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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 71-73

Too little too late? Or a small step in the right direction? - Cancer screening in India


Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Web Publication24-Dec-2021

Correspondence Address:
Prof. Sonu H Subba
Department of Community and Family Medicine, Third floor, Academic Block, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcfm.ijcfm_99_21

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How to cite this article:
Subba SH. Too little too late? Or a small step in the right direction? - Cancer screening in India. Indian J Community Fam Med 2021;7:71-3

How to cite this URL:
Subba SH. Too little too late? Or a small step in the right direction? - Cancer screening in India. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jan 23];7:71-3. Available from: https://www.ijcfm.org/text.asp?2021/7/2/71/333670



For the first time in India, National Family Health Survey-5 (NFHS-5) report has a new section on cancer. The data are on the percentage of the population aged 30–49 years who have ever undergone screening for cancer.[1] It focuses on three cancers: cervical, breast, and oral cancer for women and oral cancer for men. The screening coverage for these cancers is presented separately for urban, rural, and total populations for 23 states/union territories (UTs). It is a positive change, considering the trend of cancer in India. In 2020, more than 13 lakh new cases occurred, and more than 8.5 lakh people died due to cancer.[2] There has been a steady rise in the incidence and mortality due to cancer in India in the past decade.[3] The changing demographics, epidemiological transition, acculturation, and alteration of lifestyles have all contributed to the rise in noncommunicable diseases, including cancers in India. This warrants a robust program to decrease the cancer burden in the country.

However, NFHS-5 data on the cancer screening situation in India looks grim. The highest percentage of the eligible population covered by screening for any cancer was 10.1%, with one-tenth of eligible women in Andaman and Nicobar Islands screened for oral cancer. The state with the highest percentage coverage for cervical and breast cancer screening was Mizoram, with 6.9% and 2.7% women screened, respectively, for these cancers. For oral cancer, the highest was 6.3% in Andaman and Nicobar Islands. At the other end of the spectrum was no man screened for oral cancer in Lakshadweep and Ladakh, and only 1% of women screened for breast cancer in Gujarat and Sikkim. Cervical cancer screening was 4.7% in Andhra Pradesh and 4% in Kerala in the second and third place. The second-highest coverage for breast cancer was 2.6% in Andaman and Nicobar Islands, followed by 2.4% in Kerala. After Andaman and Nicobar Islands, the next highest coverage for oral cancer screening among women was in Andhra Pradesh at 7.3%, followed by 2.5% in Telangana. For oral cancer screening among men, Sikkim was second with 4%, followed by Andaman and Nicobar Islands at 3.8%. Cervical and breast cancer screening were higher in urban areas than rural in all the states/UTs, except in Andhra Pradesh, Andaman and Nicobar Islands, Telangana, Sikkim, and Jammu and Kashmir. Cervical and breast cancer screening were also higher in rural areas of West Bengal and Ladakh, respectively. Similarly, oral cancer screening was higher among urban women in all the states, except in Andaman and Nicobar Islands, Jammu and Kashmir, and Ladakh. However, oral cancer screening among men was higher in rural areas in a greater number of states, namely Andaman and Nicobar Islands, Gujarat, West Bengal, Maharashtra, and Karnataka, though, in some of them, the difference was narrow [Figure 1].
Figure 1: The urban–rural difference in screening for different cancers

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The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases, and Stroke (NPCDCS) has cancer screening as essential component. It lays down guidelines for screening eligible men and women for different cancers.[4],[5] Yet, the NFHS-5 data reveal that NPCDCS has not taken off in any state. With a maximum coverage of 10% for oral cancer screening among women in any state, the situation is grossly deficient. There is an asynchrony between what is required and what is happening on the ground. NPCDCS strategies notwithstanding, there are several paradoxes to the cancer screening besides the performance not matching the need. Oral cancer is the most common cancer among men and more common among men than women, i.e., 16.2% versus 4.6%;[2] however, the highest percentage of women and men screened for oral cancer in the best state was 10% and 6.3%, respectively. Even in most other states, oral cancer screening was just marginally better among men, which believes that men are more at risk of tobacco-related cancers. Tobacco smoking and chewing are more common among men in India, hence the higher risk, but their screening for oral cancer does not reflect the epidemiology.[6] Another paradox is the abysmally low level of breast cancer screening when it is the most common cancer in either sex and among women.[2] The best state had screened only 2.7% of the eligible women for breast cancer, and two states had zero screening. Cervical cancer screening is one of the earliest known methods with proven benefits, yet its coverage was no better than other cancers. Almost all cancers were screened more often in the urban areas, including cervical cancer, which should have been more in the rural areas.

