India launches plan for national cancer screening programmeBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5574 (Published 17 October 2016) Cite this as: BMJ 2016;355:i5574
The Indian government has published an operational framework for the country’s first national cancer screening programme, scheduled to start in November 2016.1 There will be mandatory screening for oral, breast, and cervical cancer in people over the age of 30 in 100 districts of India before the programme expands to other areas.
The Indian health minister, Jagat Prakash Nadda, said in a statement, “I am happy that my ministry has developed an operational framework for the screening and management of common cancer . . . This framework provides mechanisms to ‘operationalise’ screening and management of common cancer at field level.”
He said the initiative to implement population level screening for common cancers in India could “save many precious lives and improve the quality of life of many more.” He urged Indian states “to take up the issue of cancer prevention, screening, and treatment as a crusade and to use this framework to create the mechanisms needed to provide effective screening, care, and treatment to all.”
A projection from the International Agency for Research on Cancer estimated that India’s cancer burden will increase from one million new cases in 2012 to more than 1.5 million new cases each year by 2035. The projection also predicted that the absolute numbers of deaths in India resulting from cancer would increase from 680 000 to 1.2 million over the same period.
Cancers of the breast, uterine cervix, and oral cavity have accounted for nearly 34% of all cancers in India, so the operational framework has designated prevention of these cancers as a public health priority. It noted, “Each of these three cancers is amenable to early detection and treatment, reducing the burden of cancer related mortality and morbidity.”
The operational framework tackled how smaller health centres, which typically manage populations of 3000-5000 people, should implement cancer screening.
Ravi Mehrotra, director of India’s National Institute of Cancer Prevention and Research and a technical expert involved in the operational framework, told The BMJ, “Once screening is undertaken and the service providers at the sub/primary centre level identify suspicious lesions, the patient needs to be referred to the community health centre or district hospital for further examination and confirmation of diagnosis.” He said that people over the age of 30 would be screened using cost effective methodology every five years.
Initial implementation of the screening programme across 100 districts will provide data for wider implementation across India. Mehrotra said, “This will be accompanied by awareness campaigns in the community. The road blocks, if any, would be removed, and the lessons learnt may result in course corrections where essential.”
Experts have welcomed the initiative. Manish Kohli, professor of oncology at the Mayo Clinic in Rochester, USA, told The BMJ, “This is an excellent initial step to take for tackling a serious public health problem in India. To target oral cancer in males and breast cancer screening in females is extremely appropriate and pertinent, given the high incidence and prevalence rates for these cancers in India.”