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Cumulative Risk Male Female 1 in 9 1 in 8. Annual Burden of Cancer. 2005 806,300 912,000. With control of communicable diseases Increase in life expectancy Trends in smoking Changing life style. Cancer incidence and burden . ANTI-CANCER ACTIVITIES 1936

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Cumulative Risk

Male Female

1 in 9 1 in 8

Annual Burden of Cancer

  • 2005

  • 806,300 912,000

With control of communicable diseases

Increase in life expectancy

Trends in smoking

Changing life style

Cancer incidence and burden


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ANTI-CANCER ACTIVITIES

1936

First effort to set up a cancer hospital – appeal to King George V Memorial Fund by Dr.Muthulakshmi Reddy

No Major national effort for 30 years after this

Dr. Reddy also responsible for including cancer in the National Health Programme in the First 5-year Plan of Govt. Of India.

1965-71 Govt. of India committee

Concept of Regional Cancer Centre

1982 Demographic registries

1985 NCCP


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1949 Dr.Reddy had to justify the need

for a Cancer Hospital

Cancer perceived as

a disease of the Aged

a fatal / incurable disease

Needed only Morphine to help

their way to Eternity

Perception of Cancer Then

Cancer a major component of the National Health Plan

Most states have a Cancer Centre

Today’s Slogan

Cancer is preventable, curable

Stress on cancer survivors &

Children of survivors

Perception of Cancer now – 50 years later


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National Cancer Registry Project (ICMR), 1981 &

Other voluntary efforts

  • Setting up of 3 Demographic Registries

  • Bombay, Madras and Bangalore

  • A total of 14 Demographic Registries and 5 Hospital Cancer Registries (HCR) at present under NCRP

  • Only 3 are rural demographic registries

  • Six Demographic Registries outside NCRP network

  • ICMR Atlas Project – Data on cancer pattern in 82 districts from 105 centres in India.

  • Coverage: 6.9% of the population


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Objectives of the National Cancer Control

Programme, 1985

  • Objectives based on the data from the Demographic registries

  • Primary prevention of Tobacco Related Cancers

  • Early detection and treatment of cancer of the cervix (extended to cover cancer at accessible sites cervix, breast and oral)

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

  • Palliative care [added in – 1989]


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Tobacco Research Activities in India

  • Chennai cohort study (300,000 men, aged ≥ 25 years)

  • 31% of total deaths due to any cancer was attributable to tobacco smoking ranging from 39% for stomach/oesophagus to 56% for lung/larynx cancers

  • Prevalence of tobacco smoking among men aged 35 and above is estimated to be 40%

  • Mumbai Cohort Study

  • 150,000 persons; Tobacco habit – 57.6% women; 69.3% men, smokeless tobacco use more common than smoking

  • Mortality rates higher for tobacco user than non-user

  • Global Youth Tobacco Survey (GYTS) among 13-15 yrs students

  • Prevalence ranged between 59% in Bihar, 4% in Goa;

  • 7% in Tamil Nadu and

  • Survey not carried out in Kerala.


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MDCCP DATA FROM TAMIL NADU STATE (Women)

Prevalence: Tobacco smoking: 3%; Tobacco chewing: 21%

Age group

Education

Tobacco habit: with increasing age;  with increasing education

Frequency of women with awareness of

Cancer as a term 79.2%

Curability of cancer 45.0%

Cancer Trt centres 32.4%

Tobacco as a hazard 56.0%


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Legislative Action

  • Anti-tobacco measures

    • Ban on tobacco advertisement

    • Ban on sale of tobacco near schools and colleges

    • Ban on smoking in public places

    • Ban on smoking in buses, airports. etc

    • Ban on sports promotion by tobacco companies

    • Hazards of tobacco in school books (hygiene, preventive medicine)

    • Monitoring of industries

    • Our recommendations

  • Preference to non-smokers as teachers in schools and colleges

  • Declare cancer a “Notifiable Disease”


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CHINGLEPUT SURVEY OF CANCER 1961-63

Number surveyed : 10,775

Male : 3,239

Female : 4,842

Children : 2,092

Cancers detected : 67

Oral : 24

Cervix : 27

Breast : 16

Opportunistic Screening!

% Stage Distribution of

Carcinoma Cervix 1961 – 63

Foundation for the first ever pilot cancer control

Programme – Kanchipuram 1967, WHO

1st INTERNATIONAL

WHO CANCER CONTROL PROJECT

KANCHIPURAM 1967


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South Arcot District Level

Cervical cancer early detection project: 1992-99

Objective To integrate the screening & education

programme with the states’ permanent

health infrastructure and delivery system

This would significantly reduce cost

Trained 258 Medical officers

672 VHNs

30 Block health educators

2 cytotechnicians

Setup 2 Cytology laboratories

in Cuddalore and Villupuram

Total women examined 59314

Cancers detected 310

Early 12.3%

Late 87.7% MOTIVATION POOR


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Problems in the South Arcot Programme

  • VHN had multiple duties and received incentives for the FPP & immunization drive

  • No incentives in cancer detection programme

  • Fresh young women medical graduates – not confident

  • Compliance of women to be screened – Dependant on men folk!