The NFHS-5 data should be a wake-up call for the policymakers in the country that all is not well and that measures need to be taken urgently to improve cancer screening. Implementation of NPCDCS must be strengthened in all the states/UTs. Strategic planning is required to implement cancer screening after taking into consideration the epidemiology and resources. Situational analysis needs to be undertaken to find the reason for inadequate implementation and nonutilization of cancer screening services. However, it is not merely the policymakers who need to take it as a wake-up call, but all stakeholders should own responsibility and contribute their part. It has been observed that even the medical community of doctors and nurses in India does neither undergo cancer screening nor advise their family members.[7] Their knowledge and attitude have been found wanting, which hamper the service utilization by the rest of the population. The medical curriculum should place adequate emphasis on cancer screening and prevention. The department of community medicine in all the medical colleges should conduct a preventive oncology clinic in coordination with the departments of obstetrics and gynecology, surgery, pathology, radiodiagnosis, and dentistry. They should do the primary screening and refer the positive cases to respective departments for management. The peripheral centers attached to the department of community medicine should also conduct preventive oncology clinics. In remote areas, mobile screening vans can also be utilized. Along with information, education, and communication activities that should help improve awareness, every medical professional can propagate the message. Along with these, the cancer survivors who benefitted from screening can champion the cause of cancer screening, which might be more effective for those who are less inclined to accept it. These should work to increase the demand for cancer screening services. NFHS-5 data reveal that too little is being done after so many years, yet it can also be taken as a step in the right direction; at least, now, we have started acknowledging the component. Any disease control is a multipronged effort, and all stakeholders should fulfill their role. There is a need for the government and the community to join hands and act to improve cancer screening. Should this succeed, NFHS-6 may have much better statistics that should have translated into a better detection rate, management, and survival for the patients.



 
  References Top

1.
Ministry of Health and Family Welfare. KEY INDICATORS National Family Health Survey (NHFS-5) 2019-20. 2021.  Back to cited text no. 1
    
2.
World Health Organization International Agency for Research on Cancer (IARC). GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2020. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. [Last accessed on 2021 Dec 01].  Back to cited text no. 2
    
3.
World health statistics 2020: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2020.  Back to cited text no. 3
    
4.
Banerjee B. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). DK Taneja's Health Policies and Programmes in India. Jaypee Brothers Medical Publishers; 2017. p. 429.  Back to cited text no. 4
    
5.
National Health Mission. Prevention, Screening and Control of Common Non-Communicable Diseases: Hypertension, Diabetes and Common Cancers (Oral, Breast, Cervix). Gov India; 2016. p. 7-14. Available from: https://main.mohfw.gov.in/Major-Programmes/non-communicable-diseases-injury-trauma/Non-Communicable-Disease-II/National-Programme-for-Prevention-and-Control-of-Cancer-Diabetes-Cardiovascular-diseases-and-Stroke-NPCDCS. [Last accessed on 2021 Dec 01].  Back to cited text no. 5
    
6.
Drope J, Schluger N, Cahn Z, Drope J, Hamill S, Islami F, Liber A, Nargis N, Stoklosa M. 2018. The Tobacco Atlas. Atlanta: American Cancer Society and Vital Strategies. Society AC; 2016. p. 1-2.  Back to cited text no. 6
    
7.
Goyal A, Vaishnav G, Shrivastava A, Verma R, Modi A. Knowledge, attitude and practices about cervical cancer and screening among nursing staff in a teaching hospital. Int J Med Sci Public Health 2013;2:249.  Back to cited text no. 7
    


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