Cancer has emerged as the leading cause of deaths in India surpassing heart diseases. With an estimated 1,300 deaths every day recorded in 2014, there has been a 2.8% increase in cancer mortality rates from 2013 to 2014. The World Health Organization (WHO) projects annual cancer related deaths in India to rise to 13.1 million by the year 2030.
The global cancer diagnostic technology market is expected to grow at a CAGR (Compound Annual Growth Rate) of 12.9% between 2015 and 2020 to US$13.1 billion fueled mainly by increasing demands in India and China. The most frequent occurrences of cancer in men in India are head and neck related, whereas cervix uteri and breast cancer is most prevalent among women. In 2013, there were 1.17 million cancer cases detected in India and a total of 675,200 deaths recorded. Cancer in children on the other hand is very rare and biologically different from its manifestation in adults. As of 2013, paediatric cancer incidence is more than 160,000 with an estimated 90,000 annual deaths.
If detected early, cancer treatment is more effective, and less costly. However, 70% of cancer diagnosis happens in advanced stages rendering medical interventions more expensive and survival less likely. Although the reported cases of cancer in India are steadily on the rise, a large number go undetected primarily due to limited accessibility to diagnostic interventions. In the past, costs associated with various screening and diagnostic interventions rendered patients rather apprehensive about getting checked out for cancer. There are new cost-effective screening technologies available today. However, these technologies are accessible to only a section of the population in specific areas and remain out of reach for most of the population.
Lack of awareness of cancer diagnostics and prevalent patient practices to seek medical help for disease management are significant contributory factors towards the low diagnostic rates. Women between 40 and 69 need to undergo routine checks for breast cancer. However in 2014, only 1% of Indian women falling in that age group actually underwent screening, in contrast to 30% in China and 65% in the US. The relatively low accessibility to such early diagnostic interventions was also a key factor. As of 2014, there were only 2,700 mammograms installed in India and even those are mainly clustered around urban centers, which is less than 5% of the total in the US. It is estimated that 80% of all bio-medical devices used in India are imported, particularly higher end products that include cancer diagnostics and medical imaging, with US manufacturers having a quarter of the market share. This renders limited access to such devices for small hospitals and other establishments in India, as manufacturers often don’t cater to their needs
Some sections of the Indian society still remain susceptible to myths, alternative treatment and unusual illogical beliefs and fall prey to seeking remedies from non-certified medical professionals. A factor influencing this decision is also related to the projected costs and with cancer interventions being relatively expensive, these remain appealing alternatives. False medical practitioners outnumbered MBBS qualified doctors in urban areas in India. This problem is more pronounced in rural areas in India where 92% of cancer diagnosis is done by private doctors, incidentally 79% of who are not allopathic certified medical practitioners. This is an area of concern particularly in cancer diagnosis because it can not only result in unnecessary costs, but also contribute towards further deterioration of a patient’s health due to delayed effective medical intervention and undermine any efforts to improve diagnosis.
Outlook and Implications
The lack of investment in diagnostic equipment and infrastructure and its uneven penetration across different geographic regions is a key contributing factor towards the low cancer detection rates. Better diagnostic infrastructure and a structured screening program is extremely critical in ensuring that patients are detected early in the disease pathway and are thus treated more effectively. It is also important to highlight that pharmaceutical companies need to work with diagnostic service providers so that outcomes attached to a particular pharmaceutical intervention can be better managed, which will in-turn improve access and uptake of those products.
There are a number of initiatives in India aimed at increasing cancer awareness and targeting early cancer detection for accessing effective medical as well as cost-effective interventions. These include frequent cancer awareness drives across the country as well as the mobile cancer detection camps initiated by the Indian Cancer Society, a novel idea to address the needs of people who have restricted access to diagnostic interventions. However, the current Government’s recent reduction in healthcare budget raises some serious questions. In a country like India, which has made slow progress in bringing up diagnosis rates (even though they are far below than those in other countries), lack of Government support at this critical juncture could completely stifle the progress made so far.