First Irrfan Khan — star of over fifty Bollywood films and numerous international box office hits — announced in March that he had been diagnosed with a neuroendocrine tumour. Then, in July, actress Sonali Bendre, announced she was availing cancer care in New York for metastasised cancer.Khan is said to be recovering. However, the actor has said he is uncertain about when he will return to India from London, where he is being treated.
Neuroendocrine tumour is a broad term. It refers to any tumour occurring in cells within the hormonal and neuronal system. These tumours may be benign or malignant. This is one of the key factors affecting the potential for the spread of cancer as well as the survival rate. Neuroendocrine tumours most commonly occur in the intestines. However, they can also occur elsewhere in the body.
If the tumour is malignant, cancerous cells may spread throughout the body. In this instance the cancer is referred to as metastatic, and can affect a number of organs. Cancers that have progressed to this stage are notoriously difficult to treat. If the tumour is benign, it may potentially be removed via surgery with a high chance of no further complications.
Sonali has announced that her cancer has already metastasised. Further details regarding the type of cancer have not yet been revealed. In Sonali’s case chemotherapy is a necessity in order to attempt to kill off all rapidly replicating cells on a body wide level.
As mentioned above, both actors have opted to seek treatment outside of India. This is not a luxury most Indians can afford.
The high-profile nature of these cancer cases poses an opportunity to highlight the dire plight of the estimated 2.5 million cancer patients within India. Cancer has overtaken many of India’s infectious diseases to become one of the most common causes of death in the country. Around 556,000 deaths due to cancer occur in the country every year. A further 700,000 cases are diagnosed each year.
A growing public health threat
Cancer is on the rise in India and, in many cases, it is avoidable.
In males, the most common cancers are lung cancer and oral cavity cancers. The implications of the combination of these cancers being the most common is that smoking and use of tobacco products plays a considerable role in elevating the instance of cancer in Indian men.
The percentage of the population in India that smokes is falling. World Bank figures indicate that, in 2000, 34 percent of the population smoked.This figure fell to 21 percent in 2016. Despite a significant reduction, one in five individuals in India still smoke. This massively heightens the risk of the two most common cancers in men.
Alongside smoking, staggering levels of air pollution is also contributing to the risk of lung cancer across India. With the world’s fourteen most polluted cities located within India, simply breathing India’s air poses a severe risk of developing lung conditions.
“Cancer is on the rise in India and, in many cases, it is avoidable.”
Breast cancer and cervical cancer were found to be the most common cancers in Indian women. These, too, are often preventable.
More than 63,000 women in India died of cervical cancer in 2015, according to the Indian Council for Scientific Research (CSIR), . This is despite eighty percent of cervical cancer cases being preventable. The disease is often treatable and has a high survival rate if caught in its early stages.
This, unfortunately, is not the case for many Indian women. Many — particularly those living in rural areas — lack access to a gynaecologist. This could account for a large portion of the estimated eighty percent of Indian women who never receive a cervical screening in their lifetime. This lack of access to screening for the disease puts women at severe risk of developing cervical cancer, but not knowing about it until symptoms appear in the later stages. Then, it is often ineffective.
India has not included a human papillomavirus (HPV) vaccine in the country’s Universal Immunisation Programme (UIP). This despite the vaccine being clearly linked to effective prevention of cervical cancer. Simply by adding this vaccine to the UIP, a substantial number of cervical cancer cases could be prevented.
Screening programmes are a necessity in the fight against cancer. Catching the disease in its early stages vastly increases the success rates of treatment. Recent screening programmes undertaken by the central government have proven to be a success. This may indicate a potential for the scaling up of these programmes in the future.
Almost 40,000 cancer cases were detected during the government’s door-to-door screening programme last year, according to data published in the National Health Profile 2018. Under the campaign, 36 million people above the age of 30 across 100 districts were screened for three common cancers (oral, cervix and breast). The programme also screened for other noncommunicable diseases (NCDs), such as diabetes, hypertension, heart diseases and stroke.
“Screening programmes are a necessity in the fight against cancer…Importantly, these schemes must extend to rural locations”
Importantly, these schemes must extend to rural locations. Harbouring the majority of India’s population, rural areas often have lacking healthcare infrastructure. Due to this, many cancer cases go without diagnosis until it is too late – if at all.
The Centre plans to erect twenty state cancer institutes and fifty tertiary cancer care centres, Prime Minister Narendra Modi announced during a speech earlier this year at the Adyar Cancer Institute in Chennai. This may improve the situation for those seeking cancer treatment, though depending on the location of these new centres, many areas will still be lacking in cancer care facilities.
Affordability is also a key concern with those seeking cancer treatment. Out-of-pocket expenditure is a considerable issue of the Indian healthcare system. Many Indians are forced into poverty to afford medical treatment.
Prime Minister Modi has called for cooperation between the private sector and non-government organisations (NGOs) “to prevent, manage and control diseases such as cancer.” With the integration of public-private partnerships, the availability and affordability of cancer may improve.
Affordable healthcare has been a focus of the Modi government this year. The announcement of the National Health Protection Scheme (NHPS) or ‘Modicare’ in February pledged to bring affordable health insurance to around 100 million economically vulnerable households within India.
The cases of Khan and Bendre mean the media spotlight is now firmly placed on cancer within India. Awareness of the condition needs to be increased in order to encourage people to receive regular screening where possible. Simple actions such as this could bring down the rate of death due to cancer within India considerably and ensure those who need treatment for the disease receive it.