Death by cancer — it’s preventable

The incidence of cancer worldwide is on the rise. Cancer has risen from 700 new cases per million people in 2013 to nearly 1,000 new cases per million people in 2015. Even in India, the trend has been along similar lines. The World Health Organisation estimates that cancer deaths in India alone will reach 700,000 by the end of 2015, which is the highest annual estimate yet. In spite of technological advances in healthcare, India’s cancer burden is fast getting out of hand.

The root cause of this is likely to be the approach Indians have adopted towards cancer — which mostly lays emphasis on ‘cure’ rather than ‘prevention’.

The world over, experts agree that if the goal is to decrease the incidence of cancer, the first step must be to increase efforts at prevention, by establishing and ensuring access to screening processes for early detection.

Once these processes are introduced, they must also sustain, in order to screen large parts of the population effectively.

However, these screening processes present two challenges — ensure that these are affordable, accessible and available to the masses; and make sure that people come forward and utilise them.

Making it affordable The government and the private sector must look towards the expansion of public infrastructure in primary healthcare. Even the extension of services of trained nurses and health workers can go a long way, especially in conditions such as breast cancer, wherein basic screening and examinations conducted by them can contribute to early detection.

A study by Tata Memorial Hospital on Clinical Breast Exam also shows that even lesions in the early stages can be detected on examination by trained nurses.

Further, the National Cancer Grid, as envisaged by the Tata Memorial Hospital, Mumbai, is an example of a joint effort between the public and private sectors.

This grid is a network of major cancer centres in the country, which aims to establish a uniform standard for patient care, and promote collaborative research on cancer.

Although the Ministry of Health & Family Welfare has allocated ₹15, 855 crore towards the early diagnosis and treatment of cancer over the next five years, State governments are yet to submit their proposals to support initiatives such as the National Cancer Grid.

Private organisations and NGOs are also considering cross-subsidised models to ensure affordability of basic cancer care. Corporates also can play a greater role through implementing sensitisation programmes, and concentrate their social responsibility efforts towards tackling the disease.

Such efforts need to form the core of India’s response to the threat of cancer, and need to be introduced nationwide.

Getting them to test The second challenge, of motivating people to come forth for screening, poses greater difficulty. This difficulty is further exaggerated if one is to consider the example of breast cancer, owing to the reluctance of women to get themselves screened.

With their reluctance, the women are putting themselves in danger. It is a medical fact that breast cancer, in Stage 0, takes eight to 10 years to become malignant, post-exposure to causative elements.

This implies, if more women were to be screened for breast cancer regularly, we would have greater chances of an early diagnosis during this eight to 10-year latency period. The damage to the breast tissue would be minimal, survival chances nearly 100 per cent and the overall physical and psychological impact on the patient minimised.

But breast cancer remains the most common cancer in India. In 2013 alone, breast cancer claimed 47,587 lives, in spite of it being largely preventable and curable in the initial stages.

When detection is delayed, it may require surgical procedures. But with early diagnosis, as compared to invasive procedures such as mastectomies, the survivor has a greater capacity to preserve the body and self-image of the patient, conserve sexual health, and also leads to lower levels of anxiety.

Ensure prevention This eventually leads to a better quality of life of the cancer survivor. In a report by the All India Institute of Medical Sciences, it was determined that cancer care at the later stages leads to high cost to patients and their families; the findings revealed that the economic burden of cancer treatment was 20 times the annual income of the family.

Consequently, it appears that the repercussions of a diagnosis at a later stage are far more severe than at an initial stage, even fatal. Hence, it is all the more essential to ensure that efforts are made for early detection and diagnosis.

Even if one is unable to prevent the disease, and is diagnosed with cancer, there are ways to ensure a good quality of life. More developed nations are now looking at options such as genomic sequencing, and stem cell research as means of effectively curing cancer, and minimising the ill effects of the disease.

India has just started to enter the field, and has a considerable way to go. Till these advancements become viable prognosis, India needs to be able to ensure preventive measures such as regular screening, early detection and quality healthcare treatment.

Venkataramanan is with Tata Trusts. Koppikar is with Prashanti Cancer Care Mission

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