As per the latest estimates about the incidence of Cancer cases in India, the number increased from over 11.67 lakh in 2013 to 14.61 lakh cases in 2022, registering an increase of 25%. However, this number could be significantly higher since only about 10% of the population is covered by the Population-Based Cancer Registries.
Cancer is a significant public health concern in India, presenting a considerable burden on both the healthcare system and the affected individuals and families. The country faces a rising incidence of various types of cancer due to a combination of factors including population growth, aging, lifestyle changes, environmental factors, and genetic predisposition. As per Global Cancer Observatory, in 2020, the estimated incidence of cancer cases in India was over 13.2 lakhs which accounted for the third highest number of cancer cases after China with 45.7 lakh cases, and the United States of America with 22.8 lakh cases.
Globally, Cancer is a leading cause of death, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. In India, the Annual Report on the Medical Certification of Cause of Death (MCCD), 2020 revealed that neoplasms or cancer was the seventh leading cause of death accounting for roughly 5% of total medically certified deaths in the country.
NCRP compiles data on Cancer cases in India and makes estimates
In India, The Indian Council of Medical Research (ICMR) launched the National Cancer Registry Programme (NCRP) in 1981, through a network of Population and Hospital Based Cancer Registries (PBCRs and HBCRs). These cancer registries collect and analyse detailed data on cancer cases, aiding in evidence-based strategies. The data from NCRP, as provided in response to questions in Parliament has been used in this story, where we look at the decadal trends in cancer cases and mortality. The mid-year population projections of the Health Ministry from Dataful have been used to estimate per lakh incidence and mortality.
It should be noted that there is considerable difference in the 2013 figures and the figures since 2014 which may be due to the changes in methodology. In the latest NCRP report released in 2020, the estimation is based on data spanning from 2012 to 2016, while the 2013 data was based on the cancer incidence report from 2009 to 2011. Further, the 2020 report benefits from increased coverage, including a higher number of Population-Based Cancer Registries (PBCRs) and expansion of existing ones.
India’s cancer cases have increased by 25% in the last 10 years
The data shows that the incidence of cancer cases and mortality are on the rise. In the last 10 years, the estimated number of cases has increased from over 11.67 lakh in 2013 to 14.61 lakh cases in 2022, registering an increase of 25%. Meanwhile, the estimated number of deaths increased from 6.63 lakh to 8.09 lakh during the same period, registering a growth of about 22%. It is projected that the number of cases will increase further to 15.7 lakh by 2025. Global Cancer Observatory has predicted that the cases in India will increase to 20.8 lakh by 2040.
The case fatality rate of a disease is measured as the percentage of those who died of the disease out of the total diagnosed. Between 2014 and 2022, the case fatality rate of cancer in India is about 55% at the national level. That is, every other person diagnosed with cancer succumbed to the disease.
Six states account for more than 50% of the cases and deaths due to Cancer
In terms of actual figures, six states accounted for more than 50% of the estimated incidence of cancer cases in India throughout the last 10 years. These are Uttar Pradesh, Maharashtra, West Bengal, Bihar, Tamil Nadu, and Karnataka. These six states also accounted for more than 50% of the deaths estimated each year. However, when normalized for population, the trends of estimated cases and deaths are different.
Kerala had the highest incidence per lakh population with over 166 cases estimated in 2022 while Uttar Pradesh had only 90 cases. At the national level, 94 cancer cases per lakh population was estimated in 2013 which increased to 106 in 2022.
The incidence of cases is relatively higher in the five southern states with all of them estimated to have more than 100 cases per lakh population throughout the 10 years between 2013 and 2022. The findings of the National Family Health Survey revealed that the prevalence of lifestyle diseases like diabetes and hypertension was also higher in the southern states.
On the other hand, the northeastern states of Sikkim, Arunachal Pradesh, Tripura, and Manipur had less than 75 cases per lakh population during this period. In contrast, Mizoram’s figures were the second highest and were close to that of Kerala. While the incidence increased across all the states, the southern states and Mizoram experienced the highest increase in incidence rates.
Mortality was the highest in Mizoram with more than 100 deaths per lakh population
The mortality per lakh population shows that Mizoram had the highest number of estimated deaths due to cancer with more than 100 deaths per lakh population in 2021 and 2022 while Kerala had the second highest number of deaths with 90 per lakh population in 2022. At all India levels, the number of deaths increased from 52 to 59 per lakh population between 2014 and 2022. Data for 2013 has not been considered.
Punjab, which was estimated to have the fifth highest number of cases had the third highest number of deaths, along with Andhra Pradesh. The northeastern states of Sikkim, Arunachal Pradesh, Tripura, Nagaland and Manipur, and Bihar had the lowest mortality rate, with less than 50 deaths per lakh population.
Cancers associated with tobacco accounted for nearly one in 3 cases
According to estimates from NCRP 2020, the top five leading sites of cancer among males were lung (10.6%), mouth (8.4%), prostate (6.1%), tongue (5.9%) and stomach (4.8%). The estimated top five leading sites of cancer among females included breast (28.8%), cervix (10.6%), ovary (6.2%), corpus uteri (3.7%) and lung (3.7%). Liver cancer (3.9%) was among the leading ten cancers in males and not in females, whereas thyroid (3.6%) and gallbladder (2.7%) cancers were in the top ten among females but not in males. India has a huge burden of tobacco-related cancers. Lung cancer and head and neck cancers top the list. According to a study published by the National Centre for Disease Informatics and Research (NCDIR) and the Indian Council of Medical Research (ICMR), Cancers associated with tobacco use comprised nearly half of all cancers among males in India. Further, the study noted that of all cancer cases reported, cancers associated with tobacco use constituted 33.3% of all cancers or one in three cases.
Actual number of cases could the thrice the estimates
While there are several causes of cancer, it is seen that some of them are preventable. Further detection at an early stage also helps treat and cure the patient. According to a study by E&Y, the actual figures could be 1.5 to 3 times the estimates. Further, the Department-related Parliamentary Standing Committee on Health and Family Welfare in a report submitted in December 2022 noted that only about 10% of India’s population is covered by population-based cancer registries (PBCRs) under the National Cancer Registry Programme. Furthermore, it also observed that India has a poor detection rate across major cancer sites with 29%, 15%, and 33% of breast, lung, and cervical cancers being diagnosed in stages 1 and 2, respectively. This is significantly lower than that in China, the UK, and the US.
Expenditure for Cancer treatment is high in India
The 75th National Sample Survey observed that the average expenditure for cancer treatment was high in the country. It was over Rs.61,216 across all hospitals while it was nearly Rs. 1 lakh in private hospitals. When asked about this, a parliamentary standing committee report tabled in 2022 noted that the expense was high for treatment due to the medicines and equipment used for the same.
The committee made a slew of recommendations for prevention, detection, diagnosis, and treatment of the disease. Some of the recommendations include capping diagnostic charges, price negotiation for anti-cancer drugs, inclusion of HPV Vaccine in vaccination programs, and campaigns against tobacco consumption.
Featured Image: Cancer cases in India
