Are We Losing The Fight Against Cancer?

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The cancer survival rate in India, is among the lowest in the world, according to a study by an international team of doctors who tracked cancer patients from 67 countries, including India, between 1995 and 2009. The findings published recently in the medical journal Lancet show that for most types of cancer, survival rates in India are either stagnating, or inching up very slowly, despite India having some of the better treatment facilities.

Cancer is thought to be the great leveler; whether you are an Indian or a Korean or Icelander, cancer promises to be equally deadly, but a massive study of 26 million cancer patients over 15 years has shown that survival rates in the 10 most prevalent types of cancer vary hugely across countries. 

The number of people that survive for five years after being diagnosed with digestive system cancers seems to be particularly low in India compared to more advanced countries. Survival rates are just 19% for stomach cancer compared to 25-30% in most countries, with 58% surviving in South Korea. In India, survival rate for colon cancer is 37% while it is 50-59% in most countries and goes up to 65% in the US. Only 4% of liver cancer patients survive for five years in India compared to 10 to 20% elsewhere. Survival rates have dipped in the case of rectal cancer in India.

Even in breast and prostate cancers, where medical advances have ensured that over 80% patients survive in advanced countries, only about 60% of Indian patients survive. Ovarian cancer survival rates have declined in India from 23% in 1995-99 to 14% in 2005-09. Cervical cancer survival rates are 46% compared to the global figure of 50%, but there is a slight decline in India from 47% in 2005.

The lead authors of the study- Michael Coleman, a professor at the London School of Hygiene and Tropical Medicine, told TOI that one reason for the low survival rates in India could be that equitable access to early diagnosis and optimal treatment is not yet available for all people in India.

“Some of the most advanced medical facilities in the world can be found in Mumbai (for example), but they are out of reach of the vast majority of the Indian population,” he said. “The inequality in India may be extreme, but inequalities in access to cancer diagnosis and treatment exist in very many countries, including the USA and the UK, even if the disparities may be more severe in India than in some more developed countries,” he added.

According to A Nandakumar, director of the National Cancer Registry Programme at Bangalore who was associated with the study, another reason for India’s low survival rates is that patients do not (or cannot) fully comply with the treatment decided by the doctors and follow-up also tends to be patchy.

“Accessibility, affordability, lack of awareness about the nature of the disease and the need for periodic checkups and several other socioeconomic factors could contribute (to the low survival rates in India),” Nandakumar said.

Coleman said out of the 27 population based cancer registries in India only four actually participated in the study. These represent a population of about 59 lakh, which is about 0.5% of India’s 2009 population. However, this is not a small sample population and it does represent the trajectory of cancer incidence and survival accurately in these regions.

The study raises a pertinent question- Is India losing the fight against cancer? Coleman says that India’s politicians should ponder if enough is being done for India’s growing number of cancer patients. He also stresses the importance of cancer registries because only then can a valid picture of the disease emerge. Besides he warns, without population-based cancer registries that have political support, which are operationally stable and are adequately financed and staffed to publish good data on a regular basis, “any politician trying to make rational cancer policy is simply flying blind.” 

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