INTERVIEW: India dubbed ‘Cancer capital of the world’; Dr Narayana Subramaniam explains why

Yes and no. The absolute numbers are alarming, and the rate at which we detect these cancers is also increasing, which is definitely a concern. But India, being a populous nation, naturally has a high number of cancer patients. Yes, few cancers are seeing an increase in numbers but we have also got better at diagnosing cancers.

Q: Which cancers are we better at diagnosing now, and which are showing an increase in numbers?

The list may overlap to some extent. There is an increase in breast cancer among women, head and neck cancer, specifically oral cancer, thyroid cancer, gastrointestinal cancers like colorectal cancer, especially in the young, and lung cancer. Early detection has improved, especially for breast and thyroid cancers, often detected incidentally during scans for other issues.

Q: How do you differentiate between voluntary diagnosis and incidental discovery of cancer?

It’s hard to generalise as it varies by cancer type, socio-economic status, and geography. For instance, someone in a multinational corporation undergoing annual health checks will have different detection rates compared to an agricultural worker. Early detection is crucial, and screening is important for certain cancers. However, some cancers are not recommended for screening to avoid overtreatment.

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Q: Can you list the cancers that might not need screening for in India?

In the West, some cancers like Thyroid cancer, head and neck cancer are not asked for screening. Even when detected incidentally, the life span of these individuals is not reduced so it is expected to show clinically. However in India, screening for breast cancer and oral cancer in high-risk patients (those with a history of tobacco and alcohol use, those with family history of cancer, obesity etc) is valuable. Colonoscopies after a certain age and screening for those with a family history of cancer are also important. Unfortunately, there are no clear national guidelines in India, so individual awareness and proactive health checks are essential.

These days, people tend to search for symptoms and outcome of diseases online and find that every disease leads to cancer. What should people look for online when searching for cancer symptoms?

Use reputable sources like the World Health Organization, Indian Cancer Society, Mayo Clinic or trusted hospitals. Avoid general internet searches as they can lead to misinformation. After doing some background research, it’s crucial to consult an oncologist for a professional opinion.

Q: Why are cancer numbers increasing? Are there common reasons?

Improved detection and increased patient and societal awareness contribute to rising numbers. Environmental factors like pollution, lifestyle changes like increased consumption of ultra-processed food, and rising obesity rates also play a role. Research is ongoing to understand these associations better.

Is it possible to prevent cancer?

Absolutely. While some cancers have a strong genetic link, the majority are sporadic and linked to environmental factors or exposures like tobacco and alcohol. Preventive measures like lifestyle changes and awareness can significantly reduce the risk of cancer.

Some things to remember:

• Cut out tobacco and alcohol completely.
• Maintain a balanced diet with green leafy vegetables, protein, fibre, and avoid ultra-processed foods and excessive red meat.
• Exercise regularly to control weight, as obesity is linked to multiple cancers.
• Vaccinations are also crucial for Hepatitis B to prevent liver cancer and HPV to prevent cervical and oropharyngeal cancers.
• Early detection and regular screenings for high-risk individuals are key.

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Q: Cancer care is expensive. Is there any solution for patients who hesitate to seek treatment due to costs?

Please buy health insurance. If covered through your employer, great. Otherwise, invest in good health insurance coverage. Treatment becomes unaffordable because it’s not meant to be paid out of pocket. Health insurance can make treatment affordable and provide access to necessary care.

Q: Are there policy measures that India can adopt to aid in cancer management and prevention?

Screening is crucial and needs more investment. Strengthening public-private partnerships can also help. The government should promote insurance coverage, even making it mandatory for those who can afford it. This can reduce the burden on the healthcare system and improve access to treatment.

Cancer is here to stay, but it is very treatable, especially with early detection. Don’t panic or lose hope. Be proactive about your health, seek early detection, and consider health insurance seriously.

(Edited by Neena)

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