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EPIDEMIOLOGY & ETIOLOGY OF CANCER IN INDIA

INTRODUCTION
1.
Recent times have seen an increase in the incidence of cancer. This is mainly
attributed to urbanization, industrialization, lifestyle changes, population growth and
increased life span (in turn leading to an increase in the elderly population). In India,
the life expectancy at birth has steadily risen from 45 years in 1971 to 62 years in
1991, indicating a shift in the demographic profile. It is estimated that life expectancy
of the Indian population will increase to 70 years by 2021–25. This has caused a
paradigm shift in the disease pattern from communicable diseases to noncommunicable diseases like cancer, diabetes and hypertension.
2.
The epidemiology of cancer is the study of the factors affecting cancer, as a
way to infer possible trends and causes. The study of cancer epidemiology uses
epidemiological methods to find the cause of cancer and to identify and develop
improved treatments.
3.
This area of study must contend with problems of lead time bias and length
time bias. Lead time bias is the concept that early diagnosis may artificially inflate the
survival statistics of a cancer, without really improving the natural history of the
disease. Length bias is the concept that slower growing, more indolent tumors are
more likely to be diagnosed by screening tests, but improvements in diagnosing
more cases of indolent cancer may not translate into better patient outcomes after
the implementation of screening programs. A similar epidemiological concern is
overdiagnosis, the tendency of screening tests to diagnose diseases that may not
actually impact the patient's longevity. This problem especially applies to prostate
cancer and PSA screening.
4.
Some cancer researchers have argued that negative cancer clinical trials lack
sufficient statistical power to discover a benefit to treatment. This may be due to
fewer patients enrolled in the study than originally planned.
5.
Etiology is the study of causes or
origins of a disease or a matter of study.
It can also be classified as the branch of
medicine that deals with the causes or origins
of disease.
6.
Assignment of a cause, an origin,
or a reason for something. The cause or origin
of a disease or disorder as determined by
medical diagnosis.

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UNDERSTANDING CANCER
Defining Cancer & What Causes Cancer
7.
Cancer begins when cells in a part of the body start to grow out of control.
There are many kinds of cancer, but they all start because of out-of-control growth of
abnormal cells. Today, millions of people are living with cancer or have had cancer.
8.
All forms of cancer spread with the help of the
tissue-dissolving mechanism. This illustration shows
an example of the development of liver cancer. The
liver is the body’s central metabolic organ, and it is
responsible for neutralizing and removing toxins from
the body. The toxins entering the body from the diet,
such as pesticides and preservatives, are the most
common cause of liver cancer. Also, all
pharmaceutical drugs have to be detoxified in the
liver. Liver cells that are exposed to these poisonous
substances can either be destroyed or permanently
damaged. This damage often involves an error in the
genetic program of the cells (cell’s software), similar
to what we have seen in virus infections. This
damage can trigger two processes that facilitate the
development of cancer:
9.
Uncontrolled Cell Multiplication. The
software of a cancer cell is reprogrammed in such a
way that it causes constant reproduction and
multiplication of the cell. This uncontrolled cellular
multiplication is the first precondition for cancer to
develop.
10.
Mass Production of Collagen-Digesting
Enzymes. The second precondition is the production
of enzymes that destroy the surrounding connective
tissue that would otherwise keep the cancer cells
confined. Research has established that the more
enzymes a cancer cell produces, the more
aggressively the cancer develops. The faster the
cancer can spread through a body, the shorter the life
expectancy of the patient if the mechanism is not
stopped.
11.
Oldest Descriptions of Cancer.
Human beings and other animals
have had cancer throughout recorded history. So it’s no surprise that from the dawn
of history people have written about cancer. Some of the earliest evidence of cancer
is found among fossilized bone tumors, human mummies in ancient Egypt, and
ancient manuscripts. Growths suggestive of the bone cancer called osteosarcoma
have been seen in mummies. Bony skull destruction as seen in cancer of the head
and neck has been found, too. Our oldest description of cancer (although the word

