World Cancer Day, an occasion to retrospect

  • Feb 04 , 2017

World Cancer Day  is observed every year on February 4 with the objective of encouraging the prevention, detection and treatment of this deadly disease. It was first observed in 2000 at the first World Summit against Cancer organised by the Union for International Cancer Control (UICC), held at Paris. In the year 2008, the World Cancer Declaration was drawn up. This landmark declaration envisages a significant reduction in illness and death cause by cancer by 2020. Consequently, a special three year campaign was launched to last through 2016, 2017 and 2018.

Carrying the tagline - ‘We can. I can’, this special campaign seeks to involve broad sections of our society in their individual and collective capacity to play their part and help reduce the incidence of this lethal disease. The World Cancer Day aims at eradicating misinformation, raising awareness and reducing stigma attached to it. It is expected that multiple initiatives would be launched on this day aimed at building a support system for those suffering from cancer. One of the highlights this year is a global movement called #NoHairSelfie. Participants would be encouraged to shave their hair and share their selfies on the social media as a mark of respect for those undergoing cancer treatment.

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A lethal killer worldwide
Despite decades of research and development, cancer continues to evoke fear. Though with recent breakthroughs, rates of survival have doubled in the last four decades, the number of deaths related to this disease continues to remain very high. It is estimated that in the year 2012 alone there were approximately 14 million new cases, and 8.2 million deaths. According to another study carried out by Cancer Research, UK, approximately 169.3 million years of healthy life were lost globally owing to this disease in 2008. More alarming still is the projection that the number of new cases related to cancer would rise by about 70 per cent over the next two decades. The developing world bears its brunt harder than the first world, owing in no small measure to the fact that treatment facilities and access to credible medication remains precarious. Over 60 per cent of new annual cases are detected in Asia, Latin America and Asia. And together they account for almost 70 per cent of all death attributed to cancer.

Is India ready to tackle cancer?
In India, through the past few years almost a million cases were reported annually. If experts are to be believed, it is expected that the incidence of this lethal disease would rise by almost five times by 2025. A massive infrastructural upgrade would be required to tackle this challenge. However, at the moment, we seem quite inadequately prepared. According to the data released by the health ministry, out of 300 cancer centers in India, as many as 40 per cent are ill equipped to support advanced cancer treatment and care. In order to meet the challenge, we would need 600 additional cancer care centers by 2020. Further, India has just about 400 radiotherapy machines as against the estimated requirement to 1600 units to cover the cancer population.  India’s poor doctor-patient ratio as compared to the rest of the world is also responsible for an abnormally high death rate. At present this ratio is 1:2000; the government is aiming to raise it to 1:1000 by 2021. According to expert opinion, India needs at least 1 cancer care unit per 100, 000 people. Unfortunately, we are still lagging far behind this ideal number.

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Another aspect of the cancer menace is the prohibitively high cost of treatment. At the leading private facilities the cost of treatment could as high as Rs 1 lakh per month. As a result, most uninsured patients drop out of the treatment after a few months. In a country like India, where the proportion of people with health insurance is quite low, it is hardly surprising that most cases of cancer end in the death of the patient despite that fact that treatment was possible. The problem is compounded by the fact that treatment for cancer is long drawn and entails recurring expenditure. This takes a huge emotional and financial trauma on the families of the afflicted. Though, the expenditure comes down significantly if the disease is diagnosed at an early stage and treatment is initiated in the earnest. It is for this reason that doctors and researchers advocate a broad based and sustained awareness drive about the symptoms and early warning signs of cancer. Small hints, could help in early detection and treatment, however, unfortunately, due to the lack of awareness in the public domain these are ignored and often the disease isn’t detected till it has reached an advanced stage. According to a data gathered by Apollo Hospitals, in 70 per cent cases, cancer is detected at an advanced stage. The data further reveals that even among the educated and relatively well to do sections, voluntary screening is very rare.

Causes of cancer in India
According to a study published by ‘The Lancet’, majority of cancer deaths among women in India is caused by breast, cervical and stomach cancers whereas the leading causes of death among men were oral, lung and stomach cancers. However, the study might not give us the true picture as it is based on data collected primarily from urban areas. Given the fact that almost 65 per cent of India lives in rural areas, it is likely that the conclusions would have varied had the scope of this study been broader. Another aspect that might undermine the conclusions reached by this study is that due to the lack of access to proper medical attention in relatively remote areas, it is possible that a sizable number cancer related deaths go unnoticed. To partly offset the imbalances in this study, a team of researchers tried to evaluate cancer mortality in the Million Death Study (MDS). Conducted by the Office of the Registrar General of India, the MDS aimed at making a comprehensive study of disease related mortality across all socio-economic groups. The research team tried to take into account the impact of social and geographical variations in causing specific types of cancers. Simultaneously they also attempted to understand the causative agents and risk factors. It was discovered that over 7000 deaths out of a total of 120,000 reported in the study could be attributed to cancer. Further, almost 70 per cent of deaths occurred in individuals aged between 30 and 70. When all age groups were considered together, it was found that cancer accounted for 6 per cent of all death due to diseases. Within the age group of 30-70 this percentage rose to 8 per cent. Finally, among men aged 30-70 the three leader causes of death due to cancer were- lung cancer (11 per cent), oral cancer (23 per cent), stomach cancer (13 per cent); whereas among women the three most common causes of death were breast cancer (10 per cent), cervical cancer (17 per cent) and stomach cancer (14 per cent).

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A cause for concern was the finding that 42 per cent of male cancer deaths and 18.3 per cent of female death were related to tobacco addiction. Oral cancers cause twice the number of deaths as lung cancer. The fact that the number of oral cancer deaths was almost twice that of lung cancer deaths led the researchers to conclude that the pattern of deaths related to fatal cancers differs substantially from that of developed countries. Another dimension that could of interest to the policy makers is that cancer deaths do not vary between according to age group across rural and urban areas; however there is considerable variation between the states. Among educated adults cancer death is less than half as compared to what was observed among uneducated adults. An interesting observation was that the incidence of cervical cancer among Muslim women 40 percent less than in Hindu women. According to researchers circumcision among Muslim men protects their partners from human pappillomavirus infection which causes cervical cancer.

It is very apparent from these finding that tobacco control could bring the number of cancer related deaths significantly, particularly so in the rural areas which lack proper medical facilities. Another major killer, cervical cancer could be controlled if preventive measures are put in place. This isn’t very difficult as a vaccine against human papillomavirus is available now. Oral and breast cancer are easily detectable at an early stage and hence awareness drives go could a long way towards preventing mortality.

Though we have made significant gains in preventing cancer related deaths since independence, it is very apparent that we still have a long way to go towards building a credible safety net. The very fact that more than 70 per cent of deaths related to cancer occur among those within the age group 30-70 reflects that substantial economic gain could accrue to us by preventing this fatal disease. A healthy and agile workforce is the cornerstone of a vibrant economy. Cancer day might be an apt occasion for us to take stock of the situation and take decisive steps towards curbing, if not completely eradicating this lethal disease.