Uttar Pradesh, Bihar, Jharkhand and Odisha, which are currently passing through huge epidemiological changes, will bear the biggest cancer burden in the next 10-20 years, a study has shown.

These States, which already have a huge gap in demand and supply of cancer treatment facilities, will face even bigger challenges if steps are not taken to address the gap immediately, said the study, which appeared in the latest issue of the Journal of Global Oncology .

The study — History of the Growing Burden of Cancer in India: From Antiquity to the 21st Century — was carried out by Mohandas K Mallath of the Tata Medical Centre (TMC), Kolkata, and Robert Smith, a doctoral student at King’s College, London.

Mallath, the lead author of the study, said they carried out the study because they were intrigued by the popular misconception that Westernisation — a modern lifestyle — was pushing the cancer epidemic in India and wanted to get to the bottom of it.

Looking for the cause

Mallath, together with Smith, scoured through publications on cancer in India in the past two centuries available from the British Library and Wellcome Collection Library, both based in London.

The old data along with that available from recent studies helped them get a clearer idea about cancer incidence in India through the centuries.

According to Mallath, scientists have established very well it was not civilisation, but ageing that drives the increase in cancer incidence. With more people living longer, the incidence of cancer is bound to increase in a society, he said.

He said the number of patients with cancer started to increase as the life expectancy of Indians started to increase. When the big epidemics or infectious diseases started to recede, more people were living to older ages and thus at risk of cancer. According to the study, as India continues to age, cancer cases will double every 20 years.

“People gradually move from a high birth and high death state like India was in 1900 to a high birth and low death and then a low birth and low death phase when deaths from infectious diseases get controlled. Life expectancy keeps on increasing and hence degenerative diseases and cancers increase,” said Mallath, who is a senior doctor at the department of digestive diseases at TMC.

Public health experts call this Epidemiological Transition Levels (ETL). India’s States are in varying phases of ETL; while Kerala is high, Uttar Pradesh is lowest. The States with high ETL have a better development index and higher cancer rates.

“Although States with higher ETL have more cancers, the cancer mortality is proportionately lower due to better healthcare facilities and earlier diagnosis of cancer,” said the TMC doctor.

Cancer will continue to increase in India and cancer prevention can be half-truth. As the life expectancy of Indians rises, more cancers will occur. For example, if tobacco is completely banned, Indians will gain 10 more years and will get age-related cancers such as breast cancer in women and prostate cancer in men, he observed. “Governments can and should do everything to diagnose early and treat cancer adequately. In the confusion between Centre-State-concurrent responsibilities, patients are suffering. Government should not leave private hospitals to run the cancer care programme. It has been proven beyond doubt that out-of-pocket expenses are far more in private care,” said Mallath.

At the very basic the central government should enforce the age old Bhore committee report (1946) and Mudaliar committee report recommendations for cancer. Their recommendations include creation of a multidisciplinary cancer treatment unit in all medical colleges and setting up of a stand-alone cancer speciality hospital like the Regional Cancer Centre in Thiruvananthapuram in Kerala, in each State, he opined.

Published on August 5, 2019