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India has some of the highest cancer rates in the world

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7485.215-c (Published 27 January 2005) Cite this as: BMJ 2005;330:215

Increasing cancer incidence in India : What can be done

The Indian cancer atlas indicates that the incidence of cancer for
some major organs in India is highest in the world [1]. In India there has
been a steady increase in the Crude Incidence Rate (CIR) of all cancers
affecting both men and women over the last 15 years [2]. The increase
reported by the cancer registries is nearly 12 per cent from 1985 to 2001,
representing a 57 per cent rise in India's cancer burden. The total number
of new cases, which stood at 0.53 millions in 1985, has risen to over 0.83
millions today. The pattern of cancers has changed over the years, with a
disturbing increase in cases that are linked to the use of tobacco. The
World Cancer Report tells us that cancer rates are set to increase at an
alarming rate globally [3]. Cancer rates could increase by 50 % to 15
million new cases in the year 2020. Healthy lifestyles and public health
action by Governments and health practitioners could stem this trend, and
prevent as many as one third of cancers worldwide.

Tobacco use among youth in South-East Asian countries revealed a
common trend. Youth who are out-of school, earning, less educated and live
in rural areas are more likely to use tobacco and start during the preteen
years. Better educated youth may know the health effects of smoking but
the dangers of passive smoking are generally unknown. Youth are fairly
unconcerned about the present or future effect of tobacco use on health.
Studies have shown [4] that children and youth are more responsive than
adults to tobacco education. In India, a manufactured smokeless tobacco
product, gutkha, has been targeted toward youth and has become extremely
popular. An evolving epidemic of oral submucous fibrosis attributed to
gutkha use has been documented among youth, with a resultant increase in
oral cancer in lower age groups. Proper information about cancer should
thus be included in the primary, middle and high school education
curriculum. Students should be better informed about the harmful
consequences of tobacco use.

Recently, Indian Government has introduced ‘The Cigarettes and Other
Tobacco Product Act,’ which ban smoking in ‘public places’ and outlaws
“sponsorship of sports and cultural events by tobacco companies”.
Unfortunately, 80% of tobacco smoked in India is in the form of bidis,
hand rolled cigarettes that are not covered in the Act.

Healthy life style practices and balanced diet can prevent and / or
delay the incidence of cancer. Ironically, increase in life expectancy,
containment of infection diseases and adoption of ‘Western lifestyles’ are
making more people vulnerable to cancer [5]. Moreover, it is estimated
that about 50% cancers are curable if they are detected early and treated
in appropriate algorithm. Screening has got a major role in early
diagnosis. Unfortunately, the early detection tools and treatment
technology that have helped control cancer in wealthier lands are often
not readily available in many developing countries such as India. In
developing world around 80% of cancer patients have late stage incurable
disease when they are diagnosed. Various factors contribute to this
situation viz. appalling poverty, poor hygiene, lack of awareness and
complex social dynamics. Also, there is a huge shortage of specialist and
radiotherapy facilities in our country. Most of our Primary Health Care
Centers (PHC) that were created to cater the health care needs of the
rural masses lacks adequate staffs, medicines and infrastructures. As a
result of which a major proportions of our population depends on the
private practitioners practicing some form of alternative and traditional
systems of medicine viz. Ayurveda, homeopathy, herbal therapy for cancer
treatment and palliation [6]. Many in the private sector who call
themselves as doctors don’t have any medical degree [7].

To bring down the cancer incidence in India extensive persuasive
health education is needed to be directed towards control / reduce the
tobacco habit. People at all levels should be educated to change their
behaviour to avoid preventable cancers. Public awareness is needed in
nutrition education, safe sexual practice, attention to personal and
genital hygiene needs. Prophylactic vaccinations against Human Papilloma
Virus infection and hepatitis B virus are useful strategies for the
prevention of cancerous lesions of cervix and in the control of liver
cancer [8]. Educating the mass could lead to increase opportunity for
early detection and prevention of cancer. Screening programs could greatly
assist detection of cervical and breast cancer at early stages. Self
examination is a cost-effective method for early detection of breast
cancer. However, ignorance and poverty are major stumbling block for
control of cancer in developing world. Overcoming poverty is an
insurmountable hurdle in the short term, while tackling ignorance with the
necessary education is possible. One way to accomplish this mission could
be by training and providing educational materials to the paramedical
staffs of the PHC spread through the country. These staffs could then
spread the message of cancer prevention and promote healthy life style
practices in the rural masses. This could one way transform the PHC into
Health Promoting Centers (HPC). Major hospitals in India should also play
important role in educating lay public about preventable cancers. They
should develop IEC (Information, Education and Communication) strategies
to promote people to adopt healthier life style practices.

Electronic channels like television (TV) and Internet can play the
most important role in dissemination of health related knowledge in our
country. TV has proliferated in the remotest villages throughout India.
Anti tobacco campaign / advertisement by prominent personalities and movie
stars in TV could easily draw the attention of many. And their message
could have a deep impact on the minds of millions of peoples in our
country. The use of Internet is also growing fast among the young
generation. Properly designed anti-tobacco e-advertisement and website
could be one way to inform and motivate them.

Reference:

1. Mudur G. India has some of the highest cancer rates in the world.
BMJ 2005; 330: 215.

2. Pal S K, Mittal B. Improving cancer care in India: prospects and
challenges. Asian Pacific J Cancer Prev 2004; 226 - 228.

3. Stewart B M, Kleinues P (Eds.) World Cancer Report 2003, IARC
Press, Lyon.

4. Tobacco Free Initiative, World Health Organization. Tobacco and
youth in the South East Asian region. Indian J Cancer 2002; 39: 1-33.

5. Pal S K, Mittal B. Fight against cancer in countries with limited
resources: the post-genomic era scenario. Pacific J Cancer Prev 2004; 328
- 333.

6. Pal S K. Use of alternative cancer medicine in India. Lancet Oncol
2002; 3: 394 – 395.

7. Kumar S. Much health care in rural India comes from unqualified
practitioners. BMJ 2004; 328: 975.

8. Murthy N S, Mathew A. Cancer epidemiology, prevention and control.
Curr Science 2004; 86: 518 – 526.

Competing interests:
None declared

Competing interests: No competing interests

07 April 2005
Sanjoy Kumar Pal
Post Doctoral Research Fellow
Department of Gastroenterology, Sanjay Gandhi PGIMS, Lucknow 226014 UP India