Kolkata, Nov 18 (PTI) India is witnessing a significant increase in cancer cases, particularly oral and breast cancers, attributed to lifestyle changes, tobacco consumption, delayed diagnosis, and environmental influences, according to eminent haematologist and Padma Shri awardee Dr. Mammen Chandy. These developments present a major public health challenge for the nation.
Dr. Chandy highlighted that between 1990 and 2021, mortality rates for oral cancer in India rose from 5.32 to 5.92 per 100,000, with the disability-adjusted life-year rate escalating from 152.94 to 163.61. The disability-adjusted life-year (DALY) rate quantifies the overall disease burden in a population per 100,000 people.
Further, the age-standardised prevalence rate (ASPR) climbed from 15.71 to 25.46 during the same period, showing a significant annual increase. This rate allows for the comparison of disease or health rates across populations with varying age structures.
Projections indicate that by 2031, the age-standardised incidence rate (ASIR) for oral cancer is expected to hit 10.15 per 100,000, with the mortality rate (ASPR) anticipated to reach 29.38 per 100,000. Chandy noted that men experience higher rates than women, with the burden differing significantly across states.
Breast cancer cases have also surged dramatically. Dr. Chandy pointed out that globally, breast cancer is now the most prevalent malignancy among women, surpassing lung cancer. In India, the ASIR in females has increased by nearly 40% from 1990 to 2016, with every state documenting an increase.
Factors contributing to the rise include changes in lifestyle, obesity, alcohol intake, delayed childbirth, and improved access to diagnostics. Chandy noted that tobacco, alcohol, and smoking are principal risk factors for oral cancer, while breast cancer is influenced by a combination of genetic, lifestyle, and diagnostic elements.
The Padma Shri awardee welcomed the Union government’s decision to establish cancer care centres across all districts, acknowledging this as a positive move. He remarked, “India currently employs two complementary models: the private sector, where patients are directed to multi-specialty or tertiary hospitals, and the public sector, where individuals are treated at primary health centres and directed to state cancer hospitals. Though public funding is vital, enhancing the quality of care remains imperative.”
Discussing research and genomics, Dr. Chandy highlighted the Bharat Cancer Genome Atlas (BCGA) initiated by IIT-Madras. “This groundbreaking project maps the genetic landscape of cancers in India. While mainly a data-collection initiative currently, it provides researchers the opportunity to examine genetic alterations and formulate targeted therapies,” he said.
He mentioned the promise shown by the experimental drug ‘Dostarlimab-gxly (Jemperli),’ a PD-1 inhibitor that achieved a 100% complete response in a small cohort of colorectal cancer patients with mismatched repair-deficient tumors. “Though significant, this is relevant for only 4-5% of patients. The rest still necessitate conventional treatments like surgery and chemotherapy,” explained Chandy.
On Russia’s announcement of developing a personalised mRNA cancer vaccine, he commented, “The concept is promising theoretically, but no clinical data has been published yet. While mRNA vaccines proved effective against COVID-19, cancer is more complex, and its efficacy needs to be validated.”
The distinguished doctor expressed cautious optimism about precision medicine and modern diagnostics, stating, “Certain cancers such as childhood acute lymphatic leukemia and Hodgkin’s lymphoma can be cured in up to 90% of cases with modern therapy guided by molecular diagnosis. Advanced diagnostics facilitate targeted treatment with reduced side effects, yet a cancer-free future remains improbable.”
India’s increasing cancer burden highlights broader public health challenges, as noted by Chandy. “More than a million new cases surface annually. Breast, cervix, and ovarian cancers are most common among women, whereas lung, oral, and prostate cancers prevail among men. Alarmingly, younger patients in India are affected compared to those in Western countries, with the median age for lung cancer in India at 59, compared to 70 in the US and 75 in the UK,” said Chandy, deemed the father of bone marrow transplant.
Tobacco use, pollution, obesity, poor diet, and sedentary lifestyles significantly contribute to this high incidence rate. “Nearly 40% of cancer cases in India are linked to tobacco, with environmental and lifestyle factors playing contributory roles,” he mentioned.
Despite these significant hurdles, Chandy highlighted reasons for hope and progress. “We now have more cancer centres equipped with advanced diagnostics and treatment facilities, with domestically produced drugs becoming affordable. However, India must prioritize investment in prevention, screening, and research to effectively manage the burden,” he emphasized.
“National screening rates for oral, breast, and cervical cancer are below one percent. Expanding access to early detection is crucial to reducing cancer-related mortality,” Chandy added, underscoring the necessity of coordinated efforts across government, healthcare systems, and society.
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