Cancer has the potential to debilitate life physically, emotionally and economically, and in a manner few other ailments can. And the unfortunate reality in India is that the incidence of cancer and resultant mortality among women is on the rise.

Over 2,000 new women are diagnosed with cancer every day, which is expected to spiral to 3,500 every day by 2025. The challenge of high incidence is compounded by the unfortunate situation of late detection, which has an adverse impact on the cost of care and mortality. The proportion of cases detected in late stages (III + IV) for cervical cancers is 85-90 per cent and for breast cancer is 55-60 per cent, which is two to five times worse off than China, the United Kingdom and the United States.

The number of women succumbing to cancer is 1.6 to 1.7 times higher than the maternal mortality ratio(MMR). This has resulted in India having the dubious distinction of being ranked highest in mortality for breast and cervical cancers and second-highest for ovarian cancer, globally. The mortality to incidence ratio, which is a key indicator for measuring effectiveness of national cancer control programs, is the worst in India for key women-specific cancers when compared to global peers. Also, late detection of cancer increases the cost of treatment by a staggering 1.5-2 times, making it unaffordable for over 90 per cent of the population of India.

The reason for this includes low screening coverage for women, at 22 per cent for cervical cancer, 10 per cent for breast and 12 per cent for the oral cavity. Also, the reach of radiotherapy equipment is low, with about 400 installed linear accelerators (LINACs) versus the required figure of 1,900-2,000. About 40-50 per cent of oncologists are concentrated in the top 10 metro cities and close to 80 per cent of all districts do not have a comprehensive cancer centre (CCC).

Need of the hour

To overcome this skewed situation, there are various measures that need to be implemented. For instance, the Government needs to skill human resources to support healthcare requirements in States that report high incidence of cancer among women and are populous. Investment needs to be promoted in setting up CCCs in focus States, supported by appropriate funding through Centre/State allocation of budgets. This entails initial investment of $6 billion by the Government and the private sector for servicing at least 40-50 per cent of patients over the next five years.

Public-private partnerships need to be explored for the implementation of the national screening policy and the commissioning of CCCs and LINACs. New policies need to be implemented around improving access to advanced technologies, adoption of traditional medicine needs to be promoted and a nodal agency formalised to drive standardisation of cancer treatment protocols. A robust framework needs to be created for the pricing of private healthcare services procured for public cancer care delivery systems. Emphasis must be laid on promoting awareness among women on health behaviour, symptoms, screening practices and financing options. Population-based registries need to be established in 12 States currently not covered by any cancer registry.

In conclusion, it is imperative that the growing incidence of cancer among women is addressed with a sense of urgency and in a holistic manner. It needs to be dealt with by giving due emphasis to prevention, timely diagnosis, effective treatment and palliative care.

Needless to say, this has to be a national agenda and not limited to the subjective focus of individual State priorities as women play a key role in shaping the health of a family, the community and eventually the nation.

The writers are Director and Senior Manager, respectively, with consultant firm EY. Views expressed are those of EY.

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