Ashraf Engineer
April 13, 2024
EPISODE TRANSCRIPT
Hello and welcome to All Indians Matter. I am Ashraf Engineer.
Some grim news emerged on the health front over the last week. India, according to the annual Health of Nation report by Apollo Hospitals, is becoming the “cancer capital of the world”. In 2020, the report said that 14 lakh Indians had cancer. By 2025, this number is expected to rise to 15.7 lakh. The most common cancers, in order of occurrence, in India are breast, cervix and ovarian among women. For men, the most common are lung, mouth and prostate cancers. What’s worse is that the median age for cancer diagnosis in India is lower than in other countries but screening rates remain very low.
SIGNATURE TUNE
Let’s look at the numbers first. Between 2020 and 2025, cancer cases are expected to grow by 13%. Most experts believe that’s an undercount due to the low screening rates and that the actual number of cases would be way higher – both at the base year, 2020, and also 2025.
The median age for cancer diagnosis in India is lower than in other countries, as I said earlier. For breast cancer, it is 52 years as compared to 63 in the US and Europe. For lung cancer, it is 59 years of age as compared to 70 years in the West. The share of colon cancer patients aged less than 50 years is now 30%.
As for screening rates, in India it is 1.9% for breast cancer compared to 82% in the US, 70% in the UK and 23% in China. For cervical cancer, it is 0.9% compared to 73% in the US, 70% in the UK and 43% in China.
It should be noted that there is more than one report on cancer in India and the one I mentioned earlier seems to be on the conservative side. According to a 2022 report by the Indian Council for Medical Research titled the ‘Burden of Cancers in India’, the number of Indians suffering from cancer is projected to increase to 29.8 million in 2025 from 26.7 million in 2021. The highest incidence reported by this report was in the North at 2,408 patients per 100,000 and the North-East at 2,177 per 100,000. It was higher among men.
This study indicates that one in every 68 men will develop lung cancer and one in every 29 women will develop breast cancer.
According to the Indian Council for Medical Research report, seven cancers accounted for more than 40% of the total disease burden: lung at 10.6%, breast at 10.5%, oesophageal at 5.8%, mouth at 5.7%, stomach at 5.2%, liver at 4.6% and cervix uteri at 4.3%.
At even greater risk are those from the lower socioeconomic strata. Experts say there is a need for better survivorship initiatives for this demographic.
There are several factors that are leading to the rise in cancer incidence, among them junk food and the increasing consumption of packaged food that has harmful preservatives.
Oncologists say that, earlier, tobacco and alcohol were considered the major drivers. Today, obesity, radiation from cellphone towers, vegetables grown in toxic water like rivers near industries, food adulteration and artificial food colouring also increase the risk.
In fact, preservatives are one of the reasons for the higher incidence of cancer in the North and North-East. In hilly areas, locals often use preservatives to store food, leading to oesophageal and stomach cancers.
Cancer develops as normal cells transform into tumour cells through a multi-stage process, advancing from a pre-cancerous state to malignancy. These happen because of the interplay of an individual’s genetic makeup and three main types of external factors, according to the World Health Organization:
- Physical carcinogens, such as ultraviolet and ionising radiation
- Chemical carcinogens, including asbestos, tobacco smoke, alcohol, a food contaminant named aflatoxin and arsenic found in contaminated drinking water
- Biological carcinogens, such as infections caused by some viruses, bacteria and parasites
We are dealing with two-pronged crisis: the high disease burden is compounded by late detection. Blame it on the lack of awareness and screening initiatives. India’s cancer detection rate stands at a dismal 29%, with only, 15% and 33% of breast and cervical cancers being diagnosed in stages 1 and 2. This is way lower than the detection rate in China, the UK and the US. So, many cases go undetected until they reach advanced stages, which devastates patients and their families.
Experts say the risk factors for cancer are the same globally but the proportion differs due to different habits and lifestyles. In India, the modifiable risk factors include:
- In 2020, more than 50,000 cases were caused by alcohol consumption. India was second, just behind China, in the number of cases attributed due to alcohol.
- In 2020, India ranked third in Asia in obesity-attributed cancers – behind China and Japan.
- In 2020, Asia topped the world in infection-related cancer. Common infections that led to cancer were helicobacter pylori, the human papilloma virus, the Hepatitis B virus and the Hepatitis C virus.
- Tobacco-related cancers. India has a huge burden of such cancers, with lung, head and neck topping the list.
As always, prevention is the key and it can be classified into three types:
- Educate students to shun bad habits. They lead not only to cancer but also cardiovascular disorders, diabetes and metabolic issues
- Applied when people have already developed bad habits or unhealthy lifestyles but not developed cancer yet. Counselling and guiding is the advised route
- Applicable if a person has already developed cancer but doesn’t know it. Screening at the early stage is needed so that recovery rates are high
Research shows that viral infection plays an important role in causing cancer. For instance, the human papilloma group of viruses plays a role in causing cancer of the penis, vagina, vulva, mouth and throat. The Hepatitis B and C viruses play a role in liver cancer. There are vaccines and treatments available for these viruses, which means there is a shield that is especially important for the lower socioeconomic group.
Awareness about screening is crucial and early detection could mean even a normal life expectancy.
All that I have detailed are major steps towards cancer control. These can be supplemented by expanding cancer registries and health information systems that can form the basis for informed and evidence-based policy decisions.
By analysing a patient’s medical history and lifestyle, it is possible to develop what is known as a ‘behavioural phenotype’ to predict cancer incidence. This allows the patient to take preventive steps and even seek personalised advice and care. The common risk factors tracked are tobacco and alcohol use, sun exposure, environmental pollutants and family history.
India is already considered the diabetes capital of the world and the incidence of other so-called lifestyle diseases, such as heart ailments, is on the rise. We could do without adding cancer to the overall public health burden. Please get yourself screened regularly and cut out unhealthy habits. Your life is precious.
Thank you all for listening. Please visit allindiansmatter.in for more columns and audio podcasts. You can follow me on Twitter at @AshrafEngineer and @AllIndiansCount. Search for the All Indians Matter page on Facebook. On Instagram, the handle is @AllIndiansMatter. Email me at editor@allindiansmatter.in. Catch you again soon.
