Prevention & Early Diagnosis
of Common Cancers.
Indian Perspective &
Project Initiative
Dr. H.L. Kapoor
I dedicate this presentation to 24
precious lives of Engineering
students from Hyderabad whom
be lost in a “Flash” in river Beas
in Mandi Distt. on 8th June-2014
Simple precautions could have
prevented this massive tragedy
Noncommunicable diseases:
Heart disease 30.2%
Cancer 15.7%
Diabetes 1.9%
Other chronic diseases 15.7%
Infectious diseases:
HIV/AIDS 4.9%
Tuberculosis 2.4%
Malaria 1.5%
Other Infectious Diseases
20.9%
Injuries 9.3%
Total: 58.2M
(WHO, Chronic Disease Report, 2005)
Cancer Situation in India
Incidence
• 11 lakh per year
Prevalence
• 28 lakh at any point of time
Mortality
• 5 lakh every year
(Source: ICMR Data for the year 2012)
Cancer Registry Data- Urban Vs Rural
RURAL
U
R
B
A
N
6
Natural history of cancer and
levels of prevention
D2 Disability
D3 Death
Pre-clinical phase Clinical phase
Exposure Onset of disease Early
detection
Onset of symptoms and/or signs
D1 Cure
A B C
Primary prevention
Secondary prevention
Tertiary prevention
DiseaseDisease
OutcomesOutcomes
• Heart disease
• Stroke
• Diabetes
• Cancer
• Chronic resp.
disease
Physiological RFPhysiological RF
• BMI (obesity)
• Blood pressure
• Blood glucose
• Cholesterol
Behavioral RFBehavioral RF
• Tobacco
• Alcohol
• Physical
inactivity
• Diet
The causal chain
Primary prevention
(Health Promotion)
Secondary prevention
(Case management &
Health promotion
Tertiary prevention
(Tertiary care)
Risk factors and level of NCD prevention Risk factors and level of NCD prevention
and managementand management
Causes of cancer
• Tobacco
• Alcohol
• Genetic factors
• Viruses
• Parasites
• Radiations
• Pollution
• Dietary factors
• Obesity
• Customs habits and
lifestyles
• Occupational
exposures
• Reproductive factors
• Hormones
• Pesticides
• Infectious agents
• Eletromagnetic fields
Tobacco
• India 3rd largest producer of tobacco
• 2nd largest consumer of tobacco in the world
(57% men and 10.8% women)
• GYTS 2009 (13-15 yrs): 14.6% use tobacco
• Large percentage of youth are vulnerable to
tobacco use.
• Various forms of tobacco smoking and
smokeless tobacco products in use.
Main provisions of the Tobacco Act
• Prohibition of smoking in public places
• Prohibition of advertisement, sponsorship and promotion of tobacco products.
• Prohibition of sale of tobacco products to minors.
• Prohibition of sale of tobacco products within 100 yards of educational institutions.
•
• Display of pictorial health warning on tobacco products packs.
•
• Regulation of tar and nicotine contents of tobacco products.
Evolution of National Cancer Control Program
(NCCP)
1975 NCCP Launched
1984-85 Revised
1990-91 District Cancer Control Programme
started
2000-01 Modified District Cancer Control
programme
2005 Revised NCCP initiated
2010 NCCP integrated with NPCDCS
Achievements / status
• 27 RCCs recognized since inception
• 50 Medical Colleges assisted since inception
• 7 TCCs funded in 11th plan 2010-12
• 5 TCCs funded in 2012-13
Postal Stamp on Self Brest Examination
National Cancer Awareness Day 7th Nov. 2001
Screening of Cancer
S.
No.
