amount of money it costs. In fact with certain targeted treatment drugs such as Herceptin (which is used for breast cancer) could cost up to Rs. 75,000 a course and patient could need up to 17 courses!
A very minute percentage of Indians are covered with health insurance. Even those covered by insurance do not have coverage for critical illnesses and the coverage is so small that is makes no sense for a disease like cancer.
How will India overcome this deadly disease?
The first step towards working on overcoming cancer in India is increased focus and investment on prevention and early detection. According to the last census, 72% of our population lives in villages. So, cancer centers need to be set up in rural areas where there is focused public service announcements and education sessions on healthy lifestyle habits, coupled with free & compulsory basic screening for cancer. These centers should have the responsibility to educate the public so that timely referrals for better treatment could be availed.
There is also severe stigma associated with a disease like cancer especially while dealing with breast and cervical cancer. We need more community support groups to rid people of such stigmas. Such groups will ensure that more people access treatment at the right time.
Our government sector also needs to focus on increasing investment in cancer prevention & treatment. This is the only way better treatment can be made accessible to a larger population at a more affordable price.