most likely applied to the disease because the finger-like spreading projections from a cancer called to mind the shape of a crab. these words refer to a crab. The Roman physician. cancer begins to form. damage to the genes involved in cell division. It is called the Edwin Smith Papyrus and is a copy of part of an ancient Egyptian textbook on trauma surgery. Celsus (28-50 BC). “There is no treatment. Normal cells in the body follow an orderly path of growth. Galen (130-200 AD). and death. Unlike regular cells. Four key types of gene are responsible for the cell division process: oncogenes tell cells when to divide. later translated the Greek term into cancer. Cells can experience uncontrolled growth if there are damages or mutations to DNA. the Latin word for crab. 14. tumor suppressor genes tell cells when not to divide. and DNA-repair genes instruct a cell to repair damaged DNA. who is considered the “Father of Medicine. Origin of the Word Cancer. division. The writing says about the disease.” Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors. and when this process breaks down. another Roman physician. CAUSES & CURE What causes cancer? 13. This leads to a mass of abnormal cells that grows out of control. Although the crab analogy of Hippocrates and Celsus is still used to describe malignant tumors. Genes .” 12. suicide genes control apoptosis and tell the cell to kill itself if something goes wrong. Cancer is ultimately the result of cells that uncontrollably grow and do not die. In Greek. and therefore.the DNA type. . Galen’s term is now used as a part of the name for cancer specialists — oncologists. It describes 8 cases of tumors or ulcers of the breast that were treated by cauterization with a tool called the fire drill. used the word oncos (Greek for swelling) to describe tumors.3 cancer was not used) was discovered in Egypt and dates back to about 3000 BC. cancer cells do not experience programmatic death and instead continue to grow and divide. Programmed cell death is called apoptosis. The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 BC).

Tobacco. Genes . such as chewing tobacco. Theses free radicals damage cells and affect their ability to function normally. arsenic. Many of the 1. kidney and cervix. These harmful rays of the sun cause premature aging and damage the skin. uranium. such as AIDS. By wearing protective clothing and sunscreens and by avoiding prolonged exposure to the sun. are linked to cancers of the mouth. Long term exposure to chemicals such as pesticides. The use of other tobacco products. tongue and . Such carcinogens may act alone or in combination with another carcinogen. to increase the risk of cancer and other lung diseases. colon and rectum. Tobacco. larynx. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life. radiation such as gamma and x-rays. nickel. leading to uncontrollable cell growth. When our bodies are exposed to carcinogens. 18. Environmental Risk Factors. UV radiation from the sun are directly linked to melanoma and other forms of skin cancer. 17. which causes infectious mononucleosis. Immune system diseases. the sun. radon and benzene can increase the risk of cancer. Cancer can be the result of a genetic predisposition that is inherited from family members. have been associated with increased cancer risk. (a) Radiation. human papillomaviruses(HPV). Carcinogens. Carcinogens are a class of substances that are directly responsible for damaging DNA. Ultraviolet (UV) Radiation. thyroid. 20. liver. and the Epstein Barr virus. Similarly. cancer is a result of mutations that inhibit oncogene and tumor suppressor gene function. and compounds in car exhaust fumes are all examples of carcinogens. Cancer occurs when a cell's gene mutations make the cell unable to correct DNA damage and unable to commit suicide. asbestos. bladder. one may reduce the risk of skin cancer. promoting or aiding cancer. Chemicals. can make one more susceptible to some cancers. prostate. Artificial sources of UV radiation. Some viruses. Viruses. lung.the Family Type. 16. oesophagus. such as sun lamps and tanning booths. stomach and other organs. including hepatitis B and C. Smoking may also increase the likelihood of developing cancers of the stomach. free radicals are formed that try to steal electrons from other molecules in the body. pancreas. such as cigarette smoke.4 15. Cigarette smoking and regular exposure to tobacco smoke greatly increase lung cancer. asbestos. 22. as well as cancers of the breast. 19. High levels of radiation like those from radiation therapies and x-rays (repeated exposure) can damage normal cells and increase the risk of developing leukemia. 21. also increase the risk of skin cancer. Cigarette smokers are more likely to develop several other types of cancer like those of the mouth.3 million skin cancers diagnosed in the year 2000 could have been prevented by protection from the sun`s rays.

The risk of cancer decreases soon after a smoker quits. As we age. throat. Some studies suggest that even moderate drinking may slightly increase the risk of breast cancer. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. vitamins. Several viruses have also been linked to cancer such as: human papillomavirus (a cause of cervical cancer). Some oral cancers present white patches inside the mouth or white spots on the tongue. Scientific evidence suggests that up to one-third of the cancer deaths expected to occur in future are related to nutrition and other lifestyle factors.a lump on the breast or testicle can be an indicator of cancer in those locations. where it has spread. 25. and how big the tumor is.and anything else that suppresses or weakens the immune system . Cancer symptoms are quite varied and depend on where the cancer is located. colon and ovary. hepatitis B and C (causes of liver cancer). human T-cell leukemia/lymphoma virus-I (HTLV-I). High-fat. Diet. and Epstein-Barr virus (a cause of some childhood cancers). hepatitis B virus (HBV). high cholesterol diets are proven risk factors for several types of cancer such as those of the colon.5 throat. minerals and low fat items may help to reduce cancer risk. and others-that can be prevented through behavioral changes. 24. Healthy food choices and a well balanced diet including fiber. Heavy drinkers face an increased risk of cancers of the mouth. . while precancerous conditions often diminish after a person stops using smokeless tobacco. uterus and prostate. Human immunodeficiency virus (HIV) . Certain cancers are related to viral infections-for example. Obesity may be linked to breast cancer among older women as well as to cancers of the prostate. This makes age an important risk factor for cancer. What are the symptoms of cancer? 26. uterus. Other Medical Factors.inhibits the body's ability to fight infections and increases the chance of developing cancer. larynx and liver. pancreas. esophagus. human immunodeficiency virus (HIV). Alcohol. human papillomavirus (HPV). Some cancers can be felt or seen through the skin . there is an increase in the number of possible cancer-causing mutations in our DNA. All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely. Many cancers that are related to dietary factors could be prevented. 23.

