Cancer control program

NATIONAL Cancer control program

1. NATIONAL CANCER CONTROL PROGRAM PRAMOD KUMAR

2. CANCER Cancer refers to a class of disease in which a cell or a group of cell divide and replicate uncontrollably, intrude into adjacent cells and tissues and ultimately spread to other parts of the body than the location at which they arose.

3. BURDEN OF CANCER: According to IARC, there were 10.9 million new cases, 6.7 million deaths, and 24.6 million persons living with cancer in the year 2002 . Lung cancer is the most common cancer worldwide followed by the breast cancer . Cancer has became one of the ten leading causes of death in India. It is estimated that there are nearly 2-2.5 million cancer cases at any given point of time. Over 8-9 lakh new cases and 4 lakh deaths occur annually due to cancer.

4. Cont.. Cancer of oral cavity and lungs in male and cervix in females account for over 50% of all cancer deaths in India. WHO has estimated that 91 % of oral cancer in south-east Asia are directly attributing to the use of tobacco and this is the leading cause of oral cavity and lung cancer in India.

5. Report of National Cancer Registries and Atlas of Cancer in India There are 97.8 to 121.9 cancer cases per 1,00,000 population in urban males . There are 92.2 to 135.3 cancer cases per 1,00,000 population in urban females . There are 46.2 cases of cancer per 1,00,000 population in rural males .

6. Cont.. There are 57.7 cancer cases per 1,00,000 population in rural females. One in about 15 men and one in about 12 women in the urban areas could develop cancer in their lifetime. Incidence rate of esophageal cancer is women of Bangalore is one of the highest (8.3 per 1,00,000) in the world. Cancer of tongue in males in Bhopal (8.8 per 1,00,000) is the highest in the world.

7. Cont.. Cancer of stomach is one of the main cancer in males in southern registries. Gall bladder cancer in Delhi women is one of the highest ( 8.9 per 1,00,000) in the world. 75-80 % of the patients are in advanced stage of disease at the time of first attendance.

8. RISK FACTORS Factors/class % of cancer deaths in 35-64 yrs caused by factor Tobacco 30-40 Alcohol 3-10 Diet Not known Reproductive & sexual behavior 10 Occupation 6-8 Pollution 2 Industrial product 1 Medicines 1 Geophysical factors 3

9. OTHER CAUSATIVE FACTORS; Infection : Approximately 20 % of the cancers among men and women in developing countries is attributable for infectious agents as opposed to 9% in developed countries . Tobacco : It is the most important identified cause of cancer and is responsible for about 40 to 50 % of cancers . Deit : It is responsible for 10-70 % of cancers. In India dietary habits may be responsible for about 10 to 20 % of cancers.

10. Cont.. Pesticides: Increase incidence of cancer in Punjab particularly Malwa region a cotton belt where at least 15 different pesticides sprays which are acephate , dichloropropene , diurene , flucometaron , pendimethalin , tribufos . - Due to high cost of cancer treatment in state people go to nearby states such as Rajasthan and Delhi. - As 70-199 patients going to Bikaner daily using a particular trained ferried from Bhatinda to Bikaner locally named as “cancer train” .

11. Cont.. Education, socioeconomic status and health facilities : Lack of knowledge and many beliefs systems such as cancers are incurable leading to late presentation and poor treatment compliance. - Lack of trained oncologist, supporting staff, family dislocation for cancer treatment to a new city, cost of medical burden make the compliance to treatment poor. - Comorbidity such as TB, Malaria, Measels , causing immunocompromised states lead to poor tolerance to chemotherapy

12. NATIONAL CANCER CONTROL PROGRAM INRODUCTION : The cancer control program was started in 1975-76 as a central sector project. It was renamed as the National Cancer Control Program (NCCP) in 1985 and revised in 2004.

13. OBJECTIVES: Primary prevention of cancers by the health education regarding hazards of tobacco consumption and necessity of genitals hygiene for prevention of cervical cancer . Secondary prevention by early detection and diagnosis of cancers by the screening methods and patients education on self-examination methods . Strengthening of existing cancer treatment facilities, which were inadequate . Palliative care in terminal stage cancer.

14. STRATEGIES

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17. ORGANIZATIONAL STRUCTURE It is at two levels- central government and state government with linkage through the central council of health. It is suggested the respective executive committees should be assisted by a newly constituted National Cancer Control Board at the central level and state level by the corresponding Cancer Control is an oncologist who head the cancer control cell at the Directorate General of Health Services.

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19. SCHEMES UNDER THE PROGRAM Recognition of new regional cancer centers and strengthening of existing regiona ; cancer centers: There are 27 regional cancer research centers in India at present. Their main functions are-

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21. Cont.. Cobalt Therapy Installation: One crore for non-government and 1.5 crore for government institution per unit for cobalt therapy unit and other radiotherapy equipment have been brought under this scheme. Financial assistance of Rs . 30 lacs for mammography unit is also available to the institutions having cobalt unit.

22. Cont.. 2. Oncology wings in medical colleges:

23. Cont.. This program was launched in 1990-91 and under this program each state and union territory has been advised to prepare their projects on health education, early detection, and pain relief measures. This program will be run by regional centers or an oncology wing. A cluster of 3 congruent districts are developed for preventive activities through oncology wing or regional centers. For this they get up to Rs . 90 lakh spreading over a period of five years. The district program has five elements: - Health education - Early detection - Training of medical & paramedical personnel. - Palliative treatment and pain relief. - Coordination and monitoring. 3. District cancer control program:

24. Cont.. 4. Voluntary organization:

25. IMPLEMENTATION

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28. NEW INITIATIVES:

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31. RESEARCH ARTICLE A survey of the educational environment for oncologists as perceived by surgical oncology professionals in India Background: The current educational environment may need enhancement to tackle the rising cancer burden in India . The aim of this study was to conduct a survey of Surgical Oncologists to identify their perceptions of the current state of Oncology education in India .

32. Cont.. Methods: An Institutional Review Board approved questionnaire was developed to target the audience of the 2009 annual meeting of the Indian Association of Surgical Oncology in India. The survey collected demographic information and asked respondents to provide their opinions about Oncology education in India.

33. Cont.. Results: A total of 205 out of 408 attendee’s participated in the survey with a 42.7% response rate. The majority of respondents felt that Oncology education was poor to fair during medical school (75%), residency (56%) and for practicing physicians (71%). The majority of participants also felt that the quality of continuing medical education was poor and that minimal emphasis was placed on evidence based medicine.

34. Cont.. Conclusions: The results of our survey demonstrate that the majority of respondents feel that the current educational environment for Oncology in India should be enhanced. The study identified perceptions of several gaps and needs, which can be the targets for implementing measures to enhance the training of Oncology professionals.