National Cancer Control Programme

Global

Cancers in all forms are causing about 12 per cent of deaths throughout the world. In the developed countries cancer is the second leading cause of death accounting for 21% (2.5 million) of all mortality. In the developing countries cancer ranks third as a cause of death and accounts for 9.5% (3.8 million) of all deaths. Tobacco alcohol, infections and hormones contribute towards occurrence of common cancers all over the world.

India

Cancer has become one of the ten leading causes of death in India. It is estimated that there are nearly 1.5-2 million cancer cases at any given point of time. Over 7 lakh new cases of cancer and 3 lakh deaths occur annually due to cancer. Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time. Data from population-based registries under National Cancer Registry Programme indicate that the leading sites of cancer are oral cavity, lungs, oesophagus and stomach amongst men and cervix, breast and oral cavity amongst women. Cancers namely those of oral and lungs in males, and cervix and breast in females account for over 50% of all cancer deaths in India.

WHO has estimated that 91 per cent of oral cancers in South-East Asia are directly attributable to the use of tobacco and this is the leading cause of oral cavity and lung cancer in India.

Cancer usually occurs in the later years of life and with increase in life expectancy to more than 60 years, an estimate shows that the total cancer burden in India for all sites will increase from 7 lakh new cases per year to 14 lakh by 2026.

National Cancer Control Programme was started in 1975-76. Its Goals & Objectives are: -

1. Primary prevention of cancers by health education regarding hazards of tobacco consumption and necessity of genital hygiene for prevention of cervical cancer.

2. Secondary prevention i.e. early detection and diagnosis of cancers, for example, cancer of cervix, breast cancer and of the oro-pharyngeal cancer by screening methods and patients’ education on self examination methods.

3. Strengthening of existing cancer treatment facilities, which were inadequate.

4. Palliative care in terminal stage cancer.







Existing Schemes under National Cancer Control Programme:

Financial Assistance to Voluntary Organisations: This scheme is meant for IEC activities and early detection of cancer. Under the scheme financial assistance upto Rs.5.00 lakh is provided to the registered voluntary organisations recommended by the State government for undertaking health education and early detection activities in cancer. A linkage with the Regional Cancer Centre (or Medical College/Distt. Hospital if there is no RCC) is now mandatory by the NGO concerned.



District cancer Control Scheme: It is known that a large number of cancer cases can be prevented with suitable health education and early case detection. Accordingly the scheme for district projects regarding prevention, health education, early detection and pain relief measures were started in 1990-91. Under this scheme one time financial assistance of Rs.15.00 lakh is provided to the concerned State Government for each district project selected under the scheme with a provision of Rs.10.00 lakh every year for the remaining four years of the project period. The project is linked with a Regional Cancer Centre or an institution having good facilities for treatment of cancer patients. The patients are provided treatment at the concerned Regional Cancer Centre or the nodal institution.



Cobalt Therapy Installation: To strengthen the cancer treatment facilities, the financial assistance of Rs. 1.0 crore for charitable organisations and 1.5 crore for government institutions is provided for procurement of teletherapy and brachytherapy equipments etc. This is one time grant as at present.



Development of Oncology Wings in Govt. Medical College Hospitals: This scheme had been initiated to fill up the geographical gaps in the availability of cancer treatment facilities in the country. Central assistance is provided for purchase of equipments, which include a teletherapy unit beside other equipments. The civil works and manpower are to be provided by the concerned State Government/ Institution. The quantum of central assistance is Rs.2.00 crore per institution under the scheme. The scheme provides one time grant only.



Regional Cancer Centres: There are 19 Regional Cancer Research and Treatment Centres recognised by Government of India and recurring grant of Rs.75 lakhs is being given to these Regional Cancer Centres.









NEW INITIATIVES

There are some activities, which are carried out under the National cancer control programme out of WHO funding under the biennium pattern. In WHO biennium 1998-1999, 16 workshop/training programmes were carried out throughout India. The Pap Smear Kits and Can scan software were supplied to 12 RCC’s. Morphine tablets were also supplied to them. In the WHO biennium 2000-2001 following were carried out: -

Outreach activities by medical colleges for early detection and awareness of cancer.

Training of personnel in early detection and awareness of cancer.

Supply of Morphine

Telemedicine and supply of computer hardware and software.

IEC activities.

