On Cancer Day, healthcare veteran Swati Piramal highlights the ‘moral dilemma’ in screening programmes

• India’s cancer burden is expected to increase from a little over a million new cases in 2012 to over 1.7 million by 2035.
• The top three most common cancers in India, by incidence are breast, lip and oral cavity, and cervix.
• The 5-year cancer survival rate for patients in India stands at nearly 30% while for those in North America and Western Europe it is at over 60%.

India’s cancer burden is expected to increase from a little over a million new cases in 2012 to over 1.7 million by 2035 and the number of cancer deaths will rise from about 0.68 million to 1.2 million during the same period. Cancer is amongst the leading causes of mortality and morbidity in India with most deaths reported in North-eastern states.

Reports have indicated that India has high age-specific mortality due to cancer in spite of low incidence. The key reasons for this include a young population, high infection rates, rampant use of tobacco, poor awareness and lack of access to screening. The top three most common cancers in India, by incidence are breast, lip and oral cavity, and cervix. In males, oral cavity and lung cancer - and in females cervix and breast cancers account for over 50% of all cancer-related deaths.

The 5-year cancer survival rate for patients in India stands at nearly 30% while for those in North America and Western Europe it is at over 60%. This poor survival rate can be attributed to a delay in diagnosis, poor availability of and access to treatment centres as well as incomplete or inadequate treatment. Notions surrounding cancer such as the fear of death and misconceptions around the high cost of treatment further prevents patients from seeking early care.

Prevention of Cancer

In general, there are five basic strategies to combat cancer.

First is to increase cancer awareness, the risk factors surrounding it and to promote advocacy towards the same.

Second is early identification through community and hospital-based screening methods.

Third is to focus on preventing the occurrence and proliferation of risk factors such as tobacco, indoor air pollution, etc., for each cancer.

Fourth is to develop a comprehensive care system that focuses strongly on accurate diagnosis and treatment facilities.

Fifth is to ensure access to and completion of treatment and regular follow-ups that include physical access and financing mechanisms as well as palliative care.

Piramal Foundation and its contribution to cancer prevention

In India, North-Eastern states have reported a high proportional mortality rate due to cancer. The DESH Program - Detect Early, Save Her & Him, designed by Piramal Foundation is implemented in the rural district of Kamrup in Assam. Piramal Foundation has partnered with Dr. B Borooah Cancer Institute, Guwahati, (BBCI) to create an end-to-end care model for the prevention of oral, breast and cervical cancer.

Critical elements of the programme include creating awareness about the disease, its risk factors, screening methods and treatment facilities.‘The Pink Van’, a mobile medical unit that also acts as a community-based screening clinic, has been placed in these areas and is equipped with state-of-the-art facilities such as a digital mammography machine and a digital system to record data.

Dr. Mehra Golshan, Associate Professor, Surgery, Harvard Medical School, said "Cancer morbidity and mortality in India is a rapidly growing societal challenge. Partnerships like the Piramal Foundation and the BBCI creating project DESH are critical to giving access to the most vulnerable population to screening, navigation, counseling and when necessary cancer therapy. Healthcare is a human right and first hand I have seen and worked with an amazing group of empathetic, dedicated and talented healthcare and support team in giving women and men access to life giving screening and treatment of breast, cervical and oral cancer".

Beneficiaries that have been screened positive are attended by tele-counsellors for follow-ups. These tele-counsellors assist the patients with navigation activities at BBCI. Till date, 21,227 people have been screened for oral, breast, and cervical cancers.

Conclusion

The key to comprehensive cancer care programmes is creating awareness and early detection and its success lies in community engagement programmes that are carried out at the grass-root level, followed by a strong diagnostic and treatment programme. A strong referral link must be established between the screening point and final treatment center. An ideal screening programme should be followed by an appropriate plan comprising diagnosis, treatment and follow-up plans, to avoid any ‘moral dilemma’.

To combat cancer and a host of non-communicable diseases, the Ministry of Health and Family Welfare, Government of India, initiated the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). While the strategies are comprehensive, the size of the problem itself is far too big for the Government alone to combat. Therefore, it is vital for not-for-profit organizations, civil society organizations and private sector players to collaborate with one another in order to combat cancer.

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