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5 DECADES OF CANCER CONTROL 1955 – 2005

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5 DECADES OF CANCER CONTROL 1955 – 2005. Cancer Institute (WIA), Chennai, India. Dr.(Mrs.) S. Muthulakshmi Reddy 1886-1968. CANCER IN INDIA Historical 1895 Balram Jaker : Trivandrum 1905 Niblock : Govt. General Hospital, Madras

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Presentation Transcript
slide1

5 DECADES OF

CANCER CONTROL

1955 – 2005

Cancer Institute (WIA), Chennai, India

Dr.(Mrs.) S. Muthulakshmi Reddy

1886-1968

slide2

CANCER IN INDIA

  • Historical
    • 1895 Balram Jaker : Trivandrum
    • 1905 Niblock : Govt. General Hospital, Madras
  • Related association of Tobacco habit & Oral cancer
  • 1933-37 Viswanath & Grewal
  • Edward Medical College, Lahore
  • First field study of Cancer in India
  • Documented common cancers then,
  • as of now, Mouth, GI Tract, Cervix, Penis
slide3

CANCER TREATMENT FACILITIES

1941 Tata Memorial Hospital at Mumbai

1950s Chittaranjan Cancer Hospital, Calcutta

1954 Cancer Institute(WIA), Chennai

All non governmental efforts

Radiotherapy departments of General Hospitals with only High Voltage units

slide4

Cancer Control: a complex multidisciplinary effort

  • Has to co-ordinate advances in early diagnosis, prevention, therapy and palliative care
  • Develop them synchronously
  • Object: Reduce morbidity and mortality due to cancer.
slide5

Data from the Demographic Registries

  • Common cancers in women – Cervix, breast and oral cavity (52%)
  • Common cancers in men – Tobacco related (45%) (Oral, lung, pharynx and oesophagus)
  • Breast and cervix 47% of all cancers in women
  • Over 75% of patients seek treatment at a late stage.
slide6

OBJECTIVE 1 of NCCP:

Prevention of Cancer

Primary prevention – elimination of the causative

agent most cost effective

Priority to Tobacco control – more easily said than

done

Comprehensive strategy needed

Education of youth and adults

on healthy life style

Cessation programmes

Legislative action

Implementation: Needs motivated groups

slide7

ANTI TOBACCO PROGRAMME

ICMR Sponsored : Anti tobacco health education and

oral screening

Trivandrum : Unemployed youth trained

Tobacco as health hazard

Various aspects of oral cancer

Clinical appearance of normal and

abnormal oral mucosa

pre-cancer and cancer

Karnataka : Recorded 37.8% reduction in tobacco

habit in study area

slide8

Tobacco Cessation Clinics

  • Initiated by SEARO of WHO : 12 centres in India
  • TCC at Cancer Institute, Chennai
  • Objectives:
  • - aims at treatment of tobacco dependence
  • - provides pharmaceutical aids to reduce withdrawal
  • symptoms
  • - Smokeless Tobacco Cessation – a special feature
  • Activities:
  • Sub centres established - 9
  • Educational & awareness programmes
  • Training programmes - 112
  • Exhibitions etc.

slide9

OBJECTIVE 2: Crux of the Problem

Early detection & Screening:

Screening of asymptomatic population

Components: Continuing public education campaigns

Training of public health workers

Population Screening:

Successful in reducing morbidity and mortality in countries with high level resources, at certain sites viz. cervix, breast, colo rectum.

In a large country with limited resources, it is not practicable.

Screening of high risk group possible

slide10

FEASIBILITY TO TRAIN

THE VILLAGE HEALTH NURSE 1989

  • Number Trained - 101
  • To detect an abnormal cervix
  • To take an adequate pap smear
  • Clinical concordance 90%
  • Pap smear adequacy 80%
  • Motivation Low
slide11

Problems in the South Arcot Programme

  • Dual Govt. control
    • Unacceptable delays in communication and
    • release of grants.
  • Dual responsibilities in the conduct of project
  • Transfer of trained personnel
  • Without information to implementing agency
slide12

Early Detection & Screening Projects – Rest of India

Many projects completed and many ongoing.

Screening and early detection of accessible cancers.

Cervix, Breast and Oral

Objectives:

Evaluation of Screening Tests - Project Oriented

Evaluation of Screening methods

Performance of cytology, VIA, VILI Research Oriented

HPV Testing

Interventional trials

Our focus was on how to integrate early detection with routine health delivery system

slide13

Cost modelling project for Cervical Cancer in Osmanabad

Cost of screening/eligible woman [Dr.Sankaranarayanan]

Cost of one time screening

Test Cost in USD (VIA) of eligible women

covering entire country

(in million Rs.)