Modified District Cancer Control Programme

National Cancer Awareness Day

Training of cytopathologists and cytotechnicians in the quality assurance in Pap Smear technology

Participation in Health Melas and distribution of health education material

Postage stamp depicting a women carrying out ‘self breast examination’ was brought out by Deptt of Posts on National Cancer Awareness Day

Likely telecast of a health magazine ‘Kalyani’ in the current year, with cancer and anti tobacco items under the agreement with Prasar Bharti & MOHFW

Broadcast of health education audio material developed by CNCI, Kolkatta, through FM Radio

Modified District Cancer Control Programme

Modified District Cancer Control Programme has been initiated in four states namely Uttar Pradesh, Bihar, Tamil Nadu & West Bengal. Sixty Blocks have been taken and 1200 ‘NCD workers, 30 supervisor doctors, and consultants have been appointed. This will be a Survey cum health education drive in which about 12 lakh women in the age group 20-65 years are being contacted. Health education about general ailments, cancer prevention and early detection besides ‘Self Breast Examination’ will be imparted. The project will be completed in about a year’s time.



National Cancer Awareness Day

Cancer Awareness day was observed on 7-11-2001. Hon’ble Min. of State, Ministry of Communications Shri Tapan Sikdar at Vigyan Bhawan on the same day, released a commemorative stamp on Cancer and first day cover portraying Madame Curie. A newspaper advertisement on National Cancer Awareness Day was also released in prominent dailies across the country.



LIST OF REGIONAL CANCER CENTRES

1. Kidwai Memorial Institute of Oncology, Bangalore (Karnataka)

2. Gujarat Cancer & Research Institute, Ahmedabad (Gujarat)

3. Cancer Hospital Research Institute, Gwalior (Madhya Pradesh)

4. Cancer Institute, Madras (Tamil Nadu)

5. Regional Cancer Centre, Thiruvananthapuram (Kerala)

6. Regional Centre for Cancer Research and Treatment Society, Cuttack (Orissa)

7. Dr.B.B.Cancer Institute, Guwahati (Assam)

8. Chittaranjan National Cancer Institute, Kolkatta (West Bengal)

9. Institute Rotary Cancer Hospital (AIIMS), New Delhi.

10. Tata Memorial Hospital, Mumbai (Maharashtra)

11. Kamala Nehru Memorial Hospital, Allahabad (U.P.)

12. MNJ Institute of Oncology, Hyderabad (Andhra Pradesh)

13. R.S.T.Cancer Hospital, Nagpur (Maharashtra)

14. Indira Gandhi Institute of Medical Sciences, Patna (Bihar)

15. Acharya Harihar Tulsi Das Regional Cancer Centre, Bikaner, Rajasthan

16. Indira Gandhi Medical College, Shimla (Himachal Pradesh)

17. Post Graduate Institute of Medical Sciences, Rohtak (Haryana)

18. Pt. J.N.M. Medical College and Hospital, Raipur, Chattisgarh

19. JIPMER, Pondicherry





FACTS AND FIGURES FOR CANCER

(NATIONAL CANCER REGISTRY PROGRAMME 1981-2001)



97.8 (BANGALORE) TO 121.9 (DELHI) CANCER CASES PER 1,00,000 POPULATION – URBAN MALES (AGE ADJUSTED INCIDENCE RATE)

92.2 (BHOPAL) TO 135.3 (DELHI) CANCER CASES PER 1,00,000 POPULATION – URBAN FEMALES (AGE ADJUSTED INCIDENCE RATE)

46.2 (BARSHI) CANCER CASES PER 1,00,000 POPULATION – RURAL MALES (AGE ADJUSTED INCIDENCE RATE)

57.7 (BARSHI) CANCER CASES PER 1,00,000 POPULATION – RURAL FEMALES (AGE ADJUSTED INCIDENCE RATE)

ONE IN ABOUT 15 MEN AND ONE IN ABOUT 12 WOMEN IN THE URBAN AREAS COULD DEVELOP CANCER IN THEIR LIFETIME

CERVICAL CANCER AND BREAST CANCER ARE COMMONEST IN FEMALES. THE LATTER IS MORE THAN FORMER IN MUMBAI AND DELHI

CANCER LUNG IS COMMONEST OUT OF ALL TOBACCO RELATED CANCERS IN MEN

AGE ADJUSTED INCIDENCE RATE OF OESOPHAGEAL CANCER IN WOMEN OF BANGALORE IS ONE OF THE HIGHEST (8.3 PER 1,00,000) IN THE WORLD.

