The term cancer brings thoughts of disappointment, heartbreak and success but irrespective of the vivid memories, mixed feelings of elation to sadness come into the minds of many individuals and families. These are so many Bravehearts who have fought regardless along with their care providers, they are the true heroes in day-to-day life, their journey is filled with ups and downs which are heart-wrenching at times.
Globally the numbers of cancer patients are increasing, the trends can be easily picked up and have been classified depending upon age, population, incomes and geography. International Agency for Research on Cancer, an important wing of the World Health Organisation, collates data across the world. In their recent publication, they published their findings which are thought-provoking, and it suggests that in India, there are 13 lakh new cancers patients added each year and worst more than 50 per cent will die in the same year because they are in advanced stages. There is heterogeneity in the incidence of cancer in India itself, with Mizoram reporting more than double the national average cancer patients per lakh population.
There are several reasons for this silent tsunami that can be well understood, like population explosion, containment of the communicable disease, longevity and changing lifestyle. On individual basis habits, tobacco, alcohol not only increases the risks of cancer but also predisposes to other non-communicable diseases like hypertension, heart diseases etc. The general environmental pollution also contributes to this problem. India is a predominantly rural country and is reflected in the patterns of cancer distribution. There is a clear divide between the urban and rural type and a number of cancers, like in females, cervix cancer is prominent in a rural area, but breast cancer prevails in urban registries.
The changing urbanisation is changing this in terms of number and type of cancer. India being a signatory to WHO call of Sustainable Development Goal (SDG), so within the next 10 years, the target is to reduce mortality by nearly one-third across the non-communicable disease and cancer is one of the leading causes along with heart disease. On a positive note, awareness, digitalization and improving literacy rates have also contributed to the increasing number albeit temporarily but more importantly, this will help in catching the cancers early. The first focused approach should include tackling the leading common cancers in India which originate at the breast, cervix, mouth and throat.
On a similar note, in India at present extensive screening for cervical or oral cancer may be difficult but simple visual inspection of the cervix or mouth by health worker has proven to save lives, even teaching the women for self-breast examination may help in catching the disease at early stages resulting in improved cure rates.
Another major challenge in India is the poor and crumbling public health infrastructure, though the health planners are attempting to augment the medical colleges or regional cancer centres. Cancer treatments are long-haul treatments comparatively and the treatment facilities are concentrated in urban/semi-urban areas making access in the rural population difficult and at times the valid reason for incomplete treatment. It is imperative that health planners need to increase and strengthen the capacity of trained manpower and facilities so as to bring the treatment of cancer near home.
The out-of-pocket expenses are still high even for the patients who have health insurance,
The government insurance scheme has brought relief to the poor, but for the middle or salaried class who pay their due taxes, the benefit is not reaching and there is still suffering.
On similar lines, though the laws have been enacted against the uses of tobacco, the implementation is challenging and difficult too and hence the desirable outcomes are delayed or are not materializing. Another way to reduce the cost is to widen the net of essential drugs used in cancer, therapy and waiver of customs duties on radiotherapy machines i.e., linear accelerator.
Apart from the cancer prevention strategies and treatment of cancer, there should be sustainable integrated cancer research for optimal outcomes i.e., improving the cure rates and quality of life. Another dimension of this research may include the sparing and utilization of precious resources so that more patient can be treated and the institutes doing such activity may be granted special incentives.
The sustained positive health awareness right from schooling to their homes by print or digital media will bring a positive attitudinal change which will not only help in cancer control but also promote health through physical and mental well-being.
This year 2020 has been disruptive on all fronts and made each one of us think and work in different ways. The global particularly Indian health infrastructure worked brilliantly and above the expectations, the strength of our health and medical research was clearly demonstrated in manufacturing and rolling out the vaccine for its vulnerable population and even exporting it to other countries, similar strength may be used for eliminating certain anti-virus induced cancers like cervix cancer, oropharyngeal cancers.
One of the quickest ways to bring this scourge of cancer into control is to make this a notifiable disease and to improve literacy rates. This will help in corrective action in terms of time-bound planning and deliver the treatment on time.
The Covid pandemic has caused an enormous sudden tsunami of deaths across India. The deaths attributable to cancer are five times more every year which are unfortunately quietly brushed aside. We have to rise above to deal with this silent tsunami collectively across geography and income because it affects everyone.
(The author is director, department of radiotherapy, Jaslok Hospital and Research Centre. Views expressed are personal)