Cancer

In North East–Fatal,Yet There is Hope

Ratna Bharali Talukdar

The alarmingly high incidents of cancer in entire north east region in general, and Assam in particular, as revealed in recent Population Based Cancer Registries (PBCR) of the region under the National Cancer Registry Programme(NCRP) of Indian Council for Medical Research(ICMR) calls for immediate attention of authorities at policy level to work out an effective cancer control  initiative. While there is an increasing trend of cancer incidence in the region as revealed in these registries, the huge size of population living with cancer too, has posed challenge to health experts in adopting required health- infrastructure mechanism for cancer management and treatment.

The size of population living with cancer in Assam, recorded 70,887 as on 2011. There is an estimated projection of 80,916 within 2026, taking into consideration the ratio of rural-urban population, which is 86:14 during 2011.  Apart from its domestic population of people surviving with cancer, a sizeable number of patients of other north-eastern states too, visit Assam regularly, for treatment.   

The consolidated records of the NCRP has revealed alarming trend of cancer occurrence in entire north-eastern region, with  Aizawl, the capital of Mizoram, topping the  list in terms incidents of cancer per lakh population in case of both male and female.  Aizawl recorded cancer incidents of 273.4 for male and 227.8 for female per lakh population, which is the highest in India  as per latest report of PBCR of India,  2009-11. The report of the PBCRs also revealed some shocking statistics in  other pockets of north-eastern states. It revealed that in case of male, East Khasi Hills has recorded second highest cancer incidents with 216 per lakh population,  followed by Mizoram state with 189.5, Kamrup Urban District with 185.2 and Meghalaya state with 157.3.  In case of female,  Kamrup Urban District recorded second highest with 156.3, followed by Mizoram state with 153.7. Aizawl also recorded highest in incidents of cervix cancer in female (24.3) in the contry.

While Aizawl recorded highest incidents of all types of cancer, in case of oesophagus cancer East Khasi Hills district recorded highest incidents in both male and female. In case of males it is 71.4 per lakh population, followed by Meghalaya state (46.2), Aizawl district  (42.0), Kamrup Urban District(27.0) and Mizoram state (26). In case of female too, East Khasi Hills district recorded the highest (30.2), followed by Meghalaya state (19.8) and Kamrup Urban District (18.3).

The PBCR and Hospital Based Cancer Registry (HBCR) under National Cancer Registry Programme, of ICMR was set up way back in 1982, with the objective of generating reliable data on the magnitude and patterns of cancer throughout the country; undertaking epidemiological studies based on results of registry data; help in designing, planning, monitoring and evaluation of cancer control activities; and developing training programmes in cancer registration and epidemiology. Over the years, number of these registries have been increased and today, the country has altogether 29 PBCR with nine registries set up in different states of north eastern region. Additionally, it has seven HBCR with two in northeast. Assam has altogether three registries set up in Kamrup Urban District, Dibrugarh district and Cachar district. The two HBCRs are set up in B. Borooah Cancer Institute and in Assam Medical College, Dibrugarh. 

Interview

Eastern Panorama:

There is an existing 70,887 population of living with cancer in Assam and the prediction for incident of cancer during 2026 is as high as 80,919. What strategies have been to deal with the situation?

Dr.Kataki:

Number of cancer patients is increasing. We are trying to increase infrastructure facility. Apart from BBCI in Guwahati Assam has two private cancer hospitals- one in Guwahati and one in Silchar. The Gauhati Medical College Hospital  is coming up with a 200 bed cancer hospital. Apart from these, the Assam Medical College in Dibrugarh, and Silchar Medical College also have facilities to provide treatment to cancer patients. Additionally, government is planning to set up some cancer detection centres at selected district hospitals at peripheral level.

The second step is to enhance existing facilities in existing hospitals.  We have already commissioned a state-of the art tele-radiotherapy machine developed by Bhaba Atomic Research Centre this month. This will be the first of its kind in entire Assam. With commissioning of this machine, it is hoped that patient waiting period for availing radio-therapy will be shortened. We already have four radiotherapy machine in BBCI. When we compare with other north-eastern states, Assam has better facility for treatment of cancer. But we need more. The BBCI is planning to  start PET-CT, Tomotherapy facility, Bone Marrow Transplantation and Radiation Medicine Centre within next five years.              
                                                                                      
EP:How do you assess the present cancer scenario in the region?
Dr.Kataki:

There is no established screening methodology for early detection of cancers like oesophagus or gall bladder cancer. However, preventive measures can be adopted for these. There are some cancers which are very common in Assam as well as entire north-eastern region. These include cancers in cervix, breast and in head and neck region. These can be prevented to a great extent, or can be detected at an early stage, without sophisticated equipment. Massive awareness programme will have to be undertaken by the government, preferably through NHRM. The tobacco related cancers can be entirely curbed only by adopting necessary preventative measures of awareness and motivation against tobacco use. However, the efforts should be similar to that of we have adopted for HIV/AIDS.  Cancers in breast and cervix are also common in northeast which can be detected early through awareness programme.
Around 60-70 per cent cancer in northeast can be termed as “invited cancer” due to sedentary lifestyle, use of tobacco and man-made environmental issues that may include use of insecticide and pesticide, or level of arsenic in groundwater, etc.   By adopting preventive measures we can curb down possibilities of cancer to a great extent. Tobacco related cancer is a proved factor all over the world.  But the issue of how to minimize and completely eliminate consumption of tobacco is a matter of serious concern. We need a thorough, sustained and long-term awareness and strict cancer control mechanism, particularly in rural areas of the region.  

EP:Would you please throw some light on ongoing research activities on cancer situation in the region?
Dr.Kataki :

We have already initiated collaborative research work with a number of reputed institutes including Tezpur University, Gauhati University,  North East Hills University , IIT Guwahati, Institute of Pathology, New Delhi etc, Ministry of Science and Technology, ICMR and others. BBCi is also engaged with another collaborative research project to study “Role of Human Papilloma Virus Infection & other Co-Factors in the Etiology of Head & Neck Cancer in Europe and India” along with five Indian centres and nine European centres. BBCI is associated with 20 collaborative research projects and six PhD research projects.  Recently, our institution has also introduced MD courses in Radiotherapy. 
 
EP:Do you think the three Population Based Registries and two Hospital Based Registries are sufficient?

Dr.Kataki : Yes, as these are the most scientific method of keeping records, and we get regular information about the cancer incidents of the state, even if patients go to outside for treatment. The statistics, male-female breakup of incidents, the comparative study of different registries, all have been of immense help in understanding the cancer situation. 

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