Covid-19 may have grabbed everyone’s attention, but Cancer remains the biggest killer in India. Despite its prevalence in cities, towns and villages, public awareness is patchy and infrastructural barriers hamper effective treatment of the disease.
Praveen K Singh
New Delhi: Nearly 900,000 people die of Cancer in India each year. International health watchdog World Health Organisation (WHO) says 1.5 million Indians would die from the disease by year 2022. Worse, the number is expected to rise exponentially, with cancer cases rising five-fold by year 2025.
Despite the high mortality rate, the country’s healthcare infrastructure is ill-equipped to provide holistic treatment for the disease in the various stages of prevention, early detection, treatment and palliative care. Experts are hopeful that the situation will improve as advanced treatments for Cancer are available in India, much like the developed countries.
Cancer and Social stigma
There are several socio-cultural barriers that affect healthcare in India. These include cultural taboos, social stigma, economic and gender inequality, health as a low priority, fatalistic approaches to cancer diagnosis and blind faith in traditional methods of healing. Although these factors are more prevalent in rural India, they persist in urban areas too. Social taboos often prevent individuals from routine health check ups. This delays the early diagnosis of the disease with the result that by the time a trained doctor examines a patient, the disease has already deteriorated to advanced stages.
Patients often go to extreme lengths to hide a diagnosis of cancer from friends and family at the cost of compromising treatment and favourable outcomes. Even after the diagnosis and confirmation of cancer, patients want to maintain normal life routines, which negatively affects the recommended care in the form of slip ups in medical follow-ups. This leads to worse consequences.
Gender inequality is a dominant social bias in India wherein women’s well being is not accorded as much importance as that of the men. The deeply patriarchal structure of Indian society where men enjoy power and influence in the family and in community, leads to women’s health issues being ignored until they have reached a critical stage. Women and elderly people’s health are a lesser priority than that of active men and young family members. Findings from observational studies suggest that women with breast cancer in India are frequently diagnosed with the disease in its advanced stage.
Illiteracy, reliance on male family members for visiting a doctor, abstaining from regular health check-ups in the absence of symptoms, fear of gynecological examination, even if it is done by a female health worker, and the fear of the instrumentation procedure are the key factors responsible for poor health condition of women in the country.
There are sseveral myths about cancer that hinder its timely diagnosis and treatment. One popular myth is that cancer is caused due to evil eye or as a punishment for a past misdeed. This leads to a resigned acceptance of disease without seeking its treatment. Cancer patients may also fear the opinion of others and hide their symptoms, thereby, delaying diagnosis. Many falsely believe that Cancer is an infectious disease they can be spread from contact with a Cancer patient. A sense of ffatalism, the belief that death is inevitable for cancer patients, has been identified as a barrier which may strip the individuals of any desire to seek medical remedy. Last but importantly, ill-placed trust in traditional, religious healers for curing various ailments also escalates the disease. The crucial first few days and months are wasted in visiting these healers who chant, pray and dish out concocted, ineffective powders as medicine to cure the patients. Superstition also prevents people in rural belts from seeking modern health care.
Despite the gaps in infrastructure, Dr. Sapna Nangia -a Cancer specialist at Indraprastha Apollo Hospital -says India has kept abreast with the latest advances in cancer treatment. Doctors now prescribe targeted therapies for specific types of cancer. Cancer develops when cellular pathways allow blood supply to cells to divide and accumulatee into large abnormal growth. Targeted treatments are designed to disrupt such growth.
The first approved treatment was of Imatinib in year 2001. Imatinib inhibits the enzyme unique to abnormal cells in chronic myeloid leukemia, a kind of blood cancer. Dr Nangia saysadministering trastuzumab and tyrosine kinase inhibitors as ‘targeted therapies’for treatment of breast cancer and lung cancer have extended the patients’ life spans dramatically. Further, targeted treatments like Sorafenib, Sunitinib and Pazopanib have improved recovery prospects for patients suffering from cancer of liver or kidney, as their cells were found to be resistant to other treatment.
The use of x-rays to kill cancer cells as part of radiotherapy is also effective. Innovations in radiation delivery machines, linear accelerators and computer software have increased the precision of x-rays in targeting tumours while avoiding the normal growth in neighbouring cellular structures. Dr. Nangia says advanced radio therapyhas enabled large, focussed doses of radiation ineffectively destroyingabnormal cells in early stagesof cancer. The technique- Stereotactic Body Radiotherapy (SBRT) – results in exceptionally high recovery rates for lung cancer patients in the early stages of disease and who are unable to undergo surgery or are keen to try SBRT as the first treatment option. The technique is also useful in curing patients suffering from breast cancer, large intestine cancer, kidney cancer and other kinds of cancer where abnormal cell growth is still substantially limited.
VIA technique for screening cervical cancer among women is also new. A simple method of screening cervical cancer by using vinegar has led to a 30 percent reduction in deaths from the cancer of the uterus opening. The cancer is largely preventable, and a great many lives can be saved if the government collaborates with NGOs in spreading awareness of the disease in small towns and villages and allowing access to screening tests. A quarter of the world’s cervical cancer patients live in India.
Robotic Surgery for Prostate Cancer uses laparoscopy -which relies on scopes rather than large incisions to access the target – highly maneuverable surgical instruments and powerful magnifying lenses that enlarge the surgery target 40 times more than the normal view, is effective in surgery in the narrow male pelvis. It is now preferred for prostate cancer treatment. For the patients unfit for surgery, Image Guided Radiotherapy is used for treating the disease in its advanced stages.
Despite the effective treatments, thousands die of cancer each year. Public incentives and elaborate campaigns to educate masses and dispel social and cultural misperceptions are necessary to build a holistic health infrastructure that addresses the patients’ social and emotional concerns while helping them combat the disease.