Cancer has become one of the ten leading causes of death in India. It is estimated that there are nearly 1.5–2 million cancer cases at any given point of time. Over 7 lakh new cases of cancer and 3 lakh deaths occur annually due to cancer. Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time. Data from population–based registries under National Cancer Registry Programme indicate that the leading sites of cancer are oral cavity, lungs, oesophagus and stomach amongst men and cervix, breast and oral cavity amongst women. Cancers namely those of oral and lungs in males, and cervix and breast in females account for over 50% of all cancer deaths in India.
WHO has estimated that 91 per cent of oral cancers in South–East Asia are directly attributable to the use of tobacco and this is the leading cause of oral cavity and lung cancer in India.
Cancer usually occurs in the later years of life and with increase in life expectancy to more than 60 years, an estimate shows that the total cancer burden in India for all sites will increase from 7 lakh new cases per year to 14 lakh by 2026. National Cancer Control Programme was started in 1975–76.
Cancers in all forms are causing about 12 per cent of deaths throughout the world. In the developed countries cancer is the second leading cause of death accounting for 21% (2.5 million) of all mortality. In the developing countries cancer ranks third as a cause of death and accounts for 9.5% (3.8 million) of all deaths. Tobacco alcohol, infections and hormones contribute towards occurrence of common cancers all over the world.
Goals & Objectives
- Primary prevention of cancers by health education regarding hazards of tobacco consumption and necessity of genital hygiene for prevention of cervical cancer.
- Secondary prevention i.e. early detection and diagnosis of cancers, for example, cancer of cervix, breast cancer and of the oro–pharyngeal cancer by screening methods and patients’ education on self examination methods.
- Strengthening of existing cancer treatment facilities, which were inadequate.
- Palliative care in terminal stage cancer.
Financial Assistance to Voluntary Organisations
This scheme is meant for IEC activities and early detection of cancer. Under the scheme financial assistance up to Rs.5.00 lakh is provided to the registered voluntary organisations recommended by the State government for undertaking health education and early detection activities in cancer. A linkage with the Regional Cancer Centre (or Medical College/Distt. Hospital if there is no RCC) is now mandatory by the NGO concerned.
District Cancer Control Scheme
It is known that a large number of cancer cases can be prevented with suitable health education and early case detection. Accordingly the scheme for district projects regarding prevention, health education, early detection and pain relief measures were started in 1990–91. Under this scheme one time financial assistance of Rs.15.00 lakh is provided to the concerned State Government for each district project selected under the scheme with a provision of Rs.10.00 lakh every year for the remaining four years of the project period. The project is linked with a Regional Cancer Centre or an institution having good facilities for treatment of cancer patients. The patients are provided treatment at the concerned Regional Cancer Centre or the nodal institution.
Cobalt Therapy Installation
To strengthen the cancer treatment facilities, the financial assistance of Rs. 1.0 crore for charitable organisations and 1.5 crore for government institutions is provided for procurement of teletherapy and brachytherapy equipments etc. This is one time grant as at present.
Development of Oncology Wings in Govt. Medical College Hospitals
This scheme had been initiated to fill up the geographical gaps in the availability of cancer treatment facilities in the country. Central assistance is provided for purchase of equipments, which include a teletherapy unit beside other equipments. The civil works and manpower are to be provided by the concerned State Government/Institution. The quantum of central assistance is Rs.2.00 crore per institution under the scheme. The scheme provides one time grant only.
Regional Cancer Centres
There are 19 Regional Cancer Research and Treatment Centres recognised by Government of India and recurring grant of Rs.75 lakhs is being given to these Regional Cancer Centres.
There are some activities, which are carried out under the National cancer control programme out of WHO funding under the biennium pattern. In WHO biennium 1998–1999, 16 workshop/training programmes were carried out throughout India. The Pap Smear Kits and Can scan software were supplied to 12 RCC’s. Morphine tablets were also supplied to them. In the WHO biennium 2000–2001 following were carried out
- Outreach activities by medical colleges for early detection and awareness of cancer.
- Training of personnel in early detection and awareness of cancer.
- Supply of Morphine.
- Telemedicine and supply of computer hardware and software.
- IEC activities.
- Modified District Cancer Control Programme.
- National Cancer Awareness Day.
- Training of cytopathologists and cytotechnicians in the quality assurance in Pap Smear technology.
- Participation in Health Melas and distribution of health education material.