If cancer spreads to the brain. the pituitary gland. Other cancers have symptoms that are less physically apparent. and colon cancer. 31. (d) Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream. However. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. additional symptoms can present themselves in the newly affected area. 28. the adrenal gland. and unexplained weight loss. Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma. Bladder or prostate cancers cause changes in bladder function such as more frequent or infrequent urination. and changes in stool size. or metastasizes. (c) Lymphomas are cancers that begin in the lymph nodes and immune system tissues. For example. these symptoms are common in several other maladies as well. connective tissue. excessive sweating. Swollen or enlarged lymph nodes are common and likely to be present early. (b) Sarcomas are characterized by cells that are located in bone. and break easily. cartilage. diarrhea.6 27. anemia. and other supportive tissues. headaches. There are five broad groups that are used to classify cancer. As cancer cells use the body's energy and interfere with normal hormone function. fatigue. Spreading to the lungs may cause coughing and shortness of breath. the liver may become enlarged and cause jaundice and bones can become painful. it is possible to present symptoms such as fever. brittle. In addition. How is cancer classified? 30. (e) Adenomas are cancers that arise in the thyroid. Symptoms of metastasis ultimately depend on the location to which the cancer has spread. -carcinoma. When cancer spreads. or seizures. coughing and hoarseness can point to lung or throat cancer as well as several other conditions. Common prefixes include: . (a) Carcinomas are characterized by cells that cover internal and external parts of the body such as lung. patients may experience vertigo. and other glandular tissues. For example. breast. fat. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. muscle. or just -oma. colon cancers lead to symptoms such as constipation. 29.

and imaging techniques are all used together to diagnose cancer.= red blood cell. and additional personal characteristics. How is cancer diagnosed and staged? 32.= muscle. There is no single treatment for cancer. Physicians will analyze your body's sugars.= eye. (n) Retino. Surgery. age.= cartilage. the stage of the cancer (how much it has spread).= gland. it is possible to completely cure a patient by surgically removing the cancer from the body. (c) Erythro.= liver. PET scans. fats. which is a procedure that uses a thin tube with a camera and light at one end. (f) Lipo.= pigment cell. (g) Lympho. to look for abnormalities inside the body. or gene therapy. Doctors may also conduct an endoscopy. Imaging techniques such as X-rays.= white blood cell. This procedure is called a biopsy. CT scans. biopsies. (e) Hepato. proteins.= brain. (m) Uro. immunotherapy. Physicians use information from symptoms and several other procedures to diagnose cancer.7 (a) Adeno. Surgery is the oldest known treatment for cancer.= blood vessels. chemotherapy. Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. (k) Myo. (h) Melano. Cancer treatment depends on the type of cancer. health status. Other types of molecular diagnostic tests are frequently employed as well.= bone. 35. cancerous prostate cells release a higher level of a chemical called PSA (prostatespecific antigen) into the bloodstream that can be detected by a blood test. Treatments usually fall into one of the following categories: surgery. radiation.= bone marrow. If a cancer has not metastasized. and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. How is cancer treated? 34. (b) Chondro. and DNA at the molecular level. (l) Osteo. MRI scans. 33. hormone therapy. (o) Neuro. Molecular diagnostics. Early detection of cancer can greatly improve the odds of successful treatment and survival. (d) Hemangio. and patients often receive a combination of therapies and palliative care.= fat. For example. This is often seen in the removal of the prostate or a . (j) Myelo.= bladder.

but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. however. to cause inflammation that causes a tumor to shrink. 36. 37. destroys cancer by focusing high-energy rays on the cancer cells. it is nearly impossible to remove all of the cancer cells. Radiation treatment. 37. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma). Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options. These therapies are relatively young. there are still common side effects such as hair loss. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA.damaging proteins or DNA . healthy tissue. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression. researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor's immune cells will often attack the tumor or cancer cells that are present in the host. Gene therapy. some leukemia and lymphoma cases can be treated with the hormone cortisone. nausea. However. For example. Chemotherapy. most notably breast and prostate cancer.8 breast or testicle. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal. Immunotherapy. These treatments target any rapidly dividing cells (not necessarily just cancer cells).so that cancer cells will commit suicide. and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell . also known as radiotherapy. Radiation. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy utilizes chemicals that interfere with the cell division process . In addition. 38. Hormone therapy. for example. but technologies have improved so that beams can be more accurately targeted. and vomiting. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. 39. Several cancers have been linked to some types of hormones. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. and it is also used in combination with other cancer treatments. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. Immunotherapy can also be considered nonspecific if it improves cancer-fighting abilities by stimulating the entire immune system. Local immunotherapy injects a treatment into an affected area. Immunotherapy aims to get the body's immune system to fight the tumor. After the disease has spread. fatigue.

