Number of cancer cases in India predicted to double in next 20 years

Number of cancer cases in India predicted to double in next 20 years

Afew months ago, a large number of medical scientists pored over databases of cancer patients in India. The scientists were from cancer hospitals and research centres like Tata Memorial Centre, All India Institute of Medical Sciences (AIIMS), King's College in London, and other major cancer centres in India and abroad. Cancer databases on India are scarce, and are not always reliable due to the inadequate documentation of cancer cases in the country. But what was available was enough to tell a striking story:

India is on the verge of a major cancer 'epidemic'.

India reports about one million new cases every year. This is 15% less than the US, whose population is one-third that of India. The disturbing fact is that the India number is predicted to double in 20 years, according to the International Agency for Research on Cancer (IARC), based in Lyon, France.

An even more disturbing fact is that, in spite of a much lower rate of incidence, as many people in India die of cancer as in the US. "Cancer mortality is high in India," says CS Pramesh, professor at the department of surgical oncology at the Tata Memorial Hospital in Mumbai. "And so the impact of cancer on Indian society is very high." Pramesh was among the doctors who did the study, which was published this week in a series of papers in the medical journal Lancet.

The costs

The GLOBOCAN project of IARC, which looks at cancer statistics in 184 countries, estimated that 14 million new cases were recorded in the world in 2012. About 8 million people died of cancer in 2012, of which nearly 700,000 were in India. So, India has 17% of the world's population and about 8% of its cancer patients. But these figures are deceptive, as India has a lower life expectancy and an overwhelming proportion of young people.

In the US, 1.6 million are expected to be diagnosed with cancer this year and 585,000 are expected to die. So, the cost of cancer to Indian society is much greater than in developed countries, and this cost is expected to rise quickly over the decade. Cancer knocks off 2% of the world GDP. No one knows what this number would be in India.

The rising incidence of cancer in India is usually explained away by demographics.

People are living longer, and cancer is often the disease of an aging population. However, there seem to be other factors at work. A majority of India's cancer patients are between 30 and 69 years of age, an anomaly that cannot be simply explained away by saying that it has more people in that age group.

Something else seems to be at work that is adding to obvious causes like smoking, and we don't quite know it as yet. But we do know the disease is disrupting Indian families and their finances. "Cancer affects everybody," says Kiran Mazumdar-Shaw, chairman and managing director of Biocon. She should know: she has seen her mother and her best friend suffer from the disease.

In the near future, which is actually the present, cancer will extract a big cost from households. At 3.9% of GDP, Indian spending on healthcare is one of the lowest in the world. Of this, the government spends only 21%, leaving people to fight major diseases on their own. With early detection and better therapies, more and more cancer will be cured or better managed. The costs, however, are not easy to manage. "India cannot afford to spend huge amounts of money caring for sick people," says Ajay Mahal, chairman of global health at Monash University in Australia.

A year ago, Mahal was the first researcher to estimate the financial burden of cancer on Indian households. He and his colleagues used data from 74,000 homes and looked at 1,645 homes with a cancer patient. They found that cancer-afflicted homes spent 36-44% more during the period under study. They borrowed more and sold assets, and put additional burden on healthy members of the family. Data for this study is from 2004, and costs have only increased since. "Health expenditures rise faster than household income," says Mahal.

The causes

This cost will keep rising. Newer methods of diagnosis and cures require high investments. As technology advances, the cost of diagnosis and monitoring keeps going up. Newer drugs are expensive. With genetic screening, cancer is now increasingly treated individually, and targeted therapies are more expensive than general ones. Cancer patients are living longer, which also means longer duration of treatment. All this is bad news in a country where most medical expenses are out of pocket. "There is considerable private investment in the corporate sector," says R Sankaranarayanan, special advisor on cancer control, IARC, "but many do not complete treatments due to unaffordable costs."

India's poor infrastructure is one of the reasons why so many die of cancer. It is often detected late, where it has advanced to a point where treatment is difficult. India's leading cancers in men are also not curable: lung cancer and oral cancer. The second highest killer in the country, cervical cancer, is curable but not detected early enough. Smoking and tobacco use is the leading cause of cancer in India.

"Quit rates of smoking in India are quite low when compared to that of the West," says Prabhat Jha, cancer researcher and chair of disease control at the University of Toronto.

In a report released two months ago, IARC warned that cancer can be beaten only through a combination of prevention, early detection and new therapies. In India, this means finding the main causes and removing them. Recent research throws up clues on what is wrong besides smoking and tobacco use. For example, people along the Ganges Belt get the deadly gall bladder cancer, and pollution is the likely cause. Those living along the coast get stomach cancer, and the cause seems to be fried fish.

There are general causes as well.

Fatty food and sedentary lifestyles are a deadly combination. Women who have few children—and in later life—are at risk of breast and ovarian cancer. There seems to be a link between air pollution and lung cancer. Widespread use of plastics is another major cause, especially when burnt in open fields. "Cancer is going to be India's biggest epidemic," says Harit Chaturvedi, chief oncologist of Max Healthcare. No one seems to be safe from this malady.