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Annual Burden of Cancer 2001 2005 806,300 912,000 With control of communicable diseases Increase in life expectancy Trends in smoking Changing life style.

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Presentation on theme: "Annual Burden of Cancer 2001 2005 806,300 912,000 With control of communicable diseases Increase in life expectancy Trends in smoking Changing life style."— Presentation transcript:

1 Annual Burden of Cancer , ,000 With control of communicable diseases Increase in life expectancy Trends in smoking Changing life style Cancer incidence and burden Cumulative Risk MaleFemale 1 in 91 in 8

2 ANTI-CANCER ACTIVITIES 1936 First effort to set up a cancer hospital – appeal to King George V Memorial Fund by Dr.Muthulakshmi Reddy No Major national effort for 30 years after this Dr. Reddy also responsible for including cancer in the National Health Programme in the First 5-year Plan of Govt. Of India Govt. of India committee Concept of Regional Cancer Centre 1982Demographic registries 1985NCCP

3 Perception of Cancer Then 1949Dr.Reddy had to justify the need for a Cancer Hospital Cancer perceived as a disease of the Aged a fatal / incurable disease Needed only Morphine to help their way to Eternity Cancer a major component of the National Health Plan Most states have a Cancer Centre Todays Slogan Cancer is preventable, curable Stress on cancer survivors & Children of survivors Perception of Cancer now – 50 years later

4 National Cancer Registry Project (ICMR), 1981 & Other voluntary efforts Setting up of 3 Demographic Registries Bombay, Madras and Bangalore A total of 14 Demographic Registries and 5 Hospital Cancer Registries (HCR) at present under NCRP Only 3 are rural demographic registries Six Demographic Registries outside NCRP network ICMR Atlas Project – Data on cancer pattern in 82 districts from 105 centres in India. Coverage: 6.9% of the population

5 Objectives based on the data from the Demographic registries Primary prevention of Tobacco Related Cancers Early detection and treatment of cancer of the cervix (extended to cover cancer at accessible sites cervix, breast and oral) Enhancement of cancer treatment and control services through Regional Cancer Centres, Medical and Dental colleges. Palliative care [added in – 1989] Objectives of the National Cancer Control Programme, 1985

6 Tobacco Research Activities in India Chennai cohort study (300,000 men, aged 25 years) 31% of total deaths due to any cancer was attributable to tobacco smoking ranging from 39% for stomach/oesophagus to 56% for lung/larynx cancers Prevalence of tobacco smoking among men aged 35 and above is estimated to be 40% Mumbai Cohort Study 150,000 persons; Tobacco habit – 57.6% women; 69.3% men, smokeless tobacco use more common than smoking Mortality rates higher for tobacco user than non-user Global Youth Tobacco Survey (GYTS) among yrs students Prevalence ranged between 59% in Bihar, 4% in Goa; 7% in Tamil Nadu and Survey not carried out in Kerala.

7 MDCCP DATA FROM TAMIL NADU STATE (Women) Prevalence: Tobacco smoking: 3%; Tobacco chewing: 21% Age group Education Tobacco habit: with increasing age; with increasing education Frequency of women with awareness of Cancer as a term79.2% Curability of cancer 45.0% Cancer Trt centres32.4% Tobacco as a hazard56.0%

8 Legislative Action 1.Anti-tobacco measures Ban on tobacco advertisement Ban on sale of tobacco near schools and colleges Ban on smoking in public places Ban on smoking in buses, airports. etc Ban on sports promotion by tobacco companies Hazards of tobacco in school books (hygiene, preventive medicine) Monitoring of industries Our recommendations Preference to non-smokers as teachers in schools and colleges Declare cancer a Notifiable Disease

9 CHINGLEPUT SURVEY OF CANCER % Stage Distribution of Carcinoma Cervix 1961 – 63 StageSurveyC.I. Early Late Number surveyed: 10,775 Male: 3,239 Female: 4,842 Children: 2,092 Cancers detected: 67 Oral: 24 Cervix: 27 Breast: 16 Foundation for the first ever pilot cancer control Programme – Kanchipuram 1967, WHO 1 st INTERNATIONAL WHO CANCER CONTROL PROJECT KANCHIPURAM 1967 Opportunistic Screening!

10 ObjectiveTo integrate the screening & education programme with the states permanent health infrastructure and delivery system This would significantly reduce cost Trained258 Medical officers 672 VHNs 30 Block health educators 2 cytotechnicians Setup2 Cytology laboratories in Cuddalore and Villupuram Total women examined59314 Cancers detected 310 Early12.3% Late87.7% MOTIVATION POOR South Arcot District Level Cervical cancer early detection project:

11 Problems in the South Arcot Programme 4.VHN had multiple duties and received incentives for the FPP & immunization drive No incentives in cancer detection programme 5.Fresh young women medical graduates – not confident 6.Compliance of women to be screened – Dependant on men folk!

