World Cancer Day 2019 this year provided an opportunity to assess India’s cancer burden. Unfortunately, it’s not good news.
India ranks third in the world for overall number of cancer cases, placing behind China and the US. This follows a long-standing trend in India, in which cancer figures have been steadily rising for years. Cancer now ranks as India’s second most common cause of death behind heart disease. Many of India’s cancer-related deaths associated with cancer occur due to a lack of knowledge regarding the symptoms, an issue that is aimed to be combated through raising awareness. World Cancer Day, which took place on February 4th, is one such attempt at raising awareness.
Disease incidence and survival rates
India’s incidence of cancer per 100,000 people is notably lower than in many western nations. However, India’s vast population allows for a comparatively large number of cancer patients. Many patients do not seek treatment until the later stages of the disease where more apparent symptoms become noticeable.
At this stage, depending on the type of cancer, it may have become metastatic. This is where cells from the original tumour have broken away and have travelled through the body via pathways such as the circulatory or lymph system. These cells can cause the cancer to spread to other areas of the body. Once cancer has reached this stage, treatment is far more difficult.
If caught in the initial stages, the prospect for cancer survival is significantly higher. This is due to the fact that the cancer can be entirely removed via surgical removal of the tumour, as the cancer has yet to spread across the body. In catching the cancer early, the need for treatments such as chemotherapy — known for its considerable side effects — is diminished.
Survival rates in India reveal that it is unlikely that cancers are being detected in their early stages. Breast cancer — India’s most common cancer — serves as an example for this. For every two women newly diagnosed with breast cancer, one woman dies due to the condition according to the National Institute of Cancer Prevention Research (NICPR).
India’s survival rates indicate the disease is going unnoticed until late stages
India’s overall survival rate can be compared to studies that have taken place elsewhere as a means of assessing whether the country is appropriately dealing with cancer incidence. Studies from Cancer Research UK back up the assumption that breast cancer in India is likely not being detected until its late stages.
Cancer Research UK presents a study that analysed the five year survival rates of women with breast cancer over the 2002-06 period. They note a clear and considerable reduction in the potential for survival when comparing stage I breast cancer to stage IV. The overall figures show a 99 percent survival rate at stage I, indicating the overwhelming majority of individuals who were diagnosed early enough survived at least five years. This figure falls considerably to fifteen percent at stage IV. Stage I in this case refers to the period in which the tumour initially develops, where stage IV refers to metastatic cancer.
Importantly, the overall survival rate was around 85 percent, indicating the majority of women had their cancers detected in the early stages, allowing for more effective treatment. This is where India may be falling short. As India’s overall survival figure is said to be one in two individuals, or fifty percent, it is far more likely that disease cases are being picked up in their later stages, meaning treatment is less effective and survival rates are lower.
Lack of knowledge and lack of access, a deadly combination
Many forms of cancer are asymptomatic in their earlier stages. This alone can make it lethal, as a person may only suspect there is an issue once the disease has progressed to its late stages and starts displaying noticeable symptoms. However, an overall lack of knowledge regarding the myriad of symptoms relating to different types of cancer may also be playing a role.
For example, the most common causes of cancer in Indian males are lung, oral, lip, throat and neck cancers. Lung and throat cancer may be accompanied by a chronic cough, a symptom which may go unchecked as the sufferer may simply associate the condition with smoking, or in the case of many areas of India, pollution. Left unchecked, as with breast cancer, the tumour may metastasize and become far more difficult to treat.
Knowledge of the risk factors can guide both individuals and government policy. In individuals, steering clear of the many risk factors reduces the chances of developing cancers. Avoiding smoking, eating a more health diet and taking regular exercise can all help in alleviating the risk of numerous types of cancers.
Government policy can vastly improve treatment outcomes if risk factors are taken into account. For example, by knowing which areas and people are prone to acts such as smoking, targeted screening procedures can be implemented in attempts to catch cancer in its early stages.
A lack of access to cancer therapies may also play a considerable role in India’s low survival rate. For many, particularly those in rural areas, the lack of medical services available may deter many from seeking help for minor symptoms. In some cases, these minor symptoms may be an early warning of cancer.
However, healthcare infrastructure improvements may not be a prospect within the immediate future. Other means to reduce cancer incidence are available, though often not utilised by the Indian public. A key example of this is the human papillomavirus (HPV) vaccine. HPV is one of the most common causes of cervical cancer, which kills more women in India than in any other country. The HPV vaccine is very effective in preventing infection by strains of the virus that cause the majority of cervical cancers, though is often refused due to unsubstantiated rumours regarding its safety.
#IAmAndIWill, the theme of World Cancer Day
The theme of this year’s World Cancer Day is “I Am And I Will”. This serves to lend an ear to the stories of those who have suffered from and overcome cancer. The aim of the campaign is to raise awareness in the hopes that more people will get themselves checked, thereby catching the disease earlier, and improving the chance of survival.