Global Burden of Disease Estimates on Cancer

The Global Burden of Disease (GBD) estimates, as reported by The Lancet, provide critical insights into the rising cancer burden, particularly in India, contrasting with the global trend of declining cancer incidence.

1. Global Cancer Trends:

   • Global Incidence Decline: From 220.6 per 100,000 in 1990, cancer incidence globally has decreased to 205.1 in 2023, with projections estimating it will further drop to 192.9 by 2025.

   • Absolute Numbers Rising: Despite the decline in rates per 100,000, the absolute number of cancer cases and deaths is expected to rise significantly by 2050 due to population growth and aging demographics.

2. Cancer Trends in India:

   • Rising Incidence and Mortality: In India, cancer incidence has increased from 84.8 per 100,000 in 1990 to 107.2 in 2023, and cancer-related deaths have risen from 71.7 to 86.9 per 100,000.

3. Burden on Low- and Middle-Income Countries (LMICs):

   • The study highlights that LMICs, such as India, are expected to account for over 50% of new cancer cases and two-thirds of cancer deaths. This places a disproportionate burden on nations like India, which face more challenges in terms of healthcare infrastructure, early detection, and treatment accessibility.

4. Modifiable Risk Factors:

   • Globally, about 42% of cancer deaths are linked to modifiable risk factors like tobacco, alcohol, unhealthy diets, and infections. In India, this share could be as high as 70%, underscoring the significant role of lifestyle choices and infections in the cancer burden.

5. Future Predictions:

   • By 2050, the global incidence of cancer is expected to rise to 30.5 million new cases, with a 75% increase in cancer-related deaths, reaching 18.6 million globally. India is anticipated to face a growing burden, with cancers such as breast, lung, oesophagus, oral, cervical, stomach, and colon cancer being the leading causes of mortality.

Contributing Factors to India’s Growing Cancer Burden

Several factors are exacerbating India’s cancer burden, encapsulated in the CANCER mnemonic:

1. C - Changing Demographics (Aging Population):

   • India's rising life expectancy and population are leading to an increase in older adults, who are at higher risk of developing cancer. Even if rates per 100,000 people remain stable, the total number of cases is rising due to an aging population.

2. A - Adoption of Unhealthy Lifestyles:

   • Factors like high tobacco consumption, unhealthy diets, alcohol use, and sedentary lifestyles are increasing the risk of cancers such as lung, mouth, throat, esophagus, pancreatic, and liver cancers. These habits are widespread in India, contributing significantly to the rising cancer burden.

3. N - National Health System Deficiencies:

   • Late-stage diagnosis (in stages III or IV), lack of specialists (oncologists), shortages of radiotherapy machines, and catastrophic health expenditure are major issues in India. These factors contribute to delayed treatment, poorer outcomes, and higher mortality rates for cancer patients.

4. C - Carcinogenic Environmental Exposure:

   • High levels of outdoor air pollution (PM2.5, a class I carcinogen), indoor air pollution (from solid fuels), and exposure to industrial chemicals increase the risk of cancers, especially lung cancer. These environmental factors are prevalent in many urban and industrial regions.

5. E - Economic Hardship from Treatment:

   • The high cost of cancer treatment (including surgery, chemotherapy, and radiotherapy) is a significant barrier to access for many Indians, particularly the poor. This can lead to delayed or skipped treatments, ultimately contributing to higher mortality rates.

6. R - Rising Infection-Linked Cancers:

   • Infections such as Human Papillomavirus (HPV) (linked to cervical cancer), Hepatitis B and C viruses (linked to liver cancer), and H. pylori (linked to stomach cancer) contribute significantly to India's cancer burden, particularly among younger populations.

India’s Initiatives for Cancer Control

To address the growing cancer burden, India has launched several initiatives aimed at prevention, treatment, and awareness:

1. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS):

   • Aimed at prevention, early detection, and control of cancers, along with other non-communicable diseases (NCDs).