- Postage stamp depicting a women carrying out ‘Self breast examination’ was brought out by Deptt of Posts on National Cancer Awareness Day.
- Likely telecast of a health magazine ‘Kalyani’ in the current year, with cancer and anti tobacco items under the agreement with Prasar Bharti & MOHFW.
- Broadcast of health education audio material developed by CNCI, Kolkatta, through FM Radio.
Modified District Cancer Control Programme has been initiated in four states namely Uttar Pradesh, Bihar, Tamil Nadu & West Bengal. Sixty Blocks have been taken and 1200 ‘NCD workers, 30 supervisor doctors, and consultants have been appointed. This will be a Survey cum health education drive in which about 12 lakh women in the age group 20–65 years are being contacted. Health education about general ailments, cancer prevention and early detection besides ‘Self Breast Examination’ will be imparted. The project will be completed in about a year’s time.
National Cancer Awareness Day
Cancer Awareness day was observed on 7–11–2001. Hon’ble Min. of State, Ministry of Communications Shri Tapan Sikdar at Vigyan Bhawan on the same day, released a commemorative stamp on Cancer and first day cover portraying Madame Curie. A newspaper advertisement on National Cancer Awareness Day was also released in prominent dailies across the country.
List of Regional Cancer Centres
- Kidwai Memorial Institute of Oncology, Bangalore (Karnataka).
- Gujarat Cancer & Research Institute, Ahmedabad (Gujarat).
- Cancer Hospital Research Institute, Gwalior (Madhya Pradesh).
- Cancer Institute, Madras (Tamil Nadu).
- Regional Cancer Centre, Thiruvananthapuram (Kerala).
- Regional Centre for Cancer Research and Treatment Society, Cuttack (Orissa).
- Dr.B.B.Cancer Institute, Guwahati (Assam).
- Chittaranjan National Cancer Institute, Kolkatta (West Bengal).
- Institute Rotary Cancer Hospital (AIIMS), New Delhi.
- Tata Memorial Hospital, Mumbai (Maharashtra).
- Kamala Nehru Memorial Hospital, Allahabad (U.P.)
- MNJ Institute of Oncology, Hyderabad (Andhra Pradesh).
- R.S.T.Cancer Hospital, Nagpur (Maharashtra).
- Indira Gandhi Institute of Medical Sciences, Patna (Bihar).
- Acharya Harihar Tulsi Das Regional Cancer Centre, Bikaner, Rajasthan.
- Indira Gandhi Medical College, Shimla (Himachal Pradesh).
- Post Graduate Institute of Medical Sciences, Rohtak (Haryana).
- Pt. J.N.M. Medical College and Hospital, Raipur, Chattisgarh.
- JIPMER, Pondicherry.
(National cancer registry programme 1981–2001)
- 97.8 (Bangalore) to 121.9 (Delhi) Cancer Cases PER 1,00,000 Population – Urban Males (Age adjusted incidence rate).
- 92.2 (Bhopal) to 135.3 (Delhi) cancer cases per 1,00,000 population – Urban females (Age adjusted incidence rate).
- 46.2 (Barshi) cancer cases per 1,00,000 population – Rural males (Age adjusted incidence rate).
- 57.7 (Barshi) cancer cases per 1,00,000 population – Rural females (Age adjusted incidence rate).
- One in about 15 men and one in about 12 women in the urban areas could develop cancer in their lifetime.
- Cervical cancer and breast cancer are commonest in females. The latter is more than former in Mumbai and Delhi.
- Cancer of lung is commonest out of all tobacco related cancers in men.
- Age adjusted incidence rate of oesophageal cancer in women of Bangalore is one of the highest (8.3 per 1,00,000) in the world.
- Cancer of tongue in males at Bhopal (8.8 per 1,00,000) is highest in all continents.
- Cancer of stomach is one of the main cancer in males in southern registries.
- Gall bladder in delhi women is one of the highest (8.9 per 1,00,000) in the world.
- 75–80% patients are in advance stage of the disease at the time first attendance.
- New cancer patients in India are estimated between 7–9 lakhs.
Some Common Risk factors for Cancer
Smoking: Cigarette, Bidi, Cigar, Hukka, others.
Smokeless: Zarda, Gutka, Khaini, Snuff, etc.
Infections (viruses, parasites, bacteria)
Electromagnetic radiation (ionising radiation, ultraviolet rays, others)
Diet (dietary carcinogens)
Occupational exposure to carcinogens