The initial diagnosis of cancer is perceived by many patients as a grave event. Distribution of Various types Cancers across the Subcontinent 43. The myth that cancer affects people mostly in the developed countries is being broken by the fact that. a major economical burden. of the 10 million new cancer cases seen each year worldwide. which has lead to a poor survival and high mortality rate. nearly 5. Cancer is a group of diseases with similar characteristics. oral and pharyngeal cancers are more prevalent. More than 70% of the cases report for diagnostic and treatment services in the advanced stages of the disease. Cancer prevalence in India is estimated to be around 2. Burden caused by Cancer:India 40. Different cancers occur in different states of our country  Esophageal cancers: Southern states of India like Karnataka and Tamil Nadu and also in Maharashtra and Gujarat. with more than one-third of them suffering from anxiety and depression. followed by those of stomach and esophagus.000 deaths occurring each year due to this disease. 44. esophagus.50.  Oral cancers: Kerala (South India)  Pharyngeal cancers: Mumbai (Western India)  Thyroid cancers among women: Kerala .  Stomach cancers: Southern India with the highest incidence in Chennai. 41.5 million are in the less developed countries. Among men:. It could greatly affect both the family’s daily functioning and economic situation. This disease is associated with a lot of fear and despair in the country. Its diagnosis causes immense emotional trauma and its treatment. The economic shock often includes both the loss of income and the increase of expenses because of the treatment and health care. 42.The impact of cancer is far greater than mere numbers.000 new cases and 5. In women:.00. with over 8. which can occur in all living cells in the body and different cancer types have different natural history.cancers of cervix and breast are most common. 45.lung. Cancer is equally distressing for the family as well. Gene therapy is a very young field and has not yet resulted in any successful treatments. Cancer is the second most common cause of death in the developed world and a similar trend has emerged in the developing countries too.5 million.9 commits suicide. stomach. especially in a developing country like India.

The greatest increase among females was for cancer of the breast and among males for cancer of the prostate. 80-90% of all cancers are due to environmental factors of which. alcohol consumption. Trends in Incidence of Cancer in India: 46. The cancer risk of tobacco use has been extensively investigated. pancreas and bladder.000 persons in India died due . These estimates are based on occurrence of cancer of mouth. dietary habits and behavioral factors. This offers the prospect for initiating primary and secondary prevention measures for control and prevention of cancers. oesophagus. The principle impact of tobacco smoking is seen in higher incidence of cancers of the lung.10  Gall bladder cancer: Northern India. Information on mortality rates associated with tobacco use in India is available from the cohort studies which have been carried out in the country. PREVENTION & CURE Major Preventable Risk Factors For Cancers In India 47. Further there will be an overall increase by 220% of cancer deaths simply related to tobacco use by the year 2025. Tobacco consumption. There was an increasing trend for lymphoma. Dietary practices. Cancer of the colon was increasing in females and that of the kidney in males. Tobacco-related cancers account for nearly 50% of all cancers among men and 25% of all cancers among women. Tobacco. It has been estimated that in 1996. Cervical cancer showed a decreasing trend. India is the third largest producer and consumer of tobacco. bladder and pancreas. reproductive and sexual practices account for 20-30% of cancers. particularly in Delhi and West Bengal. Between 25 and 30% of all cancers in developed countries are tobaccorelated. lifestyle related factors are the most important and preventable.33 million cases annually. The burden of tobacco-related cancers in India by 2001 has been estimated to be nearly 0. either by way of chewing or smoking accounts for 50% of all cancers in men. The country has a long history of tobacco use in a variety of ways of chewing and smoking. larynx. 184 million persons used tobacco in the country in one or other. larynx. Studies have shown that appropriate changes in lifestyle will reduce the mortality and morbidity caused to cancer. urinary bladder. Applying the median risks of tobacco as obtained from the above cohort studies and the prevalence of tobacco habit as obtained from the first national sample survey showed that about 800. pharynx. There are predictions of incidence of 7-fold increase in tobacco-related cancer morbidity between 1995 and 2025. lung. The major risk factors for cancer are tobacco. According to epidemiological studies. infections. Esophageal and stomach cancers were decreasing in both sexes. Tobacco consumption remains the most important avoidable cancer risk. oesophagus. gall bladder and brain tumors in both sexes. 48. Bidi smoking is associated with cancer of oropharynx as well as. The habits of chewing (15–70%) and smoking (23–77%) vary considerably from area to. A trend analysis of the data on cancer incidence for the period 1964–96 has demonstrated that the overall occurrence of cancer is increasing with among females.

