‘Longer you live, higher the chances of dying of big cancer’

‘Longer you live, higher the chances of dying of big cancer’

MUMBAI: India's cancerburden will almost double to 20 lakh cases in the next 20 years and mainly due to demographic changes, says a new study. The country registered 11.6 lakh new cancer cases in 2018, according to GLOBOCAN, the World Health Organisation's cancer-mapping programme.

The impending doubling can be attributed to the ongoing "transitions" in India- from an infectious diseases hub to the capital of several non-communicable diseases and shift from rural to urban areas. This is the gist of the study published on Saturday in Journal of Global Oncology by Dr Mohandas K Mallath, who was formerly with Tata Memorial Hospital and is now with Tata Cancer Centre in Kolkata.

"Most of the increase in patients with cancer in India is attributable to its epidemiologic transition and the improvement and increased use of cancer diagnostics in India," he said.

Approximately 40% to 50% of cancers are due to random mutations during DNA replications and the longer a person lives, the higher the chances of accumulation of the random mutations. "If you don't die at a young age due to infection or trauma, then the chances of dying at an older age from non-communicable diseases, including cancer, will increase," said Dr Mallath.

Dr Rajendra Badwe, director of Tata Memorial Centre in Parel, concurred, giving three reasons for the "absolute increase in cancer numbers in the country"-population increase, increase in life expectancy and, most important, economic transition. "In the past two decades, life expectancy has increased by 10 years," said Dr Badwe. Considering that the incidence of cancer in the 54-64 age group is almost twice that in the 34-44 age group, this is a major contributor.

Moreover, cancer incidence shows a massive difference in urban-rural terms. "The cancer rate in urban areas is 90-110 per lakh while it is 60-75 in semi-urban areas and between 40 and 50 among the rural population," said Dr Badwe.

Every census shows that 10% of rural areas transition to semi-urban areas and another 5% of semi-urban areas to urban areas, leading to an increase in cancer rates.

Dr Mallath wrote the article tracing the origins of cancer detection and epidemiology because of the questions he is regularly asked. "Is there a cancer epidemic in India? Why did I get cancer when I don't smoke, drink or eat non-vegetarian food? These are two questions I am asked at my clinic in Kolkata and elsewhere for over a decade," said Dr Mallath.

The study also underlines the need to pay more attention to cancer. "Public cancer facilities in India are woefully inadequate, and there is large presence of private cancer care facilities. Some have exploited this situation by selling vulnerable patients unproven therapies to prevent, cure or control cancer. As a result of the great increase in cancer, all public cancer treatment facilities are overcrowded and teeming with patients, resulting in India's cancer problem being called an epidemic or a tsunami," said the authors.

The total cancer burden is projected to double by 2040 to around 20 lakh cases. "If cancer diagnosis catches up in rural India due to Ayushman Bharat and all elderly and invalid patients are subjected to CT scans and FNACs (fine needle aspiration cytology), many more cancers will be diagnosed and the burden will increase further," said Dr Mallath.
CT and PET centres are mushrooming in India in geometric proportions and most cancers will be caught before death. Screening will also catch several indolent cancers.

Dr Badwe sees a silver lining though. "If urban India has a cancer incidence of 90 per 1,00,000, it stands at 350 per 1,00,000 in the West. We are a third of all cancer rates in US cities and 70% of our cancers are preventable. If we tackle the tobacco habit as well as lack of hygiene, India will be the place to live in," he said.