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Information, Education and Health Care Intervention

IARC in collaboration with Nargis Dutt Memorial

Cancer Hospital, Barshi

Int. AreaNon Int. Area

Ca Cervix 66% 25%

Stage I & II


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Major conclusions from various Indian studies

  • Population screening not practicable

  • For Cervical cancer VIA recommended at present

  • High priority and focus on

  • Educational Programmes

  • Serious effort to integrate screening with

  • routine health delivery system

  • Introduction of opportunistic screening can be considered


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Technologic Advances

  • Enhanced Imaging

  • Enhancement in Tissue diagnosis

  • Molecular Diagnostics


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Enhanced Imaging

For evaluation of extent of disease / tumour size and tumour spread and monitor response to therapy

Ultrasound

CT Scan, Spiral CT

MRI, PET

Implications of sophisticated Imaging

Expertise in interpretation

Knowledge of relative merits of diff. available techniques

Increase in cost of diagnosis


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Molecular Markers

  • Molecular diagnostics

  • Prognostic & Predictive Markers

  • Minimal Residual Disease


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Conceptual influences in Therapeutic Oncology

  • Preventive Oncology : Based on natural history of evolution of disease

  • Definition of early disease

  • Concept of Micrometastasis

  • Evaluation of extent of disease

  • Introduction of multi disciplinary approach


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Multidisciplinary approach in

Oncologic care

  • Appreciates limitation inherent in different modalities of treatment

  • Sequencing of different modalities

  • Surgery, radiation and chemotherapy based on biologic needs

  • Different in early disease and locally advanced disease


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RESEARCH

Synthesis of clinical practice studies

&

laboratory and

research data

Essential for progress

Hereditary Cancer Clinic

only one of its kind in India - 2002


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Palliative Care:

Palliative care medicine – a speciality

A major component in cancer control

Facilities in India

Palliative care centres, hospices, hospital based centres

Domiciliary services

Andhra Pradesh 1 Tamil Nadu 5 Kerala 4

Assam 1 Uttar Pradesh 1 with 50 satellite

Chandigarh 1 Rajasthan 1 centers

Karnataka 4 Goa 1 55% of cancers

Madhya Pradesh 2 have access to

Maharashtra 3 Palliative Care

New Delhi 2

Orissa 2

Calicut Centre

WHO Demo Project

PAIN CONTROL


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INCIDENCE AND BURDEN OF CANCER$

INDIA, 2001 & 2005

$ Estimates based on urban & rural registries

Source: NCRP, ICMR Report (2004) & Individual Cancer Registry Reports


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CIRs of Cervical & Breast cancers in India

(Urban vs Rural registries)

Trend of CIR of Cervical & Breast Cancers

Urban India:1983-2002

Source: NCRP, ICMR Report (2005) & Individual Cancer Registry Reports



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Trend in survival(%) at 5 years

ALL: 0-25 Years : 1970-99 : (C.I)


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Carcinoma Breast : Survival : HBCR

All cases accepted for Treatment (All stages)

Cancer Institute(WIA), Chennai

* 9 year survival


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Testicular Germ Cell Tumour

Cancer Institute, Chennai

  • Treatment

  • Stage I : High Inguinal Orchidectomy - Observation

  • Stage II-III : High Inguinal Orchidectomy - CT

  • Role of Retroperitoneal lymphadenopathy is controversial


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Disease profile in India

Shift from communicable to

Non communicable diseases


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Health Budget and Cancer Budget (Government of India)

% of Total outlay

Health and Family Welfare 8.6% (Rs.6,283 crores)

Health 2.0% (includes cancer

Annual Rs.55 crores)

Family Welfare 6.45%

Indigenous medicine 0.18%


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Change in cancer scenario : 1955-2005

  • Improved Survival

  • Organ conservation

  • Concept of cancer prevention &

  • stress on early detection

Result of advances in Technology & conceptual influences

  • High technology involves heavy financial investment

  • Increases cost and treatment

  • Reduces affordability


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Future Directions

  • Identify individuals who have inherited or acquired defective suppressor gene

  • Identify precursor lesions & chemoprevention

  • Vaccine Based Strategies

  • Predictive Medicine – Pharmacogenomics

  • Array based methods for diagnosis, prognosis and choice of drugs for treatment


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