12 Information, Education and Health Care Intervention IARC in collaboration with Nargis Dutt Memorial Cancer Hospital, Barshi Int. AreaNon Int. Area Ca Cervix 66% 25% Stage I & II

13 Major conclusions from various Indian studies Population screening not practicable For Cervical cancer VIA recommended at present High priority and focus on Educational Programmes Serious effort to integrate screening with routine health delivery system Introduction of opportunistic screening can be considered


15 Enhanced Imaging Enhancement in Tissue diagnosis Molecular Diagnostics Technologic Advances

16 Enhanced Imaging For evaluation of extent of disease / tumour size and tumour spread and monitor response to therapy Ultrasound CT Scan, Spiral CT MRI, PET Implications of sophisticated Imaging Expertise in interpretation Knowledge of relative merits of diff. available techniques Increase in cost of diagnosis

17 Molecular Markers Molecular diagnostics Prognostic & Predictive Markers Minimal Residual Disease

18 Conceptual influences in Therapeutic Oncology 1.Preventive Oncology : Based on natural history of evolution of disease 2.Definition of early disease 3.Concept of Micrometastasis 4.Evaluation of extent of disease 5.Introduction of multi disciplinary approach

19 Multidisciplinary approach in Oncologic care Appreciates limitation inherent in different modalities of treatment Sequencing of different modalities Surgery, radiation and chemotherapy based on biologic needs Different in early disease and locally advanced disease

20 RESEARCH Synthesis of clinical practice studies & laboratory and research data Essential for progress Hereditary Cancer Clinic only one of its kind in India

21 Palliative Care: Palliative care medicine – a speciality A major component in cancer control Facilities in India Palliative care centres, hospices, hospital based centres Domiciliary services Andhra Pradesh1Tamil Nadu5Kerala4 Assam1Uttar Pradesh1with 50 satellite Chandigarh1Rajasthan1centers Karnataka4Goa155% of cancers Madhya Pradesh2have access to Maharashtra3Palliative Care New Delhi2 Orissa2 Calicut Centre WHO Demo Project PAIN CONTROL


23 INCIDENCE AND BURDEN OF CANCER $ INDIA, 2001 & 2005 MaleFemaleM+F 2001 CIR/10 5 Population (In millions) New Cancer cases , , , Population (In millions) New Cancer cases , , ,000 $ Estimates based on urban & rural registries Source: NCRP, ICMR Report (2004) & Individual Cancer Registry Reports

24 Registry (Period)BreastCervix Tamil Nadu Chennai ( )Urban Dindigul (2003)Rural Kerala Trivandrum (2000)Urban KarunagapallyRural (93-01) Maharashtra Mumbai (2000)Urban Barshi ( )Rural CIRs of Cervical & Breast cancers in India (Urban vs Rural registries) Source: NCRP, ICMR Report (2005) & Individual Cancer Registry Reports Period Cervix Breast Cx :Brt : : : :1.38 Trend Reversed now Trend of CIR of Cervical & Breast Cancers Urban India:

25 Trend of stage distribution (%), Trivandrum, Stage Breast Cervix Oral Cancer

26 Trend in survival(%) at 5 years ALL: 0-25 Years : : (C.I) Age Group (%) (%) (%) OS 0-14 Yrs (42) 43.0 (114) 56.8 (197) Yrs.16.7 (6) 30.7 (57) 46.6 (73) 0-25 Yrs (48) 38.9 (171) 54.0 (270) RFS 0-14 Yrs (30) 55.1 (89) 62.6 (176) Yrs.35.3 (3) 42.3 (39) 59.6 (57) 0-25 Yrs (33) 52.0 (128) 62.6 (233)

27 PeriodNo. Overall survival (%) Disease free survival (%) 5 yr10 yr5 yr10 yr * * p-value6604 <0.001 Carcinoma Breast : Survival : HBCR All cases accepted for Treatment (All stages) Cancer Institute(WIA), Chennai * 9 year survival

28 Testicular Germ Cell Tumour Cancer Institute, Chennai Treatment Stage I : High Inguinal Orchidectomy - Observation Stage II-III : High Inguinal Orchidectomy - CT Role of Retroperitoneal lymphadenopathy is controversial InstitutionPeriod / RegimenNo.5 Yr. OS % Cancer Institute (All Stages) (All Stages) World Survival PVB (Testicular) Proc Am Soc Cli Onc 1998; 17:


30 Disease profile in India Shift from communicable to Non communicable diseases

31 Health Budget and Cancer Budget (Government of India) % of Total outlay Health and Family Welfare8.6% (Rs.6,283 crores) Health2.0% (includes cancer Annual Rs.55 crores) Family Welfare 6.45% Indigenous medicine0.18%

32 Change in cancer scenario : Improved Survival Organ conservation Concept of cancer prevention & stress on early detection Result of advances in Technology & conceptual influences High technology involves heavy financial investment Increases cost and treatment Reduces affordability

33 Future Directions 1.Identify individuals who have inherited or acquired defective suppressor gene 2.Identify precursor lesions & chemoprevention 3.Vaccine Based Strategies 4.Predictive Medicine – Pharmacogenomics 5.Array based methods for diagnosis, prognosis and choice of drugs for treatment

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