The theme for World Cancer Day 2024 is 'Close the care gap: Everyone deserves access to cancer care', a crucial necessity in rural India.
Published Feb 04, 2024 | 9:00 AM ⚊ Updated Feb 04, 2024 | 12:32 PM
One third of all cancers are preventable and curable, if detected early. (Commons)
Globally, World Cancer Day is celebrated on 4 February every year, which aims to prevent millions of cancer deaths by raising awareness about cancer, and pressing governments and individuals around the world to take action against the disease.
The theme for World Cancer Day 2024 is “Close the care gap: Everyone deserves access to cancer care”.
It is well known that cancer is a major problem in developing countries, more so in the Indian subcontinent where it is rapidly increasing in both males and females. About 1.4 million cancer cases are diagnosed every year in our country. At any given point in time, there are more than 3.5 million cancer cases prevalent in India.
In Karnataka, it is estimated that every year, more than 70,000 cancer cases are newly diagnosed and about 2.1 lakh cancer cases are prevalent at any point in time.
It is expected that the cancer burden is likely to increase further due to several factors such as the longevity of the population, increasing pollution, obesity, changes in social factors, and many more. However, death by infectious diseases is decreasing, and childhood mortality is decreasing.
Other risk factors include adoption of Western lifestyle, which is increasing, besides the combined effect of ageing of the population as well as regional differences in the prevalence of disease.
Tobacco-related cancers contributed to the occurrence of more than one third of all cancer cases in the country. As expected, most of the cancer patients come from lower socio-economic strata, where illiteracy and limited access to health facility are rampant.
Childhood cancer incidence is increasing and it is well known that over 60-70 percent of childhood cancer cases is curable with optimal treatment. Thus, measures are required to identify these cancers early on, possible only with improved primary healthcare infrastructure.
As per reports published by the National Centre for Disease Informatics and Research (NCDIR), the common cancers, as per the population-based cancer registry at Bengaluru, are:
Among male population:
Among female population:
Increasing trend in the incidence of lung cancers among women in Indian urban registries is glaring.
Most of the cancers are diagnosed at later stages, which result in poor survival outcomes and considerable costs to the patients, who typically cannot afford the required treatment. Secondly, rural areas in middle-and-low income countries also have inadequate access to trained care providers and have access to very limited health services for early diagnosis and treatment.
As a result, delay has also been largely associated with advanced stages of cancer. This emphasises the importance of extending palliative care.
Since one third of all cancers are preventable and curable, if detected early, early detection of cancer offers the best chance for long-term survival and has the potential to improve treatment outcomes and make healthcare affordable. Strict tobacco control measures in the country will reduce the burden on this disease, as well as many other diseases.
The proverb “Prevention is better than cure” exists for a reason.
Early detection of cancer is one of the important objectives of any national programme using screening as a tool. Cancer screening aims to detect cancer before symptoms appear.
This may involve physical examination, including self-breast examination, blood tests, urine tests, and medical imaging. The benefits of screening in terms of cancer prevention, early detection, and subsequent treatment must be weighed against any harm.
It is disheartening to note that there is no nationwide organised screening programme for any of the common cancers. Cancer prevention and early detection is posed by multiple challenges, including lack of awareness and fear among the public to participate in screening camps.
It has been stated by various studies that camp-based screening are not cost effective and have low detection rate, with added logistical problems (distance, equipment), ethical (sociocultural) issues, infrastructure (mobilisation of resource), lack of access to diagnostic and treatment facilities across regions (more so in rural parts of the country).
Further, problems in linkage with existing health infrastructure, coupled with lack of involvement of governmental and non-governmental organisations, is another bottleneck. Although various state governments have framed stringent laws against tobacco and its use, the implementation is yet to yield results.
The decision of the Government of India to include HPV vaccination as part of the National Immunisation Programme is a major step in the prevention of cervical cancer, which is the second most common cancer in the Indian female population.
Even though efforts are being made to provide comprehensive cancer care, a challenge remains in that the available cancer care centres are concentrated only in the urban areas/cities. Thus, there is a huge gap between care seekers and care providers, and efforts are needed to bridge this gap.
(The author is a former professor and Head of Department of Epidemiology & Biostatistics, Kidwai Memorial Institute of Oncology, Bengaluru.)
