Catch the big C early

Arunima Patel

The prevalence of cancer and number of patients in India do not necessarily show the real picture of the healthcare crisis we are facing. The average prevalence rate for cancers in India is around 100 cases per lakh while in the advanced economies such as the US, it is around 300 per lakh. This comparatively lower prevalence of the disease in an otherwise 1.3 billion plus people is because risk of cancer increases with age and 65 per cent of Indians are younger than 35 years. On the contrary, the US has only around 27 per cent of its citizens under the age of 21 years. 

As per a report “Call for Action: Expanding cancer care for women in India 2017”, India is the third country after US and China in terms of high number of cancer cases.  

In India, one out of three patients does not survive beyond five years or more after being detected with cancer. With over 15 lakh new cases reported every year and a large population turning old, the country is staring at a catastrophe. 

In terms of gender, while the incidence of cancer is reported higher in men, more women are diagnosed with disease in India. A 2012 World Cancer Report suggests that over 5.37 lakh women were diagnosed with cancer against 4.77 lakh men.

The problem of delayed detection

While more women in India are diagnosed with cancer, what is worse is that the diagnosis happens at later stages when the cost and suffering during treatment shoots up while the chances of survival decrease. As per a National Institute of Cancer Prevention and Research-Indian Council of Medical Research (NICPR-ICMR) report, over 70 per cent of cancers in women include breast, cervical, and uterine cancer. Accordingly around 1.95 lakh women die of cancer every year.

Breast cancer and cervical cancer are one of the major causes of female deaths, leading to an estimated 76,000 annual deaths and 200 deaths daily, respectively. Putting this in to context of the data shared by National Family Health Survey, even in urban areas where awareness is supposed to be better, only 11.7 per cent and 25.3 per cent women in the age-group of 15–49 years have ever undergone examination of breasts or cervix, respectively.

The major factors behind delayed diagnosis include unawareness about cancer symptoms caused by ignorance or negligence. The prevalent gender bias in our patriarchal society, too, means women tend to compromise on their own health, keeping the health and welfare of husband, children and family first. Financial limitations, especially in the economically weaker sections, prevent women from visiting a doctor unless something serious happens. The early signs, therefore are missed, diagnosis is delayed, and chances of survival drops drastically. 

Importance of testing and diagnosis in initial stages

The importance of early testing and diagnosis cannot be stressed enough. Steps for awareness should be taken at a war-footing to encourage increasing participation. While healthcare facilities and various related stakeholders, including NGOs, medical societies, and others need to actively participate in spreading awareness and breaking the stronghold of socio-cultural myths and stigma, policy-makers and economists need to drive policies that would provide penetration of diagnostic testing in tier-II and tier-III cities and beyond. 

Today, treatment of many cancerous diseases is possible, especially if detected early. Advanced technology, including vacuum-assisted core biopsy, circulating tumour cells enable diagnosis in a minimally invasive way, ensuring early recovery. Other standard methods including surgical biopsy, core needle biopsy and fine needle aspiration biopsy are also available. Medical science has advanced to the extent that testing can be done based on molecular markers, which includes molecular profiling of somatic mutations. 

Latest testing methods include next generation sequencing, which helps in sequencing DNA and RNA quickly and accurately, conventional, reverse transcriptase, methylation-specific polymerase chain reaction (PCR), flow cytometry and Sanger sequencing. 

With evolving technology, and increasing knowledge, we need to evolve our thinking and socio-politico-economic systems as well so that the best of the medical innovations can be utilised to benefit the health of maximum number of people. 

—The writer is founder and MD, iGenetic Diagnostics