Cancer is said to be steadily inching its way up the rankings of killer disease, in India. It is the most unpredictable and complex of non-communicable diseases, accounting for 7 per cent of Indian mortality, with numbers steadily rising. Since the turn of the century, cancer has overtaken diarrhoeal diseases and respiratory infections, both communicable diseases, to become the fourth major killer disease, according to World Health Organization (WHO) data. The WHO has warned that India is the next hub for cancer in the world.
The Union Health Ministry says there are about 28 lakh cases of cancer at any given point of time in India, with 10 lakh new cases and over 5 lakh death being reported annually. Uttar Pradesh, India’s most populous state, is estimated to have the most cancer cases in 2014, Maharashtra ranks second, followed by Bihar, West Bengal and Andhra Pradesh, according to data released to the Lok Sabha. The burden of cancer is expected to increase due to rise in life expectancy, demographic transitions and the effects of tobacco. Around 40 per cent of cancer cases in India are due to tobacco use, said a Planning Commission Paper for the 12th Five year plan on non-communicable diseases (NCDs). According to the National Cancer Registry Programme’s Consolidated report of Hospital based Cancer Registries: 2007-2011, overall 45.4 per cent of cancers in men and 16.8 per cent of cancers in women are related with the use of tobacco.
A massive study by an International team of doctors tracked 26 million cancer patients from 67 countries, including India, for over 15 years, has shown that survival rates in the ten most prevalent types of cancer vary hugely across countries. Survival rates in India are quite low for most types of cancer, less than half of the advanced countries in many types. More surprising is the fact that survival rates in India are either stagnating, or inching up very slowly, despite India having improved its treatment facilities.
In India, survival rate for colon cancer is 37 per cent while it is 50-59 per cent in most countries and goes upto 65 per cent in the US. Only 4 per cent of liver cancer patients survive for five years in India compared to 10-20 per cent elsewhere. Survival rates have dipped in the case of rectal cancer in India.
Even in breast and prostrate cancer, where medical advances have ensured that over 80 per cent survive in advanced countries, only about 60 per cent of Indian patients survive. Ovarian cancer survival rates have declined in India from 23 per cent in 1995-99 to 14 per cent in recent years. Cervical cancer survival rates are 46 per cent compared to the global figure of 50 per cent, but cervical cancer is a leading cause of cancer deaths among women in India, accounting for nearly one-third of cervical cancer deaths across the world.
Experts in the field are of the opinion that one reason for the low survival rates in India could be that equitable access to early diagnosis and optimal treatment is not yet available for all people in the country. Over 70 per cent of cancer cases in India are diagnosed during the advanced stages of the disease, resulting in high mortality rates. Another reason for India’s low cancer survival rates could be patients do not (or cannot) fully comply with the treatment decided by the doctors. Consequently, the number of people living with cancer is expected to rise tremendously in the next few decades.
In fact, studies have revealed that by 2030, India and China will not only have the bulk of cancer cases globally, but are also likely to be ill-prepared to deal with cancer burden as ageing of the population and the consequent increase in cancer cases would be happening much more rapidly than it did in the developed world. For instance, while it took 115 years for the proportion of population over 65 years in a developed country like France to double from 7 per cent (1865) to 14 per cent (1980), in China, the proportion of elderly is expected to triple from 8 per cent in 2006 to 24 per cent by 2030 within just 44 years. And in India, the proportion of elderly is expected to go up from about 7 per cent in 2001 to about 13 per cent by 2030, a doubling within just 29 years. Overall, most of Asia is expected to see an increase in cancer burden in the next 25 years.
This issue of a rapidly ageing Asia ill-prepared to deal with the cancer burden has been highlighted in a report brought out by the International Prevention Research Institute. The report also highlights the plight of cancer patients in Africa.
While the incidence of cancer is rising, there are more patients alive within five years of diagnosis, which has financial implications too since it is in this five-year period that patients would need active treatment and intense follow up, said the report.
It is bad to have cancer, but worse to have it if you are poor; pointed out the report elaborating how despite continuing improvements in cancer prevention, early detection and treatment, there are wide variation in the availability and quality of care around the world. According to the report, while two out of every five people diagnosed with cancer in resource-rich countries will die prematurely, in resource-poor countries nine out of ten people will die prematurely as most cases would be coming in too late for treatment and they would be too poor to afford the treatment.
(The writer is a freelance journalist)
