India: Defying the Global Cancer Trend

As developing countries experience economic growth, they are also experiencing an increase in non-communicable diseases. Cancer specifically has become one of the leading causes of death worldwide. Low and middle-income countries (LMICs) that once struggled with high rates of infectious diseases are now shouldering a large burden of cancer. Recent data from these countries reveal that while incidence of cancer is lower than most high-income countries (HICs), there is a far higher mortality rate. Moreover, the incidence rate for men is much higher than for women.

There are three things that might account for this discrepancy in mortality:

• The disease is different among people in LMICs
• Patients may receive sub-optimal treatment
• Chaotic patient social circumstance influences how they are treated

In India, women have a higher incidence of cancer than men.

India is one of the largest developing nations in the world. Like most developing countries, they face all three of the problems mentioned above, including lack of infrastructure to properly detect and treat different types of cancers. The data reflect the same trend in incidence and mortality, with 68% of the annual cancer incidence resulting in death. However, India seems to defy the trend when it comes to the gender burden of cancer.

The most common cancers in India overall are breast and cervical. The disease is different in India than other HICs due to earlier marriage, early onset and multiple pregnancies. Thus, the peak age of onset in India for breast cancer is about 10 years younger (age 45–50 years) than the peak age in high-income countries (>60 years). This social circumstance is shared with other LMICs and is associated with triple-negative breast cancer, a more deadly variant of breast cancer. It is also interesting to note that while breast cancer has the highest incidence among all cancers overall, cervical cancer seems to be especially high in many rural areas, like Northeast India.

The Solution

In India and other LMICs, cancers are diagnosed at stage 3 or 4, making them more difficult to treat. Some of the barriers that prevent women from seeking timely and proper care include low cancer literacy, stigma, fear, health care access, and cost of care. The Indian government believes that part of the solution to the challenge of women-specific cancer is population-based screening programs. This would result in detection and increased awareness about cancer in general, risk factors, and the need for periodic screening.

Improving the system

The federal government has provided a framework to use for the the three most common cancers in rural and urban areas. They recommend intervention at the lowest level of the health care system, where staff at clinics called sub centers are meant to treat minor illnesses, collect data, and promote health education among other things. The auxiliary nurse midwife (ANM), a special health care worker required at every sub center, should be properly versed in clinical breast examinations and visual inspection techniques for cervical screening.

These data suggest that women especially need targeted interventions. Using health workers to their full potential at the community level could prove to be useful in and of itself through health promotion among its residents.