There are about 2.5 million people suffering from cancer at any given time in India. In the year 2000, nearly 800,000 people in India were diagnosed with cancer, of whom 550,000 died. Tobacco-related cancer accounts for almost one-thirds of the cancer in India, affecting the head, neck, lung and oesophagus. More than 5 million children in India are addicted to guthka – a leading cause of oral cancer. Approximately 15,000 new cases of childhood cancer are detected every year in India. This is almost double the incidence in the next highest country – the US.
When diagnosed early enough and treated with the appropriate protocols, approximately 70 percent of childhood cancers are curable. Tragically, while survival rates rise in the West, only 20 percent of the children detected with cancer in India benefit from advanced medical care, translating into an unacceptably high number of children dying of their disease. It is estimated that the death toll for women due to cervical cancer will rise to 79,000 per year by 2010. Breast cancer and oral cancer will claim about 59,000 and 53,000 respectively in the same time frame. So you see cancer is a lifestyle disease with dietary habits, lack of physical activity and alcohol consumption as some of its agents. The saddest thing about it is that in most of the cases, cancer can be prevented altogether or treated effectively if detected early.
With a disease like cancer which has a long latent period and can occur in any living cell of our body, the allocation of human resources and a state of the art infrastructure become a prerequisite for treatment – chemotherapy, radiology, surgical oncology, etc. With Tata Memorial and many other cancer speciality hospitals springing up all over the country, it is a promising future for cancer research in India.
Huge bounds have been made in treatment of cancer, the most notable being biotherapy which includes stem-cell and gene therapy, bone-marrow transplants and experiments for vaccines related to ovarian, prostrate, skin cancer and leukaemia. Cryotherapy is another development, where liquid nitrogen is pushed into the cancer infested organ to freeze the cancer. It is has been successfully used in early cases of cancer of the skin, prostrate, liver, eye and cervix. Hyperthermia has also been used in some cases where the patient is exposed to a high temperature (113 degree Fahrenheit) to kill the cancer infested cells. This treatment though is never used by itself, always as a supplement to other forms of therapy. Laser therapy is fast becoming an option to perform precision surgeries to remove pre-cancerous and cancerous tumours, as well as relieve symptoms of cancer. It is used mainly for the tumours on the surface of the body and some internal cancers like those of the oesophagus, stomach and colon.
India is one of the few developing nations’ to have formulated a National Cancer Control Programme (NCCP), which envisages the control of tobacco-related cancer; its early diagnosis and treatment of uterine and cervical cancer; distribution of therapy services, pain relief and palliative care through health infrastructure. Epidemiological studies have shown that 70-90 percent of cancers are environmental and can be avoided by simple precautionary changes in lifestyle. For example, heavy red meat consumption might lead to colon cancer.
One of the programmes that the NCCP has launched is the primary prevention and screening programme, which aims to reduce cancer by “risk-factor modification”. They advocate anti-tobacco programmes, changes in the school curricula to encompass messages for a healthy lifestyle and enforcing legislation banning advertisement of tobacco and sale of tobacco to children and young adults. Cervical cancer screening has been introduced especially for women between 35-64 years of age. Primary prevention includes genital hygiene, sexual behaviour and high level of health care during delivery. Mammographic screening for breast cancer is not yet cost effective in India, but regular self-exams are promoted.
But the fact of the matter is that in spite of all these efforts, the facilities do not reach the people on time. There is a serious lack of awareness amongst the rural and urban poor that needs to be addressed, because the main reason for the high mortality rate amongst cancer patients in India is late detection. The lack of diagnostic services at the grass root level is a major concern. It becomes imperative therefore, to make the services of specialists available at at least the district level at reasonable prices. A cancer diagnostic and prevention clinic can be set up at these hospitals to provide minimal treatment. Kerala has demonstrated that such services are not only feasible, but also sustainable.
On the more personal front, individuals with cancer face a very unsympathetic response, making it almost impossible to cope with the stigma associated with cancer, especially children, who get mercilessly teased for the side-effects of cancer and cancer therapy. Patients find it difficult to continue with their jobs due to unbending employers who refuse to give them time off from work. At the same time, it becomes necessary to keep them busy to get their mind off brooding about their condition. Hence, rehabilitation and counselling centres for the patients and their families must be set up to provide advice on medical help and provide emotional, financial and social aid to the poorer section of the patient demographic.
We have, thankfully, arrived at a stage where “cancer” doesn’t have to mean a death sentence. But more information and aid is still needed to propel us to a place where cancer patients can live with dignity.