India’s cancer cases are increasing by the day. As noncommunicable diseases (NCDs) have emerged as the country’s dominant cause of death, cancer has become India’s second biggest killer – behind only heart disease. Yet as recent figures show, there is a huge lack of infrastructure to tackle one of India’s foremost health crises.
Just 62 dedicated cancer care hospitals cater to an estimated 2.25 million people in India according to the National Institute of Cancer Prevention and Research (NICPR). Compounding matters is chronic understaffing – observed particularly in shortages of specialists. This is undermining efforts to provide treatment to India’s cancer patients, in the process causing a considerable number of deaths that would otherwise be preventable.
Is the issue being addressed by the government?
India registers an estimated 1,157,294 new cancer patients every year – with a considerable death toll. In 2018, 413,519 men and 371,302 women died of cancer, according to the Indian Council of Medical Research (ICMR). It is estimated that around 9.81 percent of men and 9.42 percent of women are at risk of developing cancer before reaching 75 years of age.
Some new cancer centres are being opened. However, the level of financial and political commitment is still lacking.
“The government has realized that cancer burden is increasing and hospitals treating cancer are meagre in number. That is why the investments in cancer hospitals is going on. Still, this is very little when we look at the unabatedly increasing number of patients,” said Ravi Mehrotra, director of the NICPR.
New hospitals benefit from new technology
The latest addition is the National Cancer Institute (NCI) at Jhajjar, Haryana, under the All India Institute of Medical Sciences (AIIMS). The NCI will have 710 beds dedicated to cancer prevention, treatment, research and education. The facility is to be equipped with cutting-edge technology, including 25 operation theatres, five linear accelerators, four PET Scanners, two CT scanners and two MRI scanners.
It still must be noted that making available an additional 710 beds against a cancer burden in excess of a million a year is just a drop in the ocean. However, some of the technology being put into place at the NCI may hold more value than simply offering more beds.
India’s first public sector Robotic Core Clinical Laboratory is due to be opened at the NCI, costing around Rs 15 crore. The laboratory can perform more than 60,000 tests per day and provide reports within two hours.
This level of output — if properly staffed in order to take samples from patients — could allow for mass testing of those deemed to be in at-risk groups. This would allow for early detection of cancer, enabling hospitals to catch the disease in its early stages when it is far easier to treat.
Early diagnosis, a stage India is missing
“The major problem in our country is late diagnosis. Most patients come to us in the third or fourth stage, which further increases the disease intensity and burden. The regional centres cater to a limited population,” said P.K. Jhulka, senior director of the Max Institute of Cancer Care.
Access to healthcare is crucial in managing illness. In diseases such as cancer, early diagnosis is a critical factor in treatment outcome and prognosis. Many, however, do not seek treatment either through lack of knowledge of the symptoms or lack of access to medical facilities. This can allow cancer to progress to an advanced stage where, .depending on the type of cancer, it may have become metastatic. This involves the cancer spreading to other areas of the body. Once cancer has reached this stage, treatment is far more difficult.
If caught in the initial stages, the prospect for cancer survival is significantly higher. This is due to the fact that the cancer can be entirely removed via surgical removal of the tumour, as the cancer has yet to spread across the body.
Survival rates in India reveal that it is unlikely that cancers are being detected in their early stages. Breast cancer — India’s most common cancer — serves as an example for this. For every two women newly diagnosed with breast cancer, one woman dies due to the condition according to the National Institute of Cancer Prevention Research (NICPR).
Prevention methods not being used
Removing risk factors is another powerful tool in the fight against cancer. In many cases this may be through reduction of lifestyle choices such as tobacco use or consuming. Government campaigns are already in place to attempt to reduce tobacco use.
Other prevention methods are, however, not being used. A key example of this is the human papillomavirus (HPV) vaccine. HPV is one of the most common causes of cervical cancer, which kills more women in India than in any other country. The HPV vaccine is very effective in preventing infection by strains of the virus that cause the majority of cervical cancers. However, its inclusion in India’s Universal Immunisation Programme (UIP) has been stalled due to political pressure stemming from unsubstantiated rumours regarding its safety.
If India is to deal with a rising future cancer burden, preventative measures such as use of the HPV vaccine must be utilised to reduce disease burden. However, even with such preventative measures, India’s cancer burden is still likely to rise. This makes an increase in infrastructure to deal with the burden across India a necessity. To ignore this would risk the future health system being completely overwhelmed.