2. National Cancer Grid:

   • A network of cancer hospitals and research institutions across India to provide collaborative treatment and improve outcomes.

3. National Cancer Awareness Day:

   • Celebrated annually to increase awareness about cancer prevention and early detection.

4. HPV Vaccine:

   • The Indian government has initiated vaccination programs to reduce the incidence of HPV-related cancers (primarily cervical cancer), focusing on young girls.

Measures India Can Adopt to Address Its Growing Cancer Burden

India can take several measures, summarized in the CURE mnemonic, to address its growing cancer burden:

1. C - Control Carcinogens:

   • Strengthen the Cigarettes and Other Tobacco Products Act (2003) and increase tobacco taxes to reduce smoking rates, prevent new users, and generate funds for cancer prevention and treatment programs.

   • Strict regulations on the use of pesticides and asbestos can help reduce occupational cancer risks.

2. U - Universal Vaccination & Screening:

   • Implement universal HPV vaccination to prevent cervical cancer and Hepatitis B vaccination to reduce liver cancer.

   • Screening programs should be expanded, integrating Primary Health Centres (PHCs) and training ASHA (Accredited Social Health Activist) and ANM (Auxiliary Nurse Midwife) workers for early detection and referrals.

3. R - Robust Treatment Infrastructure:

   • Reduce out-of-pocket expenses by expanding Ayushman Bharat to cover all aspects of cancer care.

   • Increase the availability of Tertiary Care Cancer Centres and advanced oncology departments to improve access to quality treatment.

4. E - Evidence & Research:

   • Expand the National Cancer Registry Programme (NCRP) for accurate cancer data to guide policy-making.

   • Promote indigenous research on cancer prevention, treatment, and early detection.

   • Implement a National Cancer Control Plan with clear targets for reducing the cancer burden.

What is Cancer?

Cancer is a genetic disease that arises when normal cells undergo genetic mutations causing them to divide uncontrollably, forming abnormal masses of tissue known as tumors. If left untreated, these tumors can invade other parts of the body, a process known as metastasis. Metastasis refers to the spreading of cancer cells from their original site to other organs or tissues, making the disease more complex and difficult to treat.

Cancer can develop in virtually any part of the body, and each type of cancer has its own characteristics and treatment options. The treatment usually depends on the type, location, and stage of cancer and can include surgery, radiotherapy, systemic therapies (like chemotherapy or immunotherapy), and palliative care for relief from symptoms.

Causes of Cancer

Cancer arises through a multi-step process where normal cells are transformed into tumor cells. This transformation is influenced by the interaction of genetic factors and external agents, which can be categorized into three broad groups:

1. Physical Carcinogens:

   • These include radiation (both ultraviolet (UV) and ionizing radiation) which can damage the DNA in cells, leading to mutations and cancer formation.

2. Chemical Carcinogens:

   • These are substances that can cause cancer. Common chemical carcinogens include:

     • Tobacco smoke (responsible for lung, mouth, and throat cancers)

     • Asbestos (linked to mesothelioma and lung cancer)

     • Alcohol (increases the risk of liver, throat, and breast cancers)

     • Aflatoxins (a type of mold that grows on poorly stored food, can cause liver cancer)

     • Arsenic (often found in contaminated drinking water, associated with skin and lung cancers)

3. Biological Carcinogens:

   • These are infections caused by certain viruses, bacteria, or parasites. Examples include:

     • Human papillomavirus (HPV), linked to cervical cancer

     • Hepatitis B and C viruses, linked to liver cancer

     • Helicobacter pylori, a bacterium that increases the risk of stomach cancer

Prevention of Cancer

Preventing cancer involves taking measures to reduce exposure to known risk factors and maintaining a healthy lifestyle. Here are some effective prevention strategies:

1. Healthy Lifestyle Choices:

   • Maintain a healthy weight to reduce the risk of cancers like breast, colon, and kidney cancers.

