Ageing populations, lifestyle factors, urbanisation, industrialised lifestyles (Pollution), habits such as smoking, alcohol consumption and adulterated food chain ‘excessive use of pesticides / fungicides’ are adding to the growth of cancer.
According to the World Health Organisation (WHO), cancer, an imminent “Human Disaster” would go up by 57 per cent globally, in the next 20 years. What would be necessary is a renewed focus on prevention mechanisms. The World Cancer Report, released by WHO on world cancer day, estimates that cancer cases would rise from an approximate 14 million annually in 2012 to 22 million in the next twenty years. During these years, cancer deaths on the other hand, would rise from 8.2 million a year to 13million. While the developing nations will be disproportionality hit, even rich countries will struggle to deal with the spiralling costs of treatment.
It is a disaster scenario which requires more commitment to prevention and early detection in order to complement improved treatments and address the alarming rise in cancer burden globally.1 Global economic cost of the disease as estimated in 2010was at US$1.16trillion.While it is hurting the economies of rich countries, it is beyond the means of the poorer economies. More than 60 per cent of the world’s cases and about 70 per cent of the world’s cancer deaths occurred in Africa, Asia and Central & South America2. “In the developing world, we are really at the beginning of understanding how serious the cancer problem is in these countries” said Curran, Emory School of Medicine. Cancers related to the HIV epidemics in developing countries and spread of hepatitis C are also on the rise, but so too is the general age of the population in developing nations.3 You will agree – today you hold potential to live long enough to see your grandchildren something that was not true even a decade ago in many developing economies – your risk of having cancer is going to go up.
Incidence 2012 (1.0million) Death (0.7million)
Projected 2035 (1.7million) Death (1.2 million) Source: WHO
The GLOBOCAN project of IARC, which tabulates cancer statistics globally estimated that 14 million new cases were recorded in the world in 2012. A total of 8 million people died of cancer in 2012 out of which 700,000 were in India. So India has 17 per cent of the world’s population and about 8 per cent of its cancer patients. These figures are deceptive, as accuracy of numbers is not correct firstly followed by reporting of the disease by the patients. On the other hand India has a lower life expectancy and an overwhelming proportion of young people.4 The cost of cancer to Indian society is much greater than in developed countries and the same is going to rise quickly over the decade. Cancer knocks off 2 per cent of the world GDP and no one knows what this number would be in India.5 Newer methods of diagnosis and cures require high investments. As technology advances, the cost of diagnosis and monitoring will keep going up. The newer drugs are expensive cancer patients are living longer, which means longer duration of treatment. All this is bad news in a country where most medical expenses are out of pocket6. There is poor government medical (Health Care) infrastructure and its percentage presence in rural India is practically very low. In men the leading cancers are lung and oral cancer whereas cervical cancer is the second biggest killer – this can be cured if detected earlier but awareness is missing in majority of the population. It is being expressed among communities that every 10th house in India is having a cancer case which was never heard of earlier – imagine the number in future!
Non-Awareness of the disease, high cost to set-up cancer care centres, mental stigma of high medicine cost, Lack of Specialized Oncologists are barriers which have to be overcome. Global players such as GE and Philips are developing low cost imaging equipments for the domestic (Indian) market but cohesive efforts from both government and private sector are required for positioning the same. A common issue which is very realistic is that 60 to 70 per cent of cancer patients do not respond well to the first line of chemotherapy. Although is because the genetic composition of each tumour makes it a bit resistant to a few drugs, the oncologist is unable to detect this without trial and error methods.
A major role by the government, health care bodies, pharmaceutical associations and pharmaceutical companies will have to be played. Rural programmes will have to propagate awareness and early detection of this epidemic. The reason why emphasis is being laid on rural land is because it comprises 65 per cent of the Indian population. The increasing incidence of cancer in India has got the attention of drug makers as well (Innovators & Generic Players). The generic Indian companies like; NatcoPharma, Sun Pharma, Shilpa Medicare and BDR Pharma are laying all emphasis to support both trade and government.
The fate of Indian anti-cancer drugs will depend on Indian government policy, on whether it grants compulsory licenses or not. Public awareness and mass education by the media (Television, Radio & Telecom Channels), investment strategies of private healthcare companies with specialised cancer hospitals in rural areas, generic medicines distribution across healthcare centres and free detection camps. We have a long way to go – but I am optimistic cohesive focus should yield positive dividends.
