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 .