Site Level Method
1 Cervical District VIA
2 Breast CHC BSE
CBE
3 Oral CHC Self visual
inspection &
Oral exam 16
Tertiary cancer
care centres
Comprehensive cancer
care/Policy/Research/
Registry/Training/
Telemedicine
District Hospital-
Early Detection/Cytology
Minimal surgery/Chemo/Pall Care/Telemedicine
CHC
Early detection , CBE, Examination of Oral cavity/Pain relief,
Community Awareness
Cancer Care Activities at different Health care Facilities
Referral Chain of Cancer Patients
Tertiary Cancer Centre (Medical College/Regional Cancer Centre) Population: 60,00,000 ( cater to 4 District) Estimated Case Load: 2000 (70% of 2800)
800 (30% of 2800) to Private sector
District Hospital Population: 15,00,000
Estimated Case Load: 1000 cases (100 cases x 10 CHCs)
300 treated (30% of 1000) 700 (70% referred above)
CHC Population: 1,00,000 Case Load: 100 cases
(5cases x 20 SCs) All cases referred above
Sub Centre Population: 5000
Case Load: 5 cases
:
RrRrrrrrr
Regional Cancer Centers & Oncology Wings in India
Radiotherapy Machines in India
4056
87
130
185
245
270250
227
0 6 1131
50
75
120
180
254
0 2 615
2535
75
125
227
0
50
100
150
200
250
300
1975 1980 1985 1990 1995 2000 2005 2010 2013
Cobalt Linac Remote Brachytherapy
Source: AERB
Justification for TCCC scheme • An indicator of the cancer treatment facilities in any country is
the number of radio-therapy machines vis-à-vis the population.
• The international norm is one machine per one million
population.
• India currently has 500 machines against the estimated
requirement of nearly 1240 machines.
• According to the International Atomic Energy Agency, India
has less than one machine per million population as compared
to USA which has more than 5 machines per million
population.
• Out of total of 341 Radiotherapy centres in the country only
109 are in the Govt Sector
• We need to improve access, availability and affordability for
cancer diagnosis & treatment
National Tobacco Control Programme
11th Plan Achievements 12th Plan Expectations
• Programme implemented in 21
states covering 42 districts.
• Global Adult Tobacco Survey
(GATS} conducted.
• Pilot project on alternate crops to
tobacco initiated.
• National Guidelines on Tobacco
Dependence Treatment developed.
Training modules for doctors,
teachers and health workers on
tobacco control developed.
• Guidelines on implementation of
COTPA and implementation
guidelines on NTCP developed.
• National anti tobacco mass media
campaign launched.
• Toll free helpline to report violations
of anti tobacco act established.
• To build up capacity of states and
districts for tobacco control.
• To train health & social workers & other
stakeholders.
• To set up regulatory mechanism to
monitor effective implementation of
tobacco control laws.
• To establish 1 apex & 4 regional
Tobacco testing labs
• To set up national quitline
• To cover all the states and districts in a
phased manner under the programme.
• To establish 340 Tobacco Cessation
Clinics in Distt. Hospitals.
• To strengthen national tobacco control
cell.
• To conduct Adult Tobacco Survey/Youth
Survey for surveillance.
• To create mechanism for effective
implementation of WHO FCTC.
23
School Program
State & District Tobacco
Control Cell
Monitoring tobacco
control laws &
reporting
Training of
Stakeholders
Raise awareness
through IEC
District Tobacco
Cessation Centre
National Tobacco Control Program
Target Population Mandi Distt.
Males 2,23,943
Females 2,25,346
Modular Training for 6 days was imparted to
about 140 Medical Officers in the year 2008-09
All female health workers of Distt. Mandi have
been trained for collecting PAP Smears. Quality
of Smears were reported satisfactory for
interpretation at Indira Gandhi Medical College
Shimla
LUNG - Anti smoking campaigns
CERVIX - PAP Smears. HPV Vaccination?
ORAL & OROPHARYNX - Anti smoking
campaigns and Oral Hygiene
BREAST - Awareness/BSE/BRCA-1 BRCA-2
Prophylactic Mastectomy? AJ Syndrome
STOMACH - Anti smoking campaigns and H
Pylori Eradication and Alcohol cessation.
LIVER - Alcohol cessation HPB vaccination
MIRROR
TORCH/LIGHT SOURCE
TONGUE DEPRESSOR/WOODEN SPATULA
SPECULUM
GLASS SLIDES
PERSONAL HYGIENE
NO TOBACCO
PHYSICAL ACTIVITY
DIET
OBSERVE & DEVOTE 10 MINUTES TO
YOUR SELF EVERY MONTH
ACCESSIBILITY
AFFORDABILITY
ACCOUNTABILITY
CREDIBILITY
EDUCATION
SELF EXAMINATION
In our country the major burden of
cancer is due to preventable cancers
which are on the rise.
Preventive strategies can go a long
way in containing the trend.
Strengthening of centers for early
diagnosis and early treatment are key
issues for cancer control in India .