Cancer runs deep in rural Bengal

Cancer runs deep in rural Bengal

West Bengal has slowly but steadily emerged as the dreaded cancer zone in the country. As many as 40,000 new cancer patients remain untreated here every year. A majority of them either die without treatment or are diagnosed at an advanced stage that leads to their death within an year, according to data compiled by city oncologists in the wake of a report published by British medical journal Lancet last week. The figures suggest that while less than 30% of cancer patients survive five years in India, the corresponding number in Bengal is much higher.

As per the Lancet report, around 80% of patients in India go to quacks first with their ailment. It leads to either wrong or deferred treatment, which means patients are already at the third or fourth stage when effective treatment starts.

But the ground reality was even grimmer in the state. Out of 70,000 new cancer patients in Bengal every year, 40,000 remain outside the fold of treatment. The major reason being limited access to facilities. Out of the state's 2 lakh existing cancer patients, around 1.3 lakh are believed to be from villages.

"There is a huge gulf between facilities at our rural and urban centres. All cancer treatment facilities are concentrated in urban centres, including the government hospitals. Thousands of patients remain untraced. A few report to cities for treatment rather late. We have no way of helping the rest till we have more treatment centres," said oncologist Gautam Mukhopadhyay, secretary of Bengal Oncology Foundation that assists rural and underprivileged cancer patients in the state.

"We receive scores of patients every month who are at a pretty advanced stage. A majority has either been ignoring the symptoms or have been guided wrongly by quacks. Shockingly, they are a part of the 30,000 new patients who eventually seek treatment. But a larger number die without being diagnosed," said Subir Ganguly, oncologist and senior vice-president, Bengal Oncology Foundation.

Myths and misconceptions are also responsible for people not seeking treatment, according to Joydeep Biswas, director, Chittaranjan National Cancer Research institute (CNCRI). "A substantial number of those who remain outside the purview of conventional treatment choose to go for cheaper alternative methods. These are hardly effective. The rest believe cancer is incurable and that biopsy or surgery would actually hasten death. Access to treatment is limited, but is definitely not the only reason," said Biswas.

Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage. Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average: British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows:

Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher.

Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.

The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).

Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years - about 16 percent - whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.

Results for Canada. Canada's system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada:

For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

Early Diagnosis. It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.

In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly - a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.