49. which positively suggest role of diet in human cancers. Doll and Peto have shown the percentage of cancers directly attributable to diet to be approximately 35%. According to WHO estimates. bladder. and selenium) offer protection against cancer. is one of the major risk factors for cancer and assumes a very important aspect in all primary prevention of cancer control measures.g. the annual cigarette consumption per adult in developing countries is on the rise. and oesophagus. Smokeless tobacco users also have a higher risk of mortality. Global results from several case-control and cohort studies indicate that excessive alcohol consumption is responsible for the incidence of primary liver cancer. especially those of breast. cigarette smokers have 70% greater mortality than non-smokers do. Mounting scientific evidences from epidemiological. Several studies have shown an association between alcohol consumption and an increased risk of cancers of colon. evidence indicates that sexually transmitted virus is associated with a variety of other malignancies such as oesophageal carcinoma. Other virus–cancer relationships are between Epstein–Barr virus and nasopharyngeal cancer. larynx. tobacco consumption. There is strong evidence that majority of cervical neoplasia is caused by certain sub types of human papillomavirus (HPV). WHO has estimated the excess premature mortality attributable to tobacco use amounting to 4 million deaths per year. Diet and Cancer. penile cancer and oral cancer. a sexually transmitted infection. E and A. pharynx. Alcohol. anal cancer. stomach and cervical cancers. larynx. oesophagus. which is widespread. HIV and Kaposi’s sarcoma and some forms of lymphoma. mainly oral cavity. A synergistic effect with cigarette smoking has been suggested.11 to their tobacco habit in 1996. 51. The WHO has estimated that 91% of oral cancer in this part is directly attributable to tobacco usage. In India.g. rectum and breast. oral. Even for coronary artery disease. experimental. increasing attention has been paid to various foods and their nutrients as modifiers of cancer risk. pancreas. Epidemiological studies carried out in India and abroad have shown that increased alcohol consumption is causally associated with cancers at various sites. Helicobacter pylori and stomach cancer. Dietary and nutritional profile in India In India. Persons eating diets high in various micronutrients have been shown to have a lower incidence of certain cancers. Studies carried out in India have also confirmed the role of HPV and cervical cancer. Besides cervical cancer. The nutrition scenario Cancer Prevention Strategies . colon and uterus40. These studies indicate an increased intake of fat and red meat associated with a higher risk of colorectal cancer and probably prostate cancer. High consumption of fruits and vegetables is associated with reduced risk of several cancers including lung. high fat intake) can increase the risk of cancer and that others (e. clinical/metabolic and intervention studies in the past two decades provide valuable information. chronic active infection and hepatitis B virus and primary liver cancer. Infections. In recent decades. vitamins C. high dietary fibre. Both laboratory and epidemiological studies support the hypothesis that some dietary components (e. the National Nutrition Monitoring Bureau (NNMB) has been conducting diet and nutrition surveys from 10 states of India since 1972. Heavy alcohol drinkers are frequently heavy smokers as well. 50.

importance of observation of personal hygiene and healthy lifestyle.The project has been implemented in the states of Bihar. This was later revised in 1984–85 stressing on primary prevention and early detection of cancers. The DCCP scheme has been further reoriented on a pilot basis as Modified District Cancer Control Programme. a demonstration project named district cancer control programme (DCCP) was initiated in selected districts of the country for early detection of cervical. pain control and palliative care network throughout the country National Cancer Control Programme (from 1975)INDIA 57. oral and breast cancers at the door steps of rural community. early cancer detection centres in different medical colleges and postpartum smear testing units in medical colleges in the country have been established. and sexual and reproductive health. Twenty/ten rural blocks from each of the above states have beenselected. . Tamil Nadu. Uttar Pradesh and West Bengal under thesupervision of the state regional Cancer Centres. medical college hospitals having infrastructure for treatment of cancer and the appropriate institutions that supervise and monitor the programme in collaboration with the concerned state governments. A National Cancer Control Board was constituted at the Centre to operationalize the programme. 1. During the period 1990–91. The Government of India launched the National Cancer Control Programme (NCCP) in 1975–76 to tackle the increasing incidence of cancers in the country. Primary prevention of tobacco related cancer 2. Establishment of equitable. Secondary prevention aims at early diagnosis of cancers of uterine cervix. The primary prevention focused on health education regarding hazards of tobacco consumption. etc. Several states have formulated SCCB.Similar boards were suggested at the state levels called as State Cancer Control Board (SCCB) for the proper co-ordination of activities. For each block. health education. 20 female non-communicable workers have been appointed to advice women about healthy lifestyles.12 56. India is one of the first few developing countries where a nation-wide cancer control programs were launched. genital hygiene. ill effects of tobacco consumption.training of medical and para-medical personnel. Early detection of the cancers of easily accessible sites 3. The project has five components. ill effects of tobacco and to detect the early symptoms of cancers.palliative treatment and pain relief and co-ordination and monitoring. Government of India took its first initiative in 1971. The district projects are linked with Regional Cancer Centres (RCC). early detection. The programme created awareness amongst people regarding early symptoms of cancer. For the purpose of detecting cancer of cervix at an early stage. breast and oro-pharyngeal cancers by screening methods. The National Cancer Control Program for India was formulated in 1984 with four major goals. viz. Augmentation of treatment facilities 4.