   • Eat a balanced diet, rich in fruits and vegetables, which provide essential vitamins, minerals, and antioxidants that help protect cells from damage.

   • Engage in regular physical activity, which can lower the risk of several types of cancer, including colorectal and breast cancers.

2. Avoid Harmful Substances:

   • Limit or avoid alcohol consumption, as alcohol is a known risk factor for cancers of the liver, mouth, throat, and breast.

   • Stop smoking or avoid exposure to tobacco products to reduce the risk of lung, oral, and throat cancers.

3. Vaccination:

   • HPV vaccination: Protects against the human papillomavirus, which causes cervical, anal, and throat cancers.

   • Hepatitis B vaccination: Reduces the risk of liver cancer, particularly in people at high risk for hepatitis B.

4. Sun Protection:

   • Avoid excessive sun exposure and use sunscreen to prevent skin cancer, particularly melanoma. Avoid artificial tanning devices.

5. Safe Use of Radiation:

   • Minimize unnecessary exposure to radiation in medical procedures. Ensure that radiological equipment is well-calibrated and used correctly.

6. Environmental Precautions:

   • Limit exposure to air pollution, especially PM2.5 (fine particulate matter), which has been linked to lung cancer.

   • Ensure safe living environments free from radon, a naturally occurring radioactive gas found in certain buildings.

Government Initiatives to Reduce Cancer Burden in India

The Indian government has undertaken several initiatives to prevent and reduce the cancer burden, including:

1. National Cancer Grid:

   • A collaborative network of cancer hospitals and research institutions aimed at providing quality cancer care and research across India.

2. National Tobacco Control Programme (NTCP):

   • Aims to reduce tobacco use through awareness campaigns, regulations, and programs to reduce tobacco demand and supply.

3. Rashtriya Arogya Nidhi (RAN):

   • A financial assistance scheme for individuals diagnosed with cancer, aimed at supporting low-income patients for their treatment costs.

4. HPV Vaccine Program:

   • The government supports the vaccination of girls, as well as efforts to raise awareness about the importance of HPV vaccination to prevent cervical cancer.

5. FSSAI (Food Safety and Standards Authority of India) Regulations:

   • New labeling regulations target cancer-causing chemicals in food, promoting a safer food supply and reducing cancer risks from contaminated food.

Global Efforts to Reduce the Cancer Burden

At the global level, organizations like the World Health Organization (WHO) and various international agencies have worked to reduce the cancer burden:

1. WHO Global NCD Action Plan (2013-2020):

   • A comprehensive roadmap that provides policy options for Member States, international partners, and the WHO to collectively implement strategies aimed at reducing premature deaths from Non-Communicable Diseases (NCDs), including cancer. The goal is to achieve a 25% reduction in premature mortality from NCDs by 2025.

2. World Cancer Day (February 4th):

   • World Cancer Day is observed globally to raise awareness about cancer prevention, treatment, and care. It serves as an opportunity for governments and individuals worldwide to commit to actions that reduce the cancer burden.

3. Scientific Research and Treatment:

   • Significant resources are dedicated to scientific research aimed at understanding cancer’s mechanisms, improving treatments, and developing new therapies. International research collaborations also aim to find cures for various types of cancer and improve the quality of life for patients.

Cancer Burden in India

Cancer is a growing health challenge in India, with increasing incidence and mortality rates. Major types of cancer in India include breast, lung, mouth, cervical, and esophageal cancers. Factors such as tobacco consumption, poor diet, inadequate healthcare infrastructure, and late-stage diagnoses contribute to the high cancer burden.

Conclusion

India’s growing cancer burden is driven by a combination of modifiable risk factors, systemic healthcare deficiencies, and an aging population. However, with proactive measures such as improved screening, vaccination, policy reforms, and a robust cancer treatment infrastructure, the country can significantly reduce its cancer burden and improve outcomes for millions. The CURE approach, focusing on carcinogen control, vaccination, early detection, and strengthening infrastructure, offers a comprehensive path forward.