VIA 9.5 76,166

Cytology 11.8

HPV 16.4

Conclusion of the Model Programme in Ratnagiri and Sindhudurg Awaited

Cost effectiveness and whether replicable needs to be studied

slide14

Our Recommendations

  • Separate Cancer Network
  • Health Projects
  • For Cervix & Breast only women should be involved
  • Include local rural women
  • - Self help groups
  • - Survivors
  • Ideally implemented by NGOs
  • Motivated Team – Project considered a Mission
  • Adequate financial support
slide15

OBJECTIVE : 3

Enhancement of cancer treatment and control services through Regional Cancer Centres, Medical and Dental colleges.

Treatment Centres 210 RCCs 24

RT facilities 186

Teletherapy units 345

slide16

Enhanced Imaging

Gamma Camera (1958)

CT (1971)

USG (1968-69)

PET CT (2002) ?

slide17

Enhancements in Tissue Diagnosis

Till 2 decades ago

Gross Examination, Light microscopy and clinical information only – for diagnosis and treatment plan

Today pathologic diagnosis in multimodal

Histochemistry, electron microscopy

Cytogenetics, molecular genetics have

added new dimension to diagnosis

Plays an important role in improved survival and

Tailor treatment to specific tumour type

slide18

Advances in Radiation Oncology

Introduction of

the First

Linear Accelerator - 1976

Cancer Institute(WIA),

Chennai

  • Virtual simulation 3-D planning
  • Conformational therapy IMRT
  • Modifiers of radiation response
  • (Chemopotentiation)
slide19

Changing concepts and advances

in Surgical Oncology

Conceptual change from widest

removal possible

Avoid mutilation

Stress on conservation and functional

rehabilitation without compromise on

disease eradication

Minimally invasive surgery

slide20

Training of Personnel

  • Changing scenario of cancer treatment
  • Impact of multidisciplinary management in
  • cancer survival & quality of life
  • Misconception that radiotherapy and
  • cancer care were synonymous
  • No concept of oncology
  • Militated against interdisciplinary management
  • Need for specialized trained oncologic
  • personnel for total oncologic care
  • INTRODUCTION OF SUPER SPECIALTY
  • COURSES AT Cancer Institute, Chennai - 1984
slide21

Demographic & Hospital Registries

A vital component of cancer control

slide23

Trend in Incident cancer burden, India, 1983 - 2005

Alarming ↑ due to

Demographic effect

slide24

Trend of TRC, India, 1983-2002

Minimal ↑ in males

No change in females

Trend of TRC, Chennai, 1983-2002

Minimal ↑ in females

Pronounced ↑ in males

TRC includes oral cavity, pharynx, larynx, lung, oesophagus, pancreas

and urinary bladder

slide26

TIME TREND

SURVIVAL

slide27

Carcinoma Cervix : Survival : HBCR

All cases accepted for Treatment (All stages)

Cancer Institute(WIA), Chennai

Stage II b, III & IV

(Locally advanced cancers): 81.7%

slide28

Time Trend Survival - 5 years

Hodgkin’s Disease (C.I.)

Prior to 1970 < 50%

slide29

Non Metastatic Osteosarcoma

Survival Trend: 1970-99

Cancer Institute(WIA), Chennai

slide30

Health care in India

Current Infrastructure Inadequate

1.5 Beds/1000 Bench mark 4.3

0.5 allopathic doctors/1000 Bench mark 1.8

Large dependence on unregistered and alternative medicine practitioners

(WHO managerial guide lines)

Cancer Beds No reliable information

slide31

Infrastructure for Cancer (India)

Treatment Centres 210 RCC 24

RT facilities 186

Teletherapy units 345

(Co-60 & LA)

Brachytherapy units 276 Manual 163

Remote 113

(DGHS, Government of India publication)

IAEA Recommendation (Website)

RT Units 1 / million population

Required for India 1100

Available 345

slide32

Cancer Control in India

Where are we?

Public awareness and education

(Stage of disease unchanged)

Tobacco Control

Tobacco habit ↑ LONG WAY

Tobacco related cancer ↑ TO GO

Early detection and prevention

(All programs are project or research

oriented. No effort to integrate it with

the routine health delivery system)

Treatment facilities inadequate

slide33

Strategies for future

Thrust on

Prevention, Education

Early detection

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