(d) Development of District Cancer Control Programme by providing the grantin-aid of Rs. (d) Onconet-India: 25 RCCs are linked with each other and also each RCC is in turn be linked to 5 peripheral centres. (b) National Strategic Task Force National Cancer Control Programme for the Eleventh Five. 5. tobacco cessation. Medical cyclotron. 3. .13 NCCP was revised in December 2004. 90. Though cancer per se does not feature in the United Nations 'Millennium Development Goal' health agenda.Year Plan. would also be available during the Eleventh Five Year Plan period. (c) Training: increase the capacity of the health staff at all levels of health care. which is under construction. Under the 11th 5year plan 59.00 lakh spread over a period of 5 years. cytology and palliative care.00 crore. (b) Strengthening of existing RCCs by providing a one-time grant of Rs. Training manuals have been developed in cancer control. for clinical application in treatment of cancer.The primary focus of the same is on correcting the geographic imbalance in the availability of cancer care facilities across the country. 3. Navi Mumbai. Research and Education in Cancer. almost 70% of the world's 20 million cancers patients will be in the developing nations Approximate budget allocation under the 5 schemes of the Revised Programme: (a) Recognition of new Regional Cancer Centres (RCCs) by providing a onetime grant of Rs.00 crore to the Government institutions (Medical Colleges as well as government hospitals). The scope of the programme and the quantum of assistance under the various schemes have been increased in the revision. (f) Inter-agency projects: new insights in cancer biology— identification of novel targets and development of target based molecular medicine. (e) A proton therapy unit would be assembled and installed in the Advanced Centre for Treatment. 58 Highlights of the same are (a) 25 Regional Cancer centres : comprising 217 institutions possessing radiotherapy installations (2004). (c) Development of Oncology Wing by providing enhanced grant of Rs. WHO predicts that by the year 2020.00 crore ( existing 25).

Appropriate legislative measures need to be taken up for prohibiting sale of tobacco to youngsters. higher taxation on bidis similar to that on cigarettes needs to be adopted. cigarette smoking is glamorized in various ways. The impact of this advice could be in the control of cancers of upper respiratory tract. The tobacco control could be achieved by government (including through legislation) and societal actions. . Tobacco-related cancers such as oral. warning on smokeless tobacco products. In addition to the above. Results of an eight-year primary prevention follow-up study of oral cancer among Indian villagers have shown that through extensive and persuasive health education programme. Primary Prevention. Heavy consumers of alcohol should be advised to moderate their consumption and to stop smoking. .14 (e) Decentralised NGO Scheme by providing a grant of Rs. Though there is a ban on advertisement of cigarettes. this is likely to have the greatest impact on reducing cancer incidence and cancer mortality compared with any other strategy currently known. The main strategy for control of tobacco related cancers would be through primary prevention. it is possible to control/reduce the tobacco habits in the community. advertisements. and the Bureau Against Smoking Prevention and several other international organizations interested in tobacco control. more strategies are needed for control of tobacco related cancers. Extensive persuasive health education needs to be directed to control/reduce the tobacco habit. Top priority should be given to control of tobacco. (ii) Practice of tobacco control and. to help in protection of the nonusers of tobacco – ‘passive smokers’ and for stopping advertisements on tobacco. the WHO. price increase and legislative measures form the main features of primary prevention of tobacco-related cancers. The school curricula should involve messages for a healthy lifestyle and warn about the harmful effects of tobacco and alcohol. 60. ban on sale of tobacco products to minors. (a) There are several core strategies for a comprehensive tobacco-control programme that have the support of the International Agency for Research on Cancer (IARC). Based on the recommendations for Indian situation. prohibition for smoking in public places. Public education on tobacco and its health hazards. (iii) Advocacy for tobacco control. Existing rules and regulations concerning smoking in public places of entertainment and public transport need to be rigidly enforced. 8000 per camp to the NGOs for IEC activities. The data from the National Cancer Registry Programme showed that one third of the cancers occurring in Indian population are related to tobacco usage and thus are preventable. the strategies which have been suggested are: (i) Education of public. appropriate health warning labels on cigarette and bidi packets and on all tobacco products. pharyngeal and lung are mainly amenable to primary prevention programmes. It has also been suggested that in terms of tobacco control policies. Teen-aged students need to be targeted as most of them pick up habits at this time.

