Could cancer become a notifiable disease?

India’s current cancer figures are currently based on estimates, with just a minority of cases of the condition actually recorded in cause of death reports. The true burden may be far higher than current figures suggest.

The parliamentary standing committee on health and family welfare submitted a report entitled “Cancer Care Plan and Management: Prevention, Diagnosis, Research & Affordability of Cancer Treatment” to the Rajya Sabha. The report recommends that cancer be made a notifiable condition, making it mandatory that health providers report every single case to the authorities. 

Typically, diseases that are classed as notifiable are infectious diseases, rather than noncommunicable diseases (NCDs). This is due to the need for quick identification of the disease in order to limit spread and allocate resources where needed. 

The National Cancer Registry Programme (NCRP) was put in place four decades ago, despite this, hospital cancer registries only cover around ten percent of the Indian population. As is similar for much of India’s healthcare infrastructure, there is a distinct disparity between rural and urban coverage. The committee noted that there is a pressing need for dedicated rural cancer registries in order to address this issue.

As previously reported by Health Issues India, India’s record for official medical certification of deaths is lacking. It has been more than fifty years since it was written into law that births and deaths must be officially registered, and while roughly 86 percent of estimated total deaths are registered, medical certification covers less than one in five deaths. Due to this, the cause of death, and therefore the actual figures for many diseases, are unknown.

Cancer is often overlooked in the few medical certifications that report a cause. “The Committee notes that cancer is still not classified as a notifiable disease which results in underreporting of cancer deaths…It has been brought to the notice of the Committee that many times death is simply recorded as a cardio-respiratory failure without mentioning the actual cause of death,” states the report.

As reported by the Times of India, India’s cancer mortality to incidence ratio is 0.68, far higher than that of developed countries, which average at 0.38. While India, under current estimates, has a far lower caseload as a proportion of the population compared to western nations, the significantly higher mortality rate is a cause for concern. This, again, is likely due to lower detection in India than in wealthier countries. 

When cancer is detected in its early stages, the prognosis is far more favourable. By stages three and four, chances of survival for most cancers is significantly reduced. Early detection, therefore, is a key practice in ensuring the best outcomes for patients. Detection times during the pandemic have, however, been delayed. With healthcare resources diverted, and many healthcare providers overwhelmed by the number of COVID-19 cases, detection of other diseases – including cancers – have been impacted. Some have stated that this will have lethal consequences in the years to come.

Harmala Gupta, co-president of CanSupport stated in the Times of India last year that “since the pandemic, missed detection opportunities may result in patients being diagnosed with more advanced and harder-to-treat stages of cancer in the future. A Lancet study estimates that there may be an increase in cancer deaths as a result of diagnostic delays over the next five years, ranging from 4.8 percent for lung cancer to 16.6 percent for colorectal cancer [both among the most common forms of cancers among Indian men and lung cancer being one of the most common among women].” 

Additional funding and resources will be essential to addressing India’s cancer situation. Health Issues India has reported on the need for an upgrade in cancer infrastructure and oncology human resources in the past; noting that to cope with enhanced demand, the country will need 7,300 oncologists in the years to come. The existing shortfalls of trained medical professionals operating in the area mean as many as 83 percent of Indian cancer patients are failed when it comes to their treatment. 

The panel has projected a Rs 35,000 crore expenditure in setting up a nationwide hub-and-spoke model for cancer treatment. While this is an ambitious goal, the establishment of cancer as a notifiable disease may serve to highlight the true extent of the disease in India. An estimated one in fifteen Indians lose their lives to cancer, with potentially even more should the full data be reported. A better understanding of the full picture – with real data, rather than estimates – regarding the magnitude of the lives lost to cancer could encourage additional funding, but for this to occur, as the panel recommends, cases must be reported.