Cancer scenario in India

Dr Kirti Bushan
The current Indian population is 1,270,272,105 (1.27 billion). The incidence of cancer in India is 70-90 per 100,000 population. and  cancer prevalence is established to be around 2,500,000 (2.5 million) with over 800,000 new cases and 5,50,000 deaths occurring each year. More than 70% of the cases present in advanced stage accounting for poor survival and high mortality. About 6% of all deaths in India are due to cancers  which contribute to 8% of global cancer mortality.
According to Indian Council of Medical Research (ICMR) data on site specific cancer burden,  in males, the  most common are cancers of  mouth/pharynx, esophagus, stomach, lung/bronchi while as  in females, the common cancers are cervix, breast, mouth/oropharynx and esophagus.
Carcinoma breast is more common in urban females. Cancer breast is the leading cancer among females as reported in registries from Mumbai, Delhi and Bangalore while in rest of registries, cancer cervix is the leading cancer followed by breast cancer. The estimated number of breast cancer cases in India for the year 2010, 2015 and 2020 will be approximately  90,659;  106,124  and 123,634 respectively. So breast cancer is expected to cross the figure of 100,000 cases in year 2015.
The annual global incidence of carcinoma cervix is approximately 500,000 cases and India contributes about one-fifth of the burden ,ie,100,000 cases annually. In South India, cancer cervix is the most common cancer among females. The incidence of cancer cervix in Chennai is 99 per 100,000. Over the years in spite of decreasing incidence of cervical cancers, the gynaecologic cancers have increased in India and are contributing about 30% of total cancers among women in India. Among these carcinoma cervix followed by carcinoma ovary and corpus uteri are the major contributors.
The estimated number of cancer cases related to digestive system were 107,030 in males and 86,606 in females for the year 2010. The major three cancers contributing were stomach cancers (19.8%), esophagus (18.6%) and colon cancers (14.2%). Esophageal cancers are reported maximum from South India (Karnataka, Tamil Nadu) and also from states of Maharashtra, Gujarat, Jammu & Kashmir and parts of Northeastern states. Age adjusted  incidence of esophageal cancers in females in Bangalore is one of  the highest  in the world (8.3/100,000). Carcinoma stomach has highest incidence from South India especially Chennai and  Bangalore.
Age adjusted incidence  of gall bladder cancers in Delhi is one of the highest in the world (8.9/100,000). Also gall bladder cancers are reported in increasing incidence from North Indian states and West Bengal.
Carcinoma lung is having highest incidence from Mumbai, Delhi, Bhopal regestries and hypopharyngeal and penile cancers were more reported in Baarshi registry. Overall high incidence of oral cavity cancers has been reported from  Ahmedabad while as tongue cancers were reported more in Bhopal (8.8/100,000). Cancers of oral cavity, tongue and laryngeal cancers contribute maximum towards head and neck cancers.
In recent times there has been increase in incidence of cancer in India as nearly two people are diagnosed every minute with cancer. This is mainly attributed to urbanisation, industrialisation, life style changes, population growth and increase in  life span. In India, life expectancy at birth has risen from 45 years in 1971 to 62 years in 1991 to 71 years expected by 2021-25 and so has the risk to harbour cancer.
The predominant  risk factors associated with cancers are genetic, environmental and  life style factors  which include tobacco, alcohol, infections (HIV,HPV,HBV,HCV,H. Pylori) and dietary factors which overall are involved in 80-90% cases. Tobacco contributes directly to  about 50% of cancers in males and 10-15% cancers in females..Most of the cancers have some relationship with diet. Predominant among them are cancer of esophagus, stomach, colon & liver. Consumption of large amounts of red chillies, food at very high temperatures and alcohol consumption are the main risk factors for stomach cancers in India. Consumption of a tobacco extract “tuibur” and smoked meat have been linked to a high rates of stomach cancers in Mizoram.
The impact of cancer in India is far greater than mere number of cancer cases. Its diagnosis causes immense emotional trauma and its treatment a major economic burden. The initial diagnosis of cancer is perceived by many patients as a grave event with more than one-third of them suffering from anxiety and depression. Cancer is equally distressing for family as well. It could affect both family’s daily functioning and economic situation. The economic shock often includes both loss of income and increase of expenses because of treatment and health care. This disease is associated with a lot of fear & despair in our country.
According to Boston Consulting Group Study, 60-80% cancer cases in India are diagnosed late and  60% patients do not have access to quality treatment. There are  only 300+ cancer centers in India while as 600 more required to meet the demand. About  400 radiotherapy  machines are available and  1200 more  are required to cover the cancer population adequately. Moreover, about 40% centers not equipped with all modern facilities. The group also estimated that India needs  500 PET-CTs and 1000 cancer units  by year 2020. Doctor patient ratio is 1 in 2000 and currently aim is to achieve 1 in 1000 by 2021.There is also disproportionate skilful manpower and technology in India with cancer specialists, trained staff and specialized cancer centers available in very few cities across India. For most patients in India, there is no insurance cover and treatment cost out of reach .Thus delivery of  equitable, quality and affordable cancer care in India  is  a big challenge.
( The author is Consultant, Department of Surgical Oncology,Asian Institute of Oncology (Mumbai)