primary prevention measures assume more importance for prevention of uterine cervical cancer. It is only recently that primary prevention of human breast cancer has been discussed as a practical possibility. In India. thus avoiding both under and over-nutrition. Public education and awareness about the beneficial effects of consuming plenty of fresh vegetables and fruits with species such as turmeric in adequate amounts to prevent cancer are required. other vegetables/ fruits and spices providing nutrients. due to absence of any organized mass-screening programme. pickled. attention to personal hygiene of both males and females and use of obstructive methods of contraception could help towards primary prevention of ICC. Prevention of exposure to high-risk Human Papilloma Virus (HPV) types by prophylactic vaccination may prove to be most efficient and feasible option for the prevention of pre-cancerous and cancerous lesions of cervix. The development of invasive cervical cancer (ICC) has been strongly linked with early onset of sexual activity and multiple sexual partners. (e) Animal foods (meat and fat) except fish should be curtailed. preferably fresh. (d) Plant foods such as cereals.15 (b) Nutrition education is important for increasing the public awareness. adopting safe sexual practices. roots and tubers. (a) It is essential to maintain appropriate weight for height. Introduction of vaccination against hepatitis B virus into vaccination programme of infants would help in the control of liver cancer. Raising the age at marriage beyond 18 years. should be preferable items in the diet. Dietary Guidelines. need to be increased to avoid deficiency and protection against environmental insults. pulses. as well as fibre and protective phytochemicals. observing small family size. (c) Intake of protective foods such as vegetables and fruits. (h) Continuing increased incidence of breast cancer has added urgency to investigations of prevention. (b) Physical activity needs to be promoted to avoid obesity and accumulation of fat. The recommended dietary guidelines need to be propagated. increasing intake of fibre. Epidemiological data strongly implicate sexually transmitted agents in the aetiology of invasive cervical cancer. The . Dietary intervention for cancer prevention in terms of lowering dietary fat content. promoting good health and for control of cancers. It is necessary to avoid salted. green leafy and yellow vegetables. (f) Mouldy and damaged foods should be totally eliminated from the diet. 61. besides avoiding risk factors such as smoking and alcoholism and exposure to geno toxicants. fruits and vegetables is needed to control cancer and other diseases. (g) Prospects for the primary prevention of cervical cancer are good as it is related to certain defined risk factors involving lifestyles and behaviour modifications. smoked and charred food substances. There is a need to popularize the following dietary guidelines for prevention of cancer.

62. Cancer registration was done in two parts: (a) Hospital based registration & (b) Population based registration 63.Chennai.16 following are some of the possible associated actions to prevent invasive breast cancer: (i) Avoidance of breast irradiation particularly in young women. The findings from various research studies support the possibility of reducing . Alternative strategies such as naked eye visual inspection of cervix (down staging). Though cytological examination has been the mainstay for early detection of cervical cancer. Mizoram(exc Aizwal distt). (iv) Delay in onset of menarche by avoiding over nutrition and by increased physical activity in adolescence.Aizwal Dibrugarh.Mumbai. (vii) Prophylactic mastectomy in women with history of breast cancer in first degree relatives. manpower and other facilities. early detection of cases and Treatment was focused upon. Screening (a) Cervical Cancer Screening. Population Based Cancer Registry of India: National Cancer Registry Programme : commenced in 1981.Now 23 PBCRs as follows are actively involved under the NCRP:Ahmedabad.Three Hospital based cancer registeries (HBCRs) and three Population Based Cancer Registry (PBCRs) commenced data collection in 1982 the ICMR commenced PBCRs in four of the eight North Eastern states in 2003.Imphal. (iii) To have early first full term pregnancy. its widespread use is not possible in our country due to paucity of resources. magnified VIA (VIAM). Mizoram.Barshi(rural). visual inspection with logo’s iodine (VIAL).Bangalore.Sikkim and Silchar Primary budget allocation in NCCP 64. cervicography and HPV DNA testing in detecting cervical cancer and its precursors have to be adopted.Bhopal. Secondary Prevention. (ii) Avoidance of cigarette smoking.Kolkata. (vi) Avoiding obesity especially in postmenopausal women. particularly in adolescence. active or passive. visual inspection with acetic acid (VIA). and from January 2009 in three additional states of the North East.Delhi. Under the secondary prevention of NCCP Cancer Registration. (v) Prolonging the duration of lactation.Kamrup dst.

