Cancer is a major public health challenge in India, with approximately 1 million new cases and 700,000 deaths annually. The cancer burden is projected to nearly double by 2035. Four cancers - oral, cervical, breast and lung - account for over 50% of cancer deaths. Risk factors include tobacco use and poor access to screening and early detection. Government initiatives to address cancer include the National Cancer Registry Program, National Cancer Control Program and National Program for Prevention and Control of Noncommunicable Diseases. However, challenges remain in expanding access to affordable cancer care across India given its large population and socioeconomic inequalities.

1. Cancer prevalence and
prevention in India – challenges
and opportunities
Dr Rupesh kumar Singh
MCh surgical oncology(TMH, Mumbai)
Consultant oncosurgeon @ SCPMH, Gonda.

2. History
Cancer is NOT a new disease
Hippocrates
Bernardino
Ramazzini
Henry Butlin

3. Burden of thedisease- WORLD
 Cancer isone of theleading causes of morbidityand mortality worldwide,with
approximately14 million new cases in 2020.
 The number of new cases isexpected to riseby about 7 0 % over the
next 2 decades .
 Cancer isthesecond leading causeof death globally,and was responsible for
8.8 million deaths in 2021 .Globally,nearly 1 in 6 deaths is due to cancer.
 Approximately 7 0 % of deaths from canceroccurin low- and middle-
income countries.
 The overall age standardized cancerincidencerateisalmost 2 5 %higher in
men than in women, with ratesof 205 and 165 per100,000, respectively.

4. Burden of thedisease-INDIA
Caner has become one of the ten leading causes of death in India.
It is estimated that there are nearly million cancer cases at any given
point of time. 8-9 lakh new cases and 4 lakh deaths occur annually due to
cancer.
Cancer of oral cavity and lungs in males and cervix and breast in females
account for 50% of all cancer deaths in India.
According to the Global Cancer Observatory (GLOBOCAN) estimates,
there were 19.3 million incident cancer cases worldwide for the year 2020
and India ranked third after China and the United States of America.

5. Burden of the disease-INDIA
The International Agency for Research on Cancer
GLOBOCAN project has predicted that India’s cancer
burden will nearly double in the next 20 years ,
from slightly over a million new cases in 2012 to more
than 1·7 million by 2035.
These projections indicate that the absolute number of
cancer deaths will also rise from about 680 000 to 1·2
million in the same period

6. Estimated age standardized incidence and mortality
rates, (GLOBOCAN)- WORLD
M ales
Females

7. Estimated age standardized incidence and mortality
rates, (GLOBOCAN)- INDIA
M ales
Females

8. Estimated projected incidence and mortality
burden of all cancers in Indian men and women to
2035

9. Burden of cancer deaths in Indians by educational status
in individuals aged 30–69 years7

10. What causes Cancer ?

11. Cancer control
Normal
Epithelium
Invasive Cancer
Carcinoma
In situ
Dysplasia

12. Cancer Control
Primary Prevention
Control of tobacco & alcohol
consumption
Personal hygiene
Immunization
Foods, drugs & cosmetics
Air pollution
Precancerous lesions
Legislation
Cancer education
Secondary Prevention
Cancer registration
Hospital based registries
Radiation Population-based
Occupational exposures registries
Early detection of cases
Treatment
* * * Palliative care
ONE THIRD of all cancers are PREVENTABLE !

13. Cancer screening
“ Search for unrecognized malignancy by means
of rapidly applied tests”
Why is cancer screening possible?
Methods of screening:
Mass screening by comprehensive cancer detection
examination
Mass screening at single sites
Selective screening

14. Examples of Screening
Screening for cancer Cervix
Pap smear
Visual inspection based screening tests such as
visual inspection with 5 per cent acetic acid {VIA}
VIA with magnification {VIAM} and
visual inspection post application of Lugol's iodine (VILI)
Screening for Breast cancer
breast self-examination (BSE) by the patient
palpation by a physician
thermography, and
mammography

15. Government initiatives to fight
Cancer
National Cancer Registry
Program
National programs
NCCP
NPCDCS

16. National Cancer Registry Program
(NCRP)
NCRP was commenced by the Indian Council of Medical
Research (ICMR) with a network of cancer registries across
the country in December 1981.
The main objectives of this Programme were:
1. To generate reliable data on the magnitude and patterns of cancer
2. Undertake epidemiological studies based on results of registry data
3. Help in designing, planning, monitoring and evaluation of cancer
control activities under the National Cancer Control Programme
(NCCP)
4. Develop training programmes in cancer registration and
epidemiology.

