On 4th Feb 2023, World Cancer Day, the Lancet published an article on steps to “close the cancer care gaps”. In spite of the presence of cancer care and prevention initiatives, there is a gross disparity between the  high and low or middle-income countries in terms of 

Exposure to risk factors,

Availability of public health programmes,

Access to diagnostics and treatments

Cancer deaths and survival rates

The author draws our attention to the following points:

Attention and Investment

Reducing premature mortality from non-communicable diseases (NCDs), including cancer, is a part of the Sustainable Development Goals. Yet NCDs have been neglected by the global health community. This is evident from the fact that Development Assistance for Health is much higher (US$9 billion) for HIV/AIDS than ($1 billion) for NCDs. The reason might have been due to the diversity of cancer and the complexity of cancer care. This demands a change in the mindset of global health and greater attention and investment in NCDs.

Strengthening preventive steps 

40% of cancers are preventable and a third can be cured through early detection and treatment. 

• Robust taxation and regulation to address the modifiable risk factors of cancer —primarily related to tobacco, alcohol, and junk food—is essential.

• Health promotion and education to raise awareness on prevention and early diagnosis.  

• Community-led holistic approaches, Vaccination (like HPV).

National ownership 

While more than 150 countries have national plans for cancer control, an analysis from 2018 shows that their quality varies widely. 

• 10% had no strategy for tobacco control. 

• 40% had no strategy to curb alcohol consumption.

•  33% did not mention HPV vaccination for cancer prevention.

•  Equity is often neglected.

•  Lack of implementation, governance, and accountability details.

  
  

This emphasizes the need for

• Political commitment towards Universal Health Coverage.

• Specialist plan for prevention and treatment services for cancer. 

Cancer care gap in India

In a recent news report as on 30th January 2023, over 707 District NCD Clinics, 193 District Cardiac Care Units, 268 Day Care Centres, and 5541 Community Health Centre NCD Clinics have been set up under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), as part of National Health Mission (NHM). The initiative laid guidelines for screening three common cancers i.e., oral, breast, and cervical among persons more than 30 years of age. Screening of these cancers is an integral part of service delivery under Ayushman Bharat – Health and Wellness Centres. As per the International agency for research in Cancer, the estimated age-standardized rates in India in 2020 for incidence of breast, cervical, and oral cancer are 34.6, 1.7, and 5.5 % respectively. Whereas, according to the National Family Health Survey-5 (NFHS-5) report,

Women between the ages 30-49 years who have,

Ever undergone a screening test for cervical cancer- 1.9%

Ever undergone a breast examination for breast cancer- 0.9%

Ever undergone an oral cavity examination for oral cancer- 0.9%

Men between the ages 30-49 years who have,

Ever undergone an oral cavity examination for oral cancer- 1.2%.

The above findings stress the importance of strengthening the implementation of NPCDCS in all states and UTs and measures needed to be taken to improve cancer screening urgently.

References

1. Lancet T. Global cancer: overcoming the narrative of despondency. The Lancet. 2023 Feb 4;401(10374):319.

2. Subba SH. Too little too late? Or a small step in the right direction?-Cancer screening in India. Indian Journal of Community and Family Medicine. 2021 Jul 1;7(2):71.