Does India Really Have the Lowest Cancer Incidence in the World?

A 2018 study concluded that India has one of the lowest incidences of cancer in the world. But what does it mean?

When you hear the words ‘lowest incidence of cancer in India’, it sounds unusual, to say the least. However, a 2018 study by the Institute of Health Metrics and Evaluation, Washington University, concluded the same. According to it, in 2016, India witnessed 106.6 new cases for every 100,000 people. It further ranked tenth among the countries with the lowest incidence of cancer. Now, this is comforting to hear, especially with all the growing instances of cancer one might have stumbled across in our day to day lives. However is this really what it sounds like?

India's Mortality Rate

Dr Jaskaran Singh Sethi, Director and HOD, Radiation Oncology, Fortis Hospital Shalimar Bagh, New Delhi, navigates between these stats in the following manner:

One needs to understand that there are different types of rates – there is an incidence rate, mortality rate. All these are ratios, relative to each other. An incidence rate is the number of freshly reported cases. While the rate of Incidence is low in India, the number is very high because the population of India is so large.

Dr Jaskaran Singh Sethi

While the incidence might be low, the number of people who are diagnosed with it is still disturbing. For instance, this report points out that 39 lakh cancer cases were registered in India in 2016, according to the National Cancer Registry data.

Add to all of this the fact that the cancer burden doubled in India between 1992 to 2018, according to another report.

Dr Rakesh Chopra, Director, Medical Oncology, Hematology & Bone Marrow Transplant, Aakash Healthcare Super Speciality Hospital, New Delhi, comments on the high mortality rate in India and says:

Our mortality rate when compared to the western world is higher by at least 20 to 30 percent, as compared to African and Central Asian countries. On the other hand, India is lower by 10 to 15 percent as compared to South East Asia; worse than some nations, but better than others.

Too caught up to read? Listen to it here:

Low Rate of Diagnosis and Lack of Awareness

Factors like the current healthcare facilities, the abysmal number of diagnosis for every cancer patient, the financial requirements and the paying power of an average Indian, all show that irrespective of the rate of incidence, the mortality rate is still at par with those parts of the world where the incidence might be high, as Dr Sethi mentioned.

He further comments on the same and says:

Data computation of cancer patients in India is done through the Indian Council of Medical Research. There are two registries at play in India when it comes to registering cancer patients – hospital based and population based. However many patients are uncaptured because of the methodologies involved in acquiring data. Many patients are diagnosed and are not seeking treatment from the nearest cancer centres. In India, 3/4th of the patients are diagnosed in the 3rd and the 4th stages of cancer. Abroad 1/4th are found in the 3rd and the 4th stages of cancer. This can be attributed to the fact that there is lack of basic public health awareness and education.

Cancer Diagnosis in India

When it comes to diagnosis of the disease, the list of obstacles goes on and on.

Lack of screening camps, awareness, public health facilities, machinery, treatment options, access to primary medical help are some of the gaps in our cancer delivery treatment.

Dr Jaskaran Singh Sethi

The situation is far worse in rural India where several cancer patients might not even be aware that they are living with the disease.

The facilities for cancer diagnosis are not available in the rural belt. If a patient has cancer in rural India, going for treatment will be difficult because the nearest hospital will be a few hundred kilometres away. Even then, once they reach, it is not necessary that the hospital will have all the necessary machinery for treatment. Radiation machine might not be there, chemo treatment might not be possible.

Dr Jaskaran Singh Sethi

Further on, things seem even more more bleak regarding incompetent facilities.

Tier 2 and Tier 3 cities have this issue – lack of facilities and manpower. Dedicated cancer wings and radiation wings are often not within reach, financially or physically, for most of the Indian population.

Dr Jaskaran Singh Sethi

Bad healthcare facilities is definitely an obstacle in ensuring treatment of the disease. Dr Chopra adds.

It definitely has a role in the outcomes, costs of therapies, time hours lost in mortalities and higher mortalities. Stage 1 becomes stage 4 due to ignorance of patients and caregivers, burden on the cancer delivery system institutions and the everyday questions at their places.

Dr Rakesh Chopra

Most Common Cancers in India

When it comes to men, cancers of the head and neck, along with lungs, prostrate and colorectal are most common, according to Dr Sethi. For women, it is breast, gallbladder and cervical. In addition to this, he says:

Malignancies like blood cancer affect both populations. While there is no specific age group in which cancer strikes – it is more prevalent amongst the elderly. In recent times, however, cases in children and youngsters are also rising.

Dr Jaskaran Singh Sethi

Partly in agreement with Dr Sethi, here’s another report that suggests that the most instances of cancer are found among the elderly and women during their reproductive years.

According to Dr Chopra, tobacco related cancer, infected agents related cancer, hereditary cancer are the common kinds of cancer in India. He further adds that there is a difference between urban and rural based cancers as well.

How Has India’s Approach to Cancer Changed Over the Years?

The first significant change is the manner in which we view the disease. Conversation towards reducing stigma has increased to assure someone struggling with it that treatment is possible and that cancer is not a death sentence. Dr Sethi adds to it and says:

Cancer treatment in India has flourished with experts coming in. The latest technology and machinery, treatments, research is underway on a large scale. People are more willing to come forward and get treatment, get diagnosed and there are facilities and treatments for the same.

However, this comes with a reminder that though the rate of mortality is dropping, the numbers are still large because of India’s population. Healthcare facilities for all still remain a distant dream.

In case you want to go down the prevention-is-better-than cure route, the doctor’s advice is simple.

Control your intake of alcohol and processed food. Smoking should be avoided at all costs. It is the single highest risk factor for cancer. Obesity should be tackled as it can be the harbinger of cancer troubles; exercise is important for a strong immune system

Dr Jaskaran Singh Sethi

Dr Chopra agrees that regular screenings, check-ups and awareness of early signs of cancer is the key.