India has been dubbed the ‘cancer capital of the world’ by various reports, the latest one by Apollo Hospitals earlier this year. This is not without a reason, though. Not only has there been a sharp rise in the number of cancer cases in India, but their average age of incidence has also gotten significantly younger.
To put things into perspective, the average age of diagnosis of breast cancer in India is 52 years, while it is 63 in the US and Europe. For lung cancer, the average age is 59 years, while in Western countries, it is around 70 years. Around 30% of colon cancer patients are aged less than 50 years.
As per the World Health Organization (WHO), India registered 1.4 million new cancer cases and over 910,000 deaths due to the disease in 2022, with breast cancer being the most common. It also calculated that in India, the chances of developing cancer before turning 75 years was 10.6%, while the risk of dying from the diseases by the same age was 7.2%. Globally, these figures were 20% and 9.6%, respectively.
Ironically, despite the frightening figures, cancer screening rates in India remain very low, with people being somewhat less concerned about developing the disease in their lifetime as compared to the global average. The 2020 UICC global survey found that only 43% of respondents in India indicated that they were concerned or somewhat concerned about developing cancer in their lifetime compared to a global average of 58%. In India, breast, oral cavity, and cervix-uteri are the first, second, and third most common sites of cancers among both sexes and all ages, contributing to about 463,305 cases as of 2022.
Incidentally, the National Family Health Survey (NFHS)-5 report for the period of 2019-2021 said that cervical cancer screening in India is merely 1.9% as against 73% in the US, 70% in the UK, and 43% in China. Breast cancer screening in India stands at 0.9% as against 82% in the USA, 70% in the UK, and 23% in China. Among women, oral cavity screening is 0.9% and for men, it is 1.2%. It is needless to say the cancer screening process is a no-brainer exercise if we have to make an early diagnosis to deal with the perils of this silent epidemic.
Dr Vaibhav Choudhary, consultant of medical oncology at Mumbai’s Kokilaben Dhirubhai Ambani Hospital underscores its importance: “Cancer screening looks for early indicators of the disease in patients who are asymptomatic. It can help identify cancers at an early stage when treatment is more likely to be successful. Certain screenings may prevent cancer before it even starts.” For instance, changes in the cervix that can be addressed before they cause cancer can be found by cervical screening, he says.
“Detecting cancer early results in less aggressive treatment and a higher chance of recovery. Some screening tests can detect pre-cancerous lesions which can be treated before they turn into cancer,” points out Dr Shashi Rakheja, senior consultant of preventive oncology at Delhi’s Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC).
What about late-stage diagnosis? “Late-stage diagnoses typically result in management focused on symptomatic relief and palliative care, which may not provide the same benefits as early intervention. Therefore, proactive screening is essential for increasing survival rates and maintaining a better quality of life for patients,” explains Dr Xavier Thomas Manjooran, chief of lab at Thrissur’s Metropolis Healthcare.
Proactive measures
Several statistics say that in India, one in nine people is likely to develop cancer in their lifetime. This underscores the importance of awareness and proactive measures. Screening methods can include serological (blood tests), radiological (scans), and clinical examinations, often in combination for optimal results.
Breast cancer: Women over 40 years of age should have biannual mammograms. Some doctors say regular clinical breast examinations should be done every one to two years. Those with a family history may need earlier screening and BRCA (BReast CAncer gene) testing to assess genetic risk. This gene has been found to impact a person’s chances of developing breast cancer.
Prostate cancer: Men over 50 years of age should undergo prostate-specific antigen (PSA) blood testing. Early screening might be necessary for those with a family history. Doctors also recommend annual digital rectal examinations after the age of 45 years in men.
Colorectal cancer: Colonoscopy is recommended every three years for both men and women starting at 50 years, although earlier screening may be needed for individuals with risk factors. Screening should occur every 10 years or more frequently if abnormalities are found. Other colorectal (colon) cancer screening tests include fecal tests for occult blood, sigmoidoscopy, and virtual colonoscopy.
Cervical cancer: Co-testing with liquid-based pap smears and human papillomavirus (HPV) DNA testing is advised for women of reproductive age to identify risks. Pap smear tests are recommended for females between ages 21-29 every three years. For those aged 30 years and older, along with pap smear tests, HPV tests are recommended every five years.
Blood cancers: A complete blood count with a peripheral smear can help detect various hematological malignancies.
