India observes World Cancer Day 2021 in far from normal circumstances. The raging COVID-19 pandemic has threatened to obscure the plethora of other diseases India and the world at large grapples with. Awareness events such as World Cancer Day serve to shine a light on the far-reaching impact of cancer in India, which has emerged as one of the country’s most pressing and fastest-growing public health threats.
The growing rise of cases of cancer in India translates to one in ten Indians being affected by the disease in their lifetime and one in fifteen losing their lives. Recent decades saw cancer in India emerge as the country’s second-largest killer – and the country’s cancer burden is only expected to grow.
As noted by Health Issues India on the occasion of World Cancer Day last year, “in 2018, 784,821 lives were lost to cancer in India with men accounting for 413,519 of these deaths and women for 371,302. Lip and oral cavity, lung, stomach, colorectal and esophageal cancers are the most common forms of the disease among men. Among women, the most common cancers are breast, lip and oral cavity, cervical, lung, and gastric.
“Cancer is on the rise in India, a trend aligned with the growing incidence of noncommunicable diseases (NCDs) as a whole. By 2040, cases are expected to number at approximately twenty lakh compared to almost 11.6 lakh at present. In 2018, it was reported that India’s cancer burden had more than doubled in the preceding 26 years.”
A World Health Organization report published last year did, however, carry some good news for India in terms of its fight against cancer. As Health Issues India summarised at the time, “the report…ranks [India’s] population-based cancer registry as being of high quality; the country has an operational integrated plan for tackling NCDs and an operational national cancer control programme; and has delineated cancer management guidelines.”
The report, nonetheless, did outline “gaps in India’s response to cancer – one reflective of the problems linked to LMICs [low- and middle-income countries] which is expected to drive the expansion of its cancer burden.” Indeed, Health Issues India has reported on the need for an upgrade in cancer infrastructure and oncology human resources in India; to cope with enhanced demand, the country will need 7,300 oncologists in the years to come. The existing shortfalls mean as many as 83 percent of Indian cancer patients are failed when it comes to their treatment.
The COVID-19 pandemic has only exacerbated the crisis. Early diagnosis was an area where India needed to make progress in the pre-pandemic era. “The major problem in our country is late diagnosis. Most patients come to us in the third or fourth stage, which further increases the disease intensity and burden. The regional centres cater to a limited population,” P.K. Jhulka, senior director of the Max Institute of Cancer Care, observed in March 2019.
Writing in The Times of India, Harmala Gupta, co-president of CanSupport, outlines that “since the pandemic, missed detection opportunities may result in patients being diagnosed with more advanced and harder-to-treat stages of cancer in the future. A Lancet study estimates that there may be an increase in cancer deaths as a result of diagnostic delays over the next five years, ranging from 4.8 percent for lung cancer to 16.6 percent for colorectal cancer [both among the most common forms of cancers among Indian men and lung cancer being one of the most common among women].”The pandemic may have exacerbated the issues surrounding cancer care and diagnostics in India, but it did not create them. World Cancer Day 2021 assumes heightened importance. Its official website opines that “2021 – the ultimate year of the ‘I Am and I Will’ campaign – shows us that our actions have an impact on everyone around us, within our neighbourhoods, communities and cities. And that more than ever, our actions are also being felt across borders and oceans. This year is a reminder of the enduring power of cooperation and collective action. When we choose to come together, we can achieve what we all wish for: a healthier, brighter world without cancer. Together, all of our actions matter.”
This is indeed an apt sentiment. India does have some progressions to tout, such as efforts to mitigate the damage of risk factors for developing certain forms of cancer such as its efforts against tobacco and malnutrition via the Eat Right India campaign. Expansion of telemedicine programmes is another means of plugging the cancer care gap, making screening more accessible. The Government’s inclusion of a number of crucial oncology packages in health insurance scheme Ayushman Bharat is also a positive.
However, there are gaps in similar efforts too. Delaying national rollout of the human papillomavirus vaccine to fight against cervical cancer being among the most egregious. Meanwhile, many people eligible to avail ostensibly free oncology care drop out for want of resources.
As Gupta notes, “What we also know is that underserved populations everywhere are at greater risk of dying of diseases like cancer due to limited access to detection facilities and to advances in cancer treatment that they simply cannot afford. Consequently, they are more likely to die of cancer.”
Fighting cancer in India is integral to the country’s socioeconomic development; to strengthening its communities; and meeting the Sustainable Development Goals. To do this, addressing the socioeconomic inequalities plaguing India’s health system on all fronts is vital.