A study tracing the growing burden of cancer in India states that most of the increase in cancer incidences are attributable to its epidemiological transition and improvement in the use of cancer diagnostics.
The country's cancer burden will continue to increase as a result of the ongoing ageing of India and improving access to cancer diagnostics in rural India, said Mohandas K. Mallath of the Tata Medical Centre, Kolkata, and Robert Smith from Kings College, London, in a recent paper: History of Growing burden of Cancer in India: From Antiquity to 21st century .
The paper was published in the Journal of Global Oncology which is promoted by the American Society of Clinical Oncology.
The study has stated that while cancer-like diseases were documented since antiquity, recording of cancer in India began only in the 19th century when the Western medical practices of biopsy and pathological examination came to India during the colonial British regime.
Cancer is primarily a disease of older people, hence, as life expectancy went up, cancer incidences too went up, said Dr. Mallath, a senior consultant of Digestive Oncology. Maximum increases will occur in the most populous and least developed States, where the facilities for cancer diagnostics and treatment are grossly inadequate.
According to Dr. Mallath, the present study offers lessons for planning cancer care in States as well as other countries experiencing epidemiological transition. In India the fastest epidemiological transition happened in Kerala, whereas Uttar Pradesh remained in the slowest group, he said.
A direct comparison of the demographic and social variables, available health care facilities and leading causes of mortality in these two States shows how the low incidences of infectious diseases in Kerala has given rise to more cancer compared to U.P., which is still battling high mortality from communicable diseases.
The types of cancers in India are also undergoing a transition, similar to a report from Japan five decades ago. There has been a decline of cancers caused by infections, such as cervical, stomach, and penile cancer, and an increase in cancers associated with energy intake, physical activity imbalance and ageing, such as breast, colorectal and prostate cancers.
Cancer transitions can influence the requirements for site-specialized cancer surgeons, the study says. For example Kerala will need more breast oncologists and U.P. will need more gynecological oncologists, said Dr. Mallath.
The association of tobacco chewing with cancer and subsequent warnings were published more than a century ago. But the habit has remained unchecked and has spread all over India, and it is now estimated to cause a fifth of all cancers in India, the study say.
According to the study, the populous, slow epidemiological transition in States will start to transition faster in the coming decades, and their cancer burdens will similarly increase faster. U.P., as the case in the study, has a huge gap in cancer care. More effort will be needed to close the gaps, it urges.
Cancer is the second leading cause of adult death in urban and fourth in rural India, but it is the leading cause of catastrophic health spending, distress financing, and increasing expenditure before death in India, Dr Mallath points out.
Out-of-pocket expenditure is three times higher for private inpatient cancer care in India. Approximately 40% of cancer costs are met through borrowing, sale of assets, and contributions from friends and relatives. Sadly, these costs exceed 20% of annual per capita household expenditure in 60% of Indian households with a patient with cancer, said Dr. Mallath.
India's cancer incidence is estimated at 1.15 million new patients in 2018 and is predicted to almost double as a result of demographic changes alone by 2040.
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