(c) Breast Cancer Screening. (b) Oral Cancer Screening. Under the district cancer control programme the para-medical staff of the primary health centre have been trained to conduct oral examination for early detection and for providing health education. under district cancer control programme project. Oral cancer satisfies the criteria for screening and oral visual inspection is a suitable test for oral cancer screening. which would involve minimal funds. Training of existing human resources and health education could be undertaken towards this objective. Breast self-examination could be another effort towards picking up early lesions. in selected districts medical and paramedical staff of the district hospital and anganwadi workers have been trained on the visual examination of the cervix. CONCLUSION . Several studies carried out have indicated that it is possible to train para medical staff to perform the oral cancer-screening test as accurately as doctors. It is also noted that most of the breast cancer cases in developing countries occur in women below the age of 50 years while the mammography has been found to be effective in postmenopausal women. collection of Pap smears and referring the suspected cases to the district hospital for further evaluation. (i) In India. However. The use of fine needle aspiration cytology would cut down the cost and disadvantage of unnecessary biopsies. it is critical that knowledge about these strategies should be disseminated to the public for improving awareness about the prevention and control measures. In our country. The model proposed for the control of breast cancer in the country relies mainly on physical examination of the breast by trained female health workers in a primary health care set up and referring the palpable lesions to district hospital/medical colleges/RCT and TC for further evaluation. As research advances. leading to proven intervention strategies. followed by basic treatment.17 mortality by earlier clinical detection. modified district cancer control programme need to be extended to more states and peripheral areas of the country. This offers a hope for countries with limited resources. mammography is unlikely to be a cost effective approach to early detection of breast cancer.

"National Institute for Occupational Safety and Health.. Cancer Incidence in five continents. Retrieved 200710-13. Retrieved 2005-01-29. oral and breast cancers could have a significant effect on reducing mortality from cancer. 9. D. Journalist's Resource. In Basic Information for Cancer Registry Documentation (ed. Raymond. Non-communicable diseases including cancer are emerging as important public health problems in India. S. 2. Ferlay. 11. and Young. 3.). 4.. posted October 20. 2003.. Mathew. attention to personal and genital hygiene needs to be imported for increasing public awareness. Retrieved 2007-10-13. Retrieved Nov. The World Health Report.S. WHO. United States National Institute for Occupational Safety and Health.. a project of the U.org. 1997. 14 June 2007. L. 2009. Prophylactic vaccinations against HPV infection and hepatitis B virus are useful strategies for the prevention of cancerous lesions of cervix and in the control of liver cancer. India. Regional Cancer Centre. 12. A. 1996. Lyon. World Health Organization. MHF and W. Govt. National Cancer Control Programme. dietary habits. India. New Delhi. National Cancer Institute. BBC News online. safe sexual practices. 1997.18 49. World Health Organization. "Negative Impact of HIPAA on Population-Based Cancer Registry Research: Update of a Brief Survey" (PDF). 11.Occupational Cancer". Geneva. . J. Cancer Registry Abstract. Cancer Registry Project 2001. Extensive persuasive health education is needed to be directed to control/reduce the tobacco habit. screening for uterine cervix. "WHO calls for prevention of cancer through healthy workplaces" (Press release). Trivandrum. M. 2007-04-27. "WHO Disease and injury country estimates". Newslett. Whelan. J. Natl. END NOTES : REFERENCES 1. 2011 7. Further.. "Cancer Facts and Figures 2012". Cancer: Number one killer (9 November 2000). A. 5. inadequate physical activity. 8. Mathew. 2009. 6. Cancer registration with emphasis on Indian Scenario. alcohol consumption and infections due to viruses. Nutrition education. L. India: DGHS. The major risk factors for these diseases are tobacco. SEER Stat Fact Sheets: All Sites by Surveillance Epidemiology and End Results. of 10. The greatest impact to reduce the burden of cancer comes from primary prevention. Parkin. IARC Scientific Publications. IOM Presentation.

1998. 30. S.. N. A. 29. U. and Luthra. Sehgal. Cancer. ICMR. Juneja. Trends and predictions of cancer incidence cases.. A. Prabhakar. K. Population based Cancer Registry Report 1991–95. Yeole. . K. New Delhi. 2000. B. Indian J. Trivandrum. Cancer projection by the turn of century... A consolidated study of population based registries data. A. 1999. B. Murthy. 31. cancer statistics 1990–96.19 13. Regional Cancer Centre.. National Cancer Registry Programme.

20 Masters of Social Work(Sem III) B-01: Health care social work practice Assignment : Cancer:Epeidemology Submitted Submitted by Dr. Pragya Maj (retd) Suman Dhaka to Sharma .