One in 10 Indians will develop cancer during their lifetime: WHO

NEW DELHI: One in 10 Indians will develop cancer in their lifetime and one in 15 will die of it, the International Agency for Research on Cancer’s (IARC) World Cancer Report released by the World Health Organization (WHO) on Tuesday said, highlighting the grave risk posed by the illness. The numbers are higher than India’s own internal numbers that say one in nine people have the risk of developing cancer.

“The estimates are marginally different as the IARC modelling is done using Indian Council of Medical Research-national Cancer Registry Programme (ICMRNCRP) data, which is collected from 36 population-based registries and 236 hospital-based registries across states to calculate national estimates and state-wise trends,” said Dr Prashant Mathur, director, Icmr-national Centre for Disease Informatics and Research, which runs NCRP and is working to publish the latest nationwide registry data in April.

The sharpest rise is in cancers of the breast and colorectum, associated with being overweight, low physical activity, and sedentary lifestyles, while cervical cancer rates have fallen because of improved hygiene in most parts of in India, according to the report.

The WHO classifies India’s national cancer registry programme among the world’s “high quality population-based registries”, which is the international gold standard for cancer esti

mates.

There is massive heterogeneity in cancer incidence across states, said the report, a feature reflected in NCRP data. “Incidence rates are the highest in Mizoram, where one in five men and women are at risk of developing cancer during their lifetimes, while in Barshi, Maharashtra, only one in 22 men and 1 in 18 women are at a lifetime risk,” said Dr Mathur.

The WHO-ICAR report puts the number of cancer cases reported in India in 2018 at 1.16 million and deaths in the country at 784,800 in the same time period. “NCRP doesn’t publish mortality (death) estimates as the medical certification of death in India is poor, which makes the data incomplete,” said Dr Mathur.

But according to the ICMR-LED India State-level Disease Burden Initiative study on cancer published in The Lancet Oncology in 2018, cancer deaths have more than doubled in India over the past 26 years, going up from 382,000 in 1990 to 813,000 in 2016, and accounted for 8.3% of total deaths in 2016.

CANCER IN THE WORLD

Globally, 18.1 million people in 2018 were living with cancer, which killed 9.6 million in a single year, said the WHO report. By 2040, those figures will nearly double, with the greatest increase in low and middle income countries, where more than twothirds of the world’s cancers will occur. Except cancer of the cervix, the incidence of most cancers is much lower in India than Brazil, Russia, China, and South Africa that are in a similar epidemiological transition (which basically means they are in the same state in terms of having infectious disease being replaced by chronic ones)

Cancer causes about 30% of all premature deaths from non-communicable diseases in people in the age group 30-69. The WHO warned that global cancer rates could rise by 60% over the next 20 years unless cancer diagnosis and management is ramped up in low and middle-income countries. Tobacco is the biggest risk factor for cancer, with about 80% of the world’s smokers in low and middle-income countries. In addition, 64% of the world’s daily smokers live in 10 countries, and half of the world’s male smokers live in just three countries, China, India, and Indonesia. There are 164 million users of smokeless tobacco, 69 million smokers, and 42 million smokers and chewers in India, said the report. “Stopping tobacco and alcohol use, vaccinating against hepatitis B infection that can lead to liver cancer, vaccinating against human papillomavirus (HPV) to eliminate cervical cancer, lowering obesity that raises breast cancer risk, adopting a healthy and safe to lower weight and combating infections such a H.pylori that raise stomach cancer risk, can prevent roughly 60% of all cancers,” said Dr Randeep Guleria, director All India Institute of Medical Sciences, which runs India’s largest publicfunded healthcare project, National Cancer Institute (NCI) in Jhajjar, Haryana.

COST OF CANCER

Cancer treatments are expensive, and usually include a combination of chemo-, endocrine and targeted therapies; surgery; radiotherapy; nuclear medicine; bone-marrow transplantation; and cancer cell therapy. “The cost of targeted treatment on the WHO EML (essential medicines list) for early-stage Her2-positive breast cancer, for example, would be about 10 years of average annual wages in India and South Africa, and 1.7 years in the USA,” according to the report.

“As the cost of treatment goes up with newer and newer molecules, cancer treatment will become unaffordable for most people. Cancer requires a multimodality management, with a surgeon, a medical oncologist, a radiotherapist, physician and palliative care management. Even for diagnosis, you know have a tumour board. Deaths can be prevented with efficient cancer early screening and referral, treatment, management and palliative care, including pain relief,” said Dr Guleria.

People over the age of 30 years are examined physically for signs of oral and breast cancers, and visual exam with acetic acid for cervical cancer at the community level under India’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke. “Mammograms are not just expensive but a logistical challenge and there is no consensus to make HPV vaccination against cervical cancer a part of the universal immunisation programme, so physical examination is a good way to start,” said a health ministry official on condition of anonymity.

In India, more than 90% of patients with oral cancer belong to the lower-middle socioeconomic status, according to the ICAR report. Breast cancer and colorectal cancer, on the other hand, were associated with urbanisation and more common in more developed states. “As the reduction of socioeconomic inequalities in population groups in India is addressed, highly focused and tailored public health interventions are needed to target different socioeconomic groups to reduce the disparities in cancer prevention,” said the report.

Interventions work. Improved hygiene, for example, has lowered cervical cancer rates in most parts in India, with the age-standardized incidence rates as low as 6 per 100,000 women in Kerala. Despite the annual reduction in cases, India accounts for about one-fifth of the global cases of cervical cancer. “Given the focus of primary prevention on health literacy, awareness, and behaviour change, addressing the socioeconomic determinants that influence these factors is critical to advance cancer prevention in India,” said the WHO report.