Why is it in the News?

As only a handful of Indian districts currently meet the Health Ministry's cancer screening standards, the ICMR is preparing to address this issue.

The Indian Council of Medical Research (ICMR) has called for Expressions of Interest to advance research aimed at speeding up cancer screening, early diagnosis, and treatment.

About Cancer:

Cancer is a complex and devastating group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body.

• Cellular Aberration: At its core, cancer begins with mutations in the DNA of normal cells.
• These mutations disrupt the intricate mechanisms that regulate cell growth and division.
• Uncontrolled Growth: Cancer cells multiply uncontrollably, forming a mass of tissue known as a tumor. Not all tumors are cancerous; benign tumors are non-cancerous and do not invade nearby tissues.
• Malignant Tumors: Cancerous or malignant tumors are invasive and can infiltrate nearby tissues and even spread to distant parts of the body through the bloodstream or lymphatic system.
• This process is called metastasis.
• Diverse Types: There are over 100 different types of cancer, each originating in specific cell types or tissues.
• Common types include breast, lung, prostate, and colon cancer.
• Risk Factors: Several factors can increase the risk of developing cancer, including genetics, exposure to carcinogens (such as tobacco and UV radiation), poor diet, lack of physical activity, and certain infections.
• Survival Rates: Cancer survival rates have improved over the years due to advances in research and treatment.
• Early diagnosis and prompt intervention often lead to better outcomes.

Cancer incidence and mortality in India:

• Cancer's Impact in India: Cancer is a formidable public health concern in India, where it stands as the third-highest country for cancer incidence, following China and the United States.
• Future Trends: Projections from the Global Cancer Observatory indicate a noteworthy 57.5% surge in cancer cases in India between 2020 and 2040.

Trends in cancer incidence and their contributing factors:

• Divergent Trends in Cancer Incidence: In India, there are varying trends in cancer incidence.
• Notably, cervical cancer rates have dropped from 45 to 10 cases per 100,000 people over the past five decades.
• In contrast, breast cancer rates are on the rise, especially in urban areas like Hyderabad, where it stands at 45 cases per 100,000.
• Factors Behind the Trends: Cervical cancer's decline can be attributed to factors like delayed marriages, smaller family sizes, improved hygiene practices, and the introduction of the human papillomavirus (HPV) vaccine.
• The increase in breast cancer cases is linked to late marriages, delayed childbirth, reduced breastfeeding, and diets high in protein.
• Unlike cervical cancer, there's no known specific cause for breast cancer, which makes screening crucial.
• Tobacco-related cancers, such as oral and esophageal cancer, have seen a decrease thanks to tobacco control laws that have curbed public smoking.
• Lung cancer, driven by both pollution and smoking, remains a concern.
• In regions like Arunachal Pradesh, indoor fires during winter contribute to high lung cancer rates.
• Unfortunately, lung cancer often goes undiagnosed until advanced stages, resulting in a low survival rate.

Improvements in cancer treatments and the infrastructure challenges in India:

• Advancements in Cancer Treatments: Progress in cancer treatment can be measured by examining cure rates for different types of cancers.
• For instance: Over the past half-century, the cure rate for pancreatic cancer has doubled, moving from 3% to 6%.
• The cure rate for prostate cancer has seen significant improvement, rising from 60% to 100%.
• Newer treatments have substantially boosted breast cancer survival rates, elevating them from 50% to 90%.
• Challenges in Cancer Care Infrastructure: Despite these treatment advancements, India faces challenges in its cancer care infrastructure, encompassing seven critical pillars: prevention, surgery, chemotherapy, radiotherapy, imaging, laboratory diagnostics, and palliative care.
• In developing countries, including India, the World Health Organization (WHO) recommends one radiotherapy machine per million people. Given India's population of 1.4 billion, this would require 1,400 machines. However, the country currently has only 700 such machines, highlighting a substantial deficit in cancer care infrastructure.

Steps required to reduce overall cancer mortality in India, similar to the approach in the US:

• Prioritize Screening: The initial step should focus on widespread cancer screening.
• The government has already initiated this process by upgrading health and wellness centers to screen for the three most prevalent cancers in India - breast, cervical, and oral (which together account for 34% of cancer cases).
• Accessible and Affordable Treatment: Effective screening should seamlessly lead to accessible and affordable hospital treatment.
• Ensuring that cancer care is within reach for all is crucial.
• Expand Cancer Care Facilities: The existing ratio of one cancer care facility for every 5 crore people in India must be improved.
• Increasing the number of facilities is essential to guarantee timely diagnosis and treatment.
• Early Diagnosis and Prompt Treatment: The key goal is to ensure early cancer diagnoses and prompt treatment to improve survival rates.
• Enhanced Coordination: Coordination is vital. Currently, various government programs operate independently and in isolation.
• Streamlining and synchronizing these efforts can enhance the overall impact of cancer control initiatives in India.

ICMR Project to Enhance Cancer Screening at the District Level:

• This project is scheduled to run for four years, including six months for preparatory activities and another six months for analysis and interpretation.
• It encompasses formative phases, implementation, and evaluation.
• The Indian Council of Medical Research (ICMR) aims to enhance both the coverage and quality of cancer screening within the existing healthcare system, employing established and validated methods.
• The plan involves engaging non-specialist physicians and other healthcare personnel within a supportive healthcare framework to conduct cancer and precancerous condition screenings.
• A key objective is to ensure that individuals testing positive are promptly connected to facilities for early diagnosis and treatment.
• Active involvement of local communities is crucial to motivate the target population to undergo screening for early detection and treatment.
• For instance, research has shown that frontline health workers like Accredited Social Health Activists (ASHAs) can promote and perform home-based cancer screening, which has led to higher participation rates due to the privacy and convenience it offers.

Mains Question:

• What strategies can be implemented to improve cancer screening rates and access to timely treatment in India, especially considering the existing deficit in cancer care facilities and the need for coordinated efforts? (10M)