Fourteen years is a long time to get something right. Especially when it can save lives. That is why India’s continued inability to screen for cancer – oral, breast and cervical – is not just baffling but shows an appalling apathy for the large-scale suffering inflicted by the disease. The three cancers made up 32 per cent of all cancers reported in India in 2022.
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010. Included in its mandate was screening for the three cancers – the only ones from the dreaded pantheon for which screening is possible. In 2018 Ayushman Bharat, the NDA government’s flagship health programme, was launched. One of its components was establishing 1,50,000 health and wellness centres (HWCs) – since renamed Ayushman Arogya Mandirs – whose mandate also included screening for non-communicable diseases including but not limited to cancer.
Yet, as per data from the National Family Health Survey 5 (2019-2021), about 1.9 per cent women have ever undergone screening for cervical cancer while only 0.9 per cent women have undergone screening for breast or oral cancer. Moreover, just 1.2 per cent men have ever undergone screening for oral cancer.
This is what makes a recent article on “huge gaps” in cancer screening – highlighted in a NITI Aayog report and kept carefully under wraps for close to a year now – an indictment of the worst kind. It shows that a new flagship health programme with a fancy monikered primary care component changed nothing on the ground in terms of cancer screening.
Women affected disproportionately
The lack of cancer detection is a national concern, but it is also undeniable that it affects women disproportionately. Two of the top three killers among women – breast and cervical cancer – can be identified at an early and treatable stage if a regular screening routine is put in place for all women. India has a population of over 51 crore women above the age of 15 who are at risk of developing cervical cancer. Current estimates suggest that every year, about 1,20,000 women are diagnosed with cervical cancer. Of these, over 77,000 succumb to the disease. Breast cancer has the highest incidence rate among Indian females and the country saw about 1,92,000 new cases in 2023. The disease kills approximately 90,000 women in India every year.
In the current charged election atmosphere, while nari shakti (women power), gas cylinders and mangalsutras dominate the discourse, screening for women’s cancers does not figure at all.
Last year, a report by The Lancet Commissions – ‘Women, Power and Cancer’ – threw up some astounding figures. It estimated that nearly two-thirds of the cancer deaths in Indian women were preventable and 37 per cent were treatable if only they had been diagnosed on time and had the patients received optimal care. Around 6.9 million cancer deaths in women were preventable and 4.03 million were treatable. That figure – 6.9 million – is more than the entire population of countries like Denmark, Finland, Norway, Libya and Paraguay.
Not once in his relentless listing of UPA failures did Prime Minister Narendra Modi talk about his government’s failure to implement the 2010 programme. And not once has the Opposition brought the Modi government to task for the shortcomings of Ayushman Arogya Mandirs. The disease that kills over 9 lakh Indians every year is not even a speck on the political horizon.
Also reads: Breast cancer accounted for highest number of cancer fatalities in India in 2022, says WHO report
Why the inaction?
Unfortunately, the government has known for some time that its current plan for cancer screening through HWCs is not working. But no initiative has been taken to get preventive screening covered under the tertiary care arm of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) – which entitles eligible families to an annual health insurance coverage of Rs 5 lakh. That would have needed an amendment to the packages list. And given that the government’s defence on the cancer screening front has, for a long time now, been a lack of trained human resources, it could have mitigated that challenge to a large extent by utilising private sector capabilities. That it was not done shows how little cancer matters in India’s larger policy conversation.
Beyond Constitutional mandates and people’s right to life, there is another ethical question involved here. How do you not save lives when you know how to?
Screening is just the first step in saving lives. A mature health system also needs to have treatment linkages in place. Last year, a report supported by Roche and the APAC Women’s Cancer Coalition, analysed breast and cervical cancer prevention and care in six focus countries – India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam. It also highlighted the need to establish viable treatment linkages. On the eve of Women’s Day in March this year, Chase India organised a roundtable in collaboration with the Atal Bihari Vajpayee Institute of Good Governance and Policy Analysis. The event, held in Madhya Pradesh’s Bhopal, saw health experts and state government officials discuss the need for structured treatment referrals and support for patients to ensure they can access and complete treatments after diagnosis.
Anybody who has ever done the rounds of the Institute Rotary Cancer Hospital at the All-India Institute of Medical Sciences (AIIMS), New Delhi would know the excruciating and sometimes undignified conditions endured by poor people who travel from all across the country to seek treatment. Cancer is among the top reasons for the “catastrophic health expenses” that impoverish families and the fact that PMJAY does not cover anybody who owns a bike or a refrigerator means that large swathes of the population, with no savings to fall back on, continue to be outside the ambit of whatever succour it does provide.
For far too long, India has talked about cancer screening without walking it, even as the year-on-year casualties have steadily risen. It is, perhaps, time to dissociate cancer from the generic non-communicable diseases list and draw up a separate and comprehensive plan that includes vaccinations, screening and treatment.
Why not that in the 100-day agenda?
Abantika Ghosh is a former journalist and author. She is currently working with Chase India. She tweets @abantika77. Views are personal.
(Edited by Zoya Bhatti)