Cancer Burden in India
Over the years low-income countries are undergoing an epidemiological transition, whereinthe burden of non-communicable diseases (NCDs) is on the rise. NCDs account for 71% of total deaths globally, cancer being the leading one. With huge diversity and population, India also joins in and shows great variation in the incidence and epidemiology of all cancers. Cancer accounts for 9% of all deaths occurring due to NCDs in India. The International Agency for Research on Cancer reported 7,84,821 deaths due to cancer in India in 2018 alone.
The incidence of cancer in 2020 was reported to be 6,79,421 and 7,12,758 in men and women respectively. About 2.25 million cancer patients are existing and over 11,57,294 lakh new cases get registered every year. The risk of developing cancer before the age of 75 years is 9.81% in males and 9.42% in females while mortality risk is 7.34% in males and 6.28% in females respectively. The most common sites of cancer in men are lung, stomach, oral cavity, colorectal and esophagus while in women it is breast, cervix, lung, oral cavity and gastric. Breast cancer accounts for 14% of all cancers in women, incidence rates high in age group 30-50 years, followed by cervical cancer which is the second common accounting for 22.86% of all cancer cases in India. Earlier, cervical cancer was the most common cancer throughout the nation, but now the incidence of breast cancer has surpassed it and is the leading cause of death.
The incidence of cancer is progressively increasing in the state of Rajasthan, with a reported estimation of 67,380 cases in 2018 to 70, 987 cases in 2020. In India, oral cancer is another most common cancer accounting for 16.1% in men and 10.4% in women and is caused mostly due to tobacco chewing, smoking, betel leaves, and alcohol consumption. Tobacco related cancers account for 52% of cases in Rajasthan. A study from Jaipur reported 43.36% patients with head and neck cancers (age group <40 years) and 56.64% of them with oral cancer (age 50-59 years). Colorectal cancer is on the rise in Rajasthan contributing to 2.14% of total cancer cases during 2016-2020 registered at Hospital-Based Cancer Registry of Regional Cancer Center (RCC), Bikaner. In a study done by Sharma et al, the different patterns pf cancer observed in Rajasthan included Head and Neck cancers (24.93%), Lung cancers (13.25%), Gastrointestinal cancers (12.01%), Lymphoid malignancies (10.6%) and genitourinary tract cancers (10.5%) being common in males and breast cancer (25.6%), genitourinary tract cancers (20.27%), gastrointestinal cancers (11.2%) and head and neck cancers (8.11%) in females.
In India, cancer data is collected from various population-based cancer registries (PBCRs), where data is being collected and reported from different sources of registration in the respective institutions. However, there is a lack of registration of newly diagnosed due to which the exact cancer burden and profile is often underestimated. In these circumstances, hospital-based cancer registries (HBCRs) play a crucial role in estimating the cancer prevalence. Presently, there are 36 PBCRs and 236 HBCRs registered under the National Cancer Registry Programme (NCRP)–National Centre for Disease Informatics and Research (NCDIR) of the Indian Council of Medical Research (ICMR-NCDIR-NCRP). Some of the HBCRs of Rajasthan include Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner; Bhagwan Mahaveer Cancer Hospital & Research Centre, SMS Medical College and Santokba Durlabhji Memorial Hospital cum Medical Research Institute in Jaipur; Dr. S.N. Medical College, Jodhpur; J.L.N. Medical College, Ajmer; and RNT Medical College, Udaipur.
The central government is also planning to establish 19 State Cancer Institutes (SCIs) and 20 Tertiary Care Cancer Centres (TCCCs) in order to reach out to the rural areas, the one in Rajasthan is Jhalawar Medical College & Hospital. Most of the low-income countries like India lack an organized and functional cancer care system due to financial, social, and logistical issues. Population ageing is considered as the main driver of rise in cancer incidence and mortality and catastrophic health expenditures.
Moreover, poor awareness of cancer delays the process of timely detection and treatment. It is a fact that 1/3 rd of all cancers are curable with early diagnosis. Apart from this, it is equally important to consider the social and cultural barriers to avoid delay in diagnosis. In Rajasthan, tobacco chewing and beeda practice is more common and there is less knowledge regarding relation of tobacco and cancer. Moreover, most people have little or inappropriate knowledge regarding the disease. Awareness and educational campaigns needs to be conducted which should address the importance of cancer screening, early diagnosis and treatment, possible causes or risk factors, identification of initial symptoms.
Doapmine foundation is my initiative and we will leave no stone unturned in reducing the impact, grief and pain caused by Cancer. Doapmine foundation is also working on creating a state registry for enrolling cancer patients and collecting the relevant data that shall help the local state government in formulating policies regarding Cancer prevention and management.