India is facing a cancer crisis, with smoking, belated diagnosis and unequal access to treatment causing large-scale problems, experts said.
Every year in India, around one million new cancer cases are diagnosed and around 600,000 to 700,000 people die from cancer in India, with this death toll projected to rise to around 1.2 million deaths per year by 2035, a new report on cancer care in India published in The Lancet Oncology reported.
The new report has been compiled by Professor Richard Sullivan and Professor Arnie Purushotham from King's Health Partners Cancer Centre at King's College London with the help of senior Indian colleagues including Professor CS Pramesh and Professor Rajan Badwe at the Tata Memorial Cancer Centre, Mumbai.
"Access to affordable cancer treatment and care in India lags behind other parts of the world.
Making such treatment and care accessible will require addressing its causes, while also developing affordable treatments," Professor Sunil Khilnani, Director, King's India Institute, King's College London, said.
Making such treatment and care accessible will require addressing its causes, while also developing affordable treatments," Professor Sunil Khilnani, Director, King's India Institute, King's College London, said.
Although India has a relatively lower incidence of cancer (around a quarter of that in the USA or Western Europe), the rate of deaths from cancer, adjusted for age, is similar to that seen in high-income countries, the report said.
Less than a third of patients with cancer in India currently survive for more than five years after diagnosis.
Around 95 per cent of the medical colleges in India do not have comprehensive cancer care services, comprising Surgical, Medical and Radiation Oncology departments, in the same campus.
Currently there are around 2,000 medical and radiation oncologists in India – one per 5000 newly diagnosed cancer patients – and in almost all remote or rural areas even the most basic cancer treatment facilities are non-existent, it said.
As a result, urban cancer centres are overcrowded and under-resourced, leading to long waiting times, delayed diagnoses, and treatment that comes too late for many patients.
"The need for political commitment and action is at the heart of the solution to India's growing cancer burden," said Mohandas Mallath, a professor at the Tata Medical Centre in Kolkata.
"The extent to which death and illness from cancer will actually increase in the next 20 years will depend a lot on the investments made in future decades in tobacco control, healthcare delivery, cancer research, (and) clinical trials," Mallath said.
Also vital, he said, will be boosting public awareness about smoking and of the benefits a healthy diet and lifestyle, as well as investment in vaccinations against cancer-causing viruses.
Globally, there is a well-established correlation between research activity and positive patient outcomes, and in the report authors point out that because of its existing research infrastructure and successes in developing low-cost cancer treatment and prevention solutions, India is uniquely poised to be able to make a far greater contribution to global cancer control than can research done by high-income countries.
Improving cancer outcomes in India will also need far more concerted efforts towards preventing people from getting cancer in the first place.
The potential economic benefits of implementing better tobacco control are stark – two fifths (40 per cent) of all cancers in India are attributable to tobacco use, and the economic costs of illness and premature death due to tobacco consumption exceed combined government and state expenditure on medical and public health, water supply, and sanitation.
Finally, public awareness of and attitudes towards cancer in India are, in some cases, preventing patients from receiving effective treatment.
Cancer carries a stigma and many Indians believe that cancer is generally incurable and that it should be kept secret from family and neighbours.
These attitudes can negatively affect uptake of and adherence to treatment, even after a cancer diagnosis, and the only solution to this issue is a concerted effort to educate and engage the public on the facts about cancer, it said.
"Cancer research needs to be central to plans for national cancer control, and cancer needs to be one of the focuses of national research agendas and priorities," said Professor Richard Sullivan, King's College London, series coordinator and lead author of the series paper on cancer research in India.