Lung cancer: To date, only one form of lung cancer screening — low-dose computed tomography (CT-LDCT) — appears to decrease the risk of dying from lung cancer in high-risk populations. CT-LDCT is recommended for adults aged 50 years and above with a history of smoking.
Oral cancer: Complete oral examination is recommended for men and women. No single oral exam or oral cancer screening test is proven to reduce the risk of dying of oral cancer.
Ovarian cancer: There aren’t any screening tests for ovarian cancer. Healthcare providers may order CA-125 assay (blood test) and genetic testing for women and people with an increased risk of ovarian cancer. They may also recommend tumour marker CA-125 for ovarian cancer, transvaginal scan, and ultrasound pelvis to see the uterus and ovaries.
Skin cancer: Regular skin checkups are advised especially for those with a high risk, for example, fair skin people or there is a history of sunburn.
Liver cancer: Ultrasound, CT scan, and alpha-fetoprotein (AFP) tumour markers are generally recommended to test for liver cancer. AFP is the most widely used tumour marker for detecting liver cancer.
Effective cancer screening usually involves a combination of blood tests, imaging studies, and thorough clinical examinations. Relying on a single modality can miss important indicators, so a comprehensive approach is essential for accurate detection and timely intervention, warn experts.
Who should be wary
Cancer screening is offered at ages when the benefits are biggest, and the harms are smallest, says Dr Choudhary of Kokilaben hospital. So, any healthy individual in the prescribed age-specific subgroup is eligible for a particular cancer screening test. People who are younger than the screening age are usually at a lower risk for that type of cancer. “Normally, you can’t be screened for cancer before the age the programme starts. If you are at higher risk, you may be able to start screening earlier. For example, if you have a family history of breast or bowel cancer,” he adds.
Experts say while age 50 is often used as a general cutoff for many screenings, it’s important to consider individual risk factors, family history, and specific cancer types, as guidelines can vary. Individuals with certain lifestyle risk factors, for example, smokers for lung cancer, heavy alcohol users for liver cancer, and individuals with a family history of cancers or genetic predisposition should get screened earlier and more frequently.
Medical experts acknowledge that cancer screening may have some fallouts but the overall reliability depends on several factors such as the type of cancer, the method used, and individual patient characteristics such as age, family history, and lifestyle.
“Cancer screening is generally reliable but not infallible. No screening test is 100% accurate,” says Dr Rakheja of RGCIRC. A healthy person may receive an abnormal test which is a false positive. They are subjected to further investigations leading to anxiety and potential complications of investigations. It can also mean people have follow-up tests they don’t need, which may have side effects, points out Dr Choudhary of Kokilaben hospital.
Screening can pick up harmless cancers that wouldn’t cause any problems, even if they were never found (overdiagnosis). This is different from a false-positive result. People with these harmless cancers may have treatment they don’t need, as their cancer would never have caused symptoms. It is also possible that the person with the condition may get a normal test or false negative which can make them ignore their symptoms and eventually result in a delayed diagnosis. Despite these challenges, Dr Manjooran of Metropolis Healthcare emphasises that regular screening is strongly recommended, as early detection significantly enhances treatment options and outcomes.
Signs and Symptoms
Colorectal cancer: Constipation or diarrhoea that doesn’t go away, or change in how your stools look, blood in stool, persistent abdominal discomfort, unexplained weight loss
Prostate cancer: Difficulty in urination, increased frequency of urination, especially at night, or blood in urine, prostatic enlargement
Breast cancer: Any new lumps or changes in the breast tissue, including swelling or changes in shape, texture, or skin appearance
Skin cancer: Changes in moles, such as enlarging, altering in colour, or irregular borders, as well as new growths or chronic ulcers that do not heal
Screening Options
Population-based screening for cervical, breast, and oral cancers implemented under the National Health Mission, available in govt hospitals for free or at a nominal cost
Various private hospitals have specific cancer screening packages for common cancers at affordable rates.
Average cost of cancer screening in India is approximately Rs 5,000 to Rs 30,000
Prices may vary depending on hospitals in different cities; mammogram may cost Rs 1,000 to Rs 5,000, pap smear Rs 500 to Rs 1,500.
Many healthcare centres run cancer screening camps at no cost or have cancer screening packages at subsidised rates.
Many labs offer comprehensive health packages that cover a range of markers related to various organs, often starting from around Rs 8,000