Cancer In India - The Real Picture
What is Cancer and how is it caused?
Cancer occurs whenever cells mutate in the body. The person may be born with a genetic mutation (10% of cases are hereditary) which may remain dormant or may be triggered to manifest itself due to a carcinogen (Knudson’s two-hit theory), or in an offspring when both parents have the defective genes.
These carcinogens are present everywhere (especially in known causes like tobacco, betel nuts etc.) in the environment, including the polluted air we are breathing nowadays, the polluted water we are drinking (due to the various chemicals being dumped by the factories into all our major water bodies and the pesticides which leach into the soil and groundwater) and the food that we eat (due to the same carcinogens getting into our crops and the toxic colouring agents being added into some prepared foods). It can also be due to radiation or asbestos in the environment, or occupational hazards such as those handling toxic chemicals, paints and heavy metals.
Once the mutated cell is detected by the body, it is usually killed by the body’s defensive mechanisms (apoptosis). But when the cell regulators themselves are defective, the mutant cells are allowed to multiply unchecked. Normal cells in the body have a particular life and then die. However, the mutant cancer cells continue to replicate in an immortal manner and form a tumour, which invades the particular organ in which it is formed (e.g. breast, lung, stomach, colon, prostate etc.). Since a cell takes about 250 days to double, it would normally take the mutated cell about 10 cell divisions to reach a size of 1 cm diameter, at which size it would be detectable by palpation. So an early stage cancer does not form overnight, but the cancer would have been present in the body for several years before being detected. The tumour also sheds cancer cells into the bloodstream or lymphatics, by which means it spreads to other parts of the body (metastases) like the brain, lung, liver, bones, marrow etc, when it is called a Stage IV cancer.
Magnitude of the problem
Population-based cancer registries within the “National Cancer Registry Programme” (NCRP) estimated that there are about 8 lakh new cases of cancer in India every year. Since a large number of cases go unreported, especially in the underserved parts of the country, the number is likely to be over 1 million new cases per year. As per GLOBOCAN, this figure is likely to double by 2035. The incidence varies in different parts of the country, varying from 260 cases (of a particular cancer) per 100,000 populations in certain parts of the North-east, to 30 cases per 100,000 populations.
Of these, 60% of cases of cancer are preventable, since 40% of all cancers are related to tobacco and 20% are due to other preventable causes including viral infections like Hepatitis B & C and HPV (Human Papilloma Virus) the incidence of which can be controlled by vaccines.
Since more than 70% of the cases in our country report in the late stages, where a cure is not likely, eventually half of these cases will die due to cancer. Thus the Mortality/ Incidence Ratio is 0.68 in India, whereas its 0.57 in high HDI (Human Development Index) countries and 0.38 in very high HDI countries. Our aim should be to reach a figure comparable to the HDI countries and then better it.
The chief causes of the decreased survival from cancer in India are due to a combination of: -
Hence there is an urgent need to address these problems, create awareness about the various issues enumerated above, as well as the “early warning signs of cancer” so that we can reduce the incidence of cancer in our country, as well as to detect more cases in early stages and treat them appropriately.