17. Population-based cancer
registries (total 29) seek to
collect data on all new cases
of cancer occurring in a well
defined population. Usually,
the population is that which
is resident in a particular
geographical region
Hospital-based cancer
registries (total 09) maintain
data on all patients diagnosed
and/or treated for cancer at a
particular facility. The focus of
the hospital-based cancer
registry is on clinical care and
hospital administration

18. NCCP
1975-76- NCCP was launched with priorities given for equipping the
premier cancer hospitals. Central assistance at the rate of Rs.2.50 lakhs
was given to each institution for purchase of cobalt machines.
1984-85- The strategy was revised and stress was laid on primary
prevention and early detection of cancer cases.
1990-91- District Cancer Control Program was started in selected
districts (near the medical college hospitals).
2000-01- Modified District Cancer Control program initiated.
2004 - Evaluation of NCCP was done by National Institute of Health &
Family Welfare, New Delhi.
2005 - The programme was further revised after evaluation.
RCC – new/strenthening; Oncology wing; Decentralised NGO scheme

19. NPCDCS

20. NPCDCS
Service Package for Cancer
Sub center
Health promotion for behavior change and counseling.
‘Population based/ Opportunistic’ Screening of common NCDs
including cancer.
Awareness generation of early warning signals of common cancer
& other risk factors of NCD (Cancer)
PHC + CHC/RH = Subcentre +
‘Population based/ Opportunistic’ Screening of 3 common
cancers (oral, breast, and cervical by VIA).
Identification of early warning signals of common cancer.
DH= PHC/CHC +
Follow up chemotherapy in cancer cases, Rehabilitation and
physiotherapy services.

21. NPCDCS
Service Package for Cancer
Medical College
Mentoring of District Hospitals, Early diagnosis and
management of Cancer
Training of health personnel, Operational Research.
Tertiary Cancer Centre
Mentoring of District Hospital and outreach activities,
Comprehensive cancer care including prevention, early
detection, diagnosis, treatment, palliative care and
rehabilitation.
Training of health personnel &
Operational Research

22. The distribution of the population (2011) and cancer mortality
(2010) in five zones of India compared with the corresponding
proportions of radiotherapy centres, oncology departments,
and
postgraduate oncology training positions

23. Training facilities and yearly intake for formal
training of oncology staff in India, by
postgraduate course
# Source:MCI
No of MBBS seats:49918/year

24. Burden of the disease-INDIA
The International Agency for Research on Cancer
GLOBOCAN project has predicted that India’s cancer
burden will nearly double in the next 20 years ,
from slightly over a million new cases in 2012 to more
than 1·7 million by 2035.
These projections indicate that the absolute number of
cancer deaths will also rise from about 680 000 to 1·2
million in the same period

25. Are we doing things right???

26. Conclusion
The burden of cancer in India is intimately linked to the
country’s major socioeconomic inequalities in access to
health care and other areas.
Rebalancing of the distribution of power, social goods,
and resources33 will be a crucial determinant of how
India will address its cancer burden in the long term.
Even greater losses of welfare are associated with
longstanding weaknesses in the country’s public health
system and its capacity to deliver preventive services

27. Conclusion contd…
At the root of the solutions to India’s cancer burden is the
need for political commitment and action. Measures such as
a fully committed eff ort to reduce, and, in the long term,
eliminate, use of tobacco products through the vigorous
implementation of the Framework Convention on Tobacco
Control, would in time substantially decrease the incidence
of, and consequently the mortality caused by,

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29. Thank you !!!