CANCER OF TONGUE IN MALES AT BHOPAL (8.8 PER 1,00,000) IS HIGHEST IN ALL CONTINENTS

CANCER OFSTOMACH IS ONE OF THE MAIN CANCER IN MALES IN SOUTHERN REGISTRIES.

GALL BLADDER IN DELHI WOMEN IS ONE OF THE HIGHEST (8.9 PER 1,00,000) IN THE WORLD.

75-80% PATIENTS ARE IN ADVANCE STAGE OF THE DISEASE AT THE TIME FIRST ATTENDENCE.

NEW CANCER PATIENTS IN INDIA ARE ESTIMATED BETWEEN 7-9 LAKHS



Frequently asked questions about cancer



What is cancer?

Cancer is an abnormal growth of a cell or an organ due to a specific stimulus (carcinogen). This growth is an uncoordinated, purposeless one, which continues to grow even after the cessation or withdrawal of the stimulus.



What are the types of Cancer?

Cancer can originate from any organ or part of the body. The natural behaviour of a particular cancer depends upon the site of involvement and the histopathological type of the cancer. Some of the cancers are very mild and can be controlled very easily while some are very aggressive and results of treatment are very poor.



How does cancer spread?

As Cancer grows it invades the surrounding structures and interferes with the local function. It spreads to the draining lymph nodes through the lymphatic. Through the blood streams it spreads to the others parts of the body. The common organs of distant metastasis are lung, liver, bones, brain etc.



What are the causes of Cancer

Exact cause of cancer is not yet known. However, there are certain risk factors, which may cause this disease in individual prone to develop Cancer. Among the common factors, chemicals are one of the important causes. These chemicals may be in the form of Tobacco or chemicals present in food, air, water, etc. These chemicals are known as carcinogens. Till now about 60 agents have been identified.

Some Common Risk factors for Cancer.

Tobacco
Smoking: Cigarette, Bidi, Cigar, Hukka, others
Smokeless: Zarda, Gutka, Khaini, Snuff, etc.
Alcohol
Infections (viruses, parasites, bacteria)
Electromagnetic radiation (ionising radiation, ultraviolet rays, others)
Diet (dietary carcinogens)
Occupational exposure to carcinogens
Pollution (air/water/food)
Reproductive hormones


Is Cancer a preventable Disease?

In majority of Indian patients, cancer can definitely be prevented. About 50% cancer are Tobacco related e.g. Lung Cancer, Oral Cancer (Cancer of Mouth), Laryngeal Cancer (Voice box), Oesophageal Cancer (Food pipe), etc. and they can be prevented to a large extent by avoiding intake of Tobacco. Certain other Cancers like bowel Cancers can also be prevented by Dietary habits.



What are the signs and symptoms of Cancer?

The signs and symptoms of cancer depend upon the body part affected by the disease. The primary tumour or the spread of tumour to lymph nodes or distant parts of the body may cause symptoms. In general, cancer has a tendency to start as a nodule or mass of tissue, which keeps on growing. The growth rate of cancers is variable with some cancers growing very rapidly and others growing slowly. With further growth, cancers, which affect external or internal body surfaces, can form wounds or ulcers leading to dirty discharge, bleeding etc. Common symptoms of cancer can be described as follows.

Lump or swelling:

A sore that doesn’t heal:

Recent change in a wart/mole:

Unusual bleeding or discharge:

Changes in bladder or bowel habits:

Nagging cough or hoarseness:

Difficulty in swallowing or dyspepsia:



Is Cancer Curable?

Yes, Cancer if curable if detected early. The results of treatment in stage I and stage II (early stage Cancer) are about 80%. In late stage diseases (Stage III & Stage IV) the results are very poor. (Less than 20%). In India, about 70% patients present in advanced stage diseases and hence difficult to treat.



How is cancer treated?

Basically, there are three main modalities of Cancer treatment - Surgery, Radiotherapy and Chemotherapy (Drugs). The treatment of cancer is described as a multimodality approach as a large number of patients need to be treated with a combination of the approaches available. Thus, some patients may need only one modality of treatment, some need a combination of two modalities and some need to be treated with all three modalities to achieve the best results. To decide the best treatment for a given patient, initial testing is done to make the diagnosis (diagnostic investigations) and decide the stage of disease (staging investigations). After the initial treatment plan, the treatment is started. The progress of treatment and response of disease is assessed from time to time. A review of the progress is made in subsequent tumour board meetings to decide whether any change in the treatment plan is required or not. Once the planned treatment is completed, cancer patients need regular follow-up.