We need to focus on risk reduction, early detection, and programmatic and policy solutions The Indian Council of Medical Research (ICMR)-National Centre for Disease Informatics and Research (NCDIR) National Cancer Registry Programme Report of August 2020 has estimated that the number of cancer cases in India in 2020 is 13.9 lakh. India has seen a steady rise in cancer cases over many decades. A 2017 report showed that India’s cancer burden increased 2.6 times between 1990 to 2016, and deaths due to cancers doubled during the time.
Almost two-thirds of these cancer cases are at late stages. In men, the most common cancers are of the lung, oral cavity, stomach and oesophagus, while in women, breast, cervix, ovary and gall bladder cancers are the most common. Tobacco use (in all forms) is a major avoidable risk factor for the development of cancer in 27% of cancer cases. Other important risk factors include alcohol use, inappropriate diet, low physical activity, obesity, and pollution.
Cancer causes loss of lives and also has a tremendous socioeconomic impact. Reducing cancer is a prerequisite for addressing social and economic inequity, stimulating economic growth and accelerating sustainable development. But merely investing in cancer treatment is not an economically viable option. We need to focus on three key aspects: risk reduction, early detection and programmatic and policy solutions.
Cancer occurrence is a complex interplay of host and environmental determinants, which makes it difficult to predict it at an individual level. But it is estimated that nearly 50%-60% of cancer cases can be avoided by tackling the known risk factors effectively. Community empowerment through a multisectoral approach that brings together government, private practitioners and civil society to increase health literacy and promote certain behaviour can go a long way in reducing potential risk factors. Improved awareness can also prevent stigma attached to the disease. We need to ensure that health systems are strengthened so that there is greater access to screening and vaccination, early detection, and timely, affordable treatment.
The importance of data:
Population health approaches are also relevant for large-scale impact. Programmatic and policy-level solutions need to be driven by data. The information collected through the National Cancer Registry Programme has been used effectively over the years to advocate for better access to screening, early detection, referral, treatment and palliative care services. It has also helped shape cancer research in the country, which is of crucial importance to guide our efforts on cancer prevention and control. Making cancer a notifiable disease could be one of the ways to help drive this research further by providing greater access to accurate, relevant data that can drive policy decisions.
India is committed to achieving a one-third reduction in cancer-related deaths by 2030 as part of the Sustainable Development Goals, and it has made considerable progress. India has improved in some areas, such as personal hygiene, which are distant drivers of cancer. Government programmes such as Ayushman Bharat, Swasthya Bharat, Swachh Bharat Abhiyan, Poshan Abhiyaan and Pradhan Mantri Bhartiya Janaushadhi Pariyojana and initiatives such as FSSAI’s new labelling and display regulations and drug price control can encourage inter-sectoral and multi-sectoral action. Other initiatives such as the National Health Policy, the National Tobacco Control Programme, and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke are also paving the way for progress.
Our approach should not simply focus on diagnostics, treatment modalities and vaccines, but emphasise inclusivity in thinking and action for equitable solutions that can greatly reduce the impact of cancer across all socioeconomic levels in the country.
By Dr. Balram Bhargava, Director General, ICMR, and Secretary, Department of Health Research; and Dr. Prashant Mathur, Director, ICMR-NCDIR, Bengaluru