Lok Sabha Question No. 2212 (UNSTARRED), answered on 2017-07-28
Subject: Prevention and Early Detection of Cancer
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SANTOKH SINGH CHAUDHARY, NIHAL CHAND CHAUHAN, KAUSHALENDRA KUMAR

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 2212 TO BE ANSWERED ON 28 TH JULY, 2017

## PREVENTION AND EARLY DETECTION OF CANCER

## 2212. SHRI SANTOKH SINGH CHAUDHARY: SHRI NIHAL CHAND: SHRI KAUSHALENDRA KUMAR:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the details of different type of cancer cases and attributable deaths recorded in the country, State/UT - wise;
- (b) whether as per WHO, cancer deaths are preventable if diagnosed at an early stage and if so, the details thereof;
- (c)  whether  a  number  of  cancer  cases are  detected  at  an  advanced  stage  due  to shortage  of Primary Screening Centres (PSCs) and if so, the details thereof;
- (d) whether the Government proposes to increase the number of PSCs and doctor patient ratio in these PSCs in the country and if so, the steps taken by the Government in this regard, State/UT -wise;and
- (e) the details of schemes/programmes launch ed/proposed to be launched and funds allocated for prevention and treatment of Cancer, State/UT - wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SMT. ANUPRIYA PATEL )

- (a): As per Indian Council of Medical Research's Cancer registry data; the estimated number of  incidence  and  mortality  of  cancer  cases  in  the  country  during  2016,  State/UT - wise  are  at Annexure I & II respectively.
- (b): As per World Health Organisation(WHO) Fa ct Sheet dated Feb 2017; 'Around 30 - 50% of  cancers  can  be  prevented.  This  can  be  accomplished  by  avoiding  risk  factors implementing  existing  evidence - based  prevention  strategies.  The  cancer  burden  can  also  be reduced through early detection of cancer a nd management of patients who develop cancer'.
- (c) to (e) : Cancer can be diagnosed and treated at various levels in the Health Care sys Many of the patients present themselves at advanced stages due to various factors.

The National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular  Diseases  and  Stroke  (NPCDCS)  is  being  implemented  under  National  Health Mission  (NHM)  up  to  district  level  interventions  in  36  States/UTs.  The  programme  incl health promotion activities, op portunistic screening, and control of Non Communicable Diseases (NCDs) including cancer.  The program focuses on opportunistic screening for common NCDs at District hospital and Community Health Centre levels, through the setting up of NCD c As inf ormed by the States, 419 District NCD Clinics and 2116 CHC NCD Clinics have been se up till June, 2017.

Since 2015 - 16  funds are released to States/UTs under NCD Flexipool for programmes including NPCDCS. Funds released position for NCD Flexipool for 201 7- 18 is at Annexure III.

In view of the increasing incidence and mortality linked with NCDs (including canc MoHFW  has  launched  the  initiative  of  upgrading  the  existing  Sub  centers  to  Health Wellness Centres(HWC), in the year 2016.  The HWCs would provide expanded package of services  related  to  Non - Communicable  Diseases,  Mental  health,  ENT,  Opthalmology,  Oral health, Geriatric and palliative health care and Trauma care, in addition to the existin (Reproductive Child Health and communicabl e diseases).   The HWC team would comprise of existing Sub - Health Centre team i.e, Multi Purpose Worker (Male and Female) and Accredited Social Health Activists (ASHAs) with an additional skilled Human Resources in Health -a Midlevel Provider (Ayurvedic doctor or Nurse).

Population based screening of common NCDs, hypertension and cancers (Oral, Breast and Cervical cancer) has also been initiated under NHM. Key components of population ba screening of NCDs include community based risk assessment, sc reening, referral, and follow up of all individuals of 30 years and above for selected NCDs (hypertension, diabetes, oral breast cancer and cervical cancer).

Government of India is implementing Strengthening of Tertiary Care for Cancer sche under  National  Programme  for  Prevention  and  Control  of  Cancer,  Diabetes,  Cardiovascul Diseases and Stroke (NPCDCS). Under the scheme, it is envisaged to support the establish of State Cancer Institutes (SCIs) and  Tertiary Care Cancer Centres (TCCCs) in different parts of the country. The maximum permissible assistance for SCI is Rs.120 crores and for TCCC Rs.45 crores, which includes State share of 40%, except for North - Eastern and Himalayan States where  the  State  share  is  10%.  The  broad  objective  of the  scheme  is  to  develop  capacity  for tertiary care for cancer in all States so as to provide universal access for comprehens care. SCIs and TCCCs will mentor all cancer related activities in their respective region The details of funds released under the said scheme from 2014 - 15 onwards is at Annexure - IV.

## ANNEXURE - I

## Estimated Incidence of cancer cases in India State/UT-wise - All sites - (2016) - Both sexes

| States                    |    2016 |
|---------------------------|---------|
| Jammu &Kashmir            |   15652 |
| Himachal Pradesh          |    8029 |
| Punjab                    |   32474 |
| Chandigarh                |    1274 |
| Uttaranchal               |   12381 |
| Haryana                   |   30611 |
| Delhi                     |   20015 |
| Rajasthan                 |   82836 |
| Uttar Pradesh             |  245231 |
| Bihar                     |  130628 |
| Sikkim                    |     479 |
| Arunachal Pradesh         |    1272 |
| Nagaland                  |    1300 |
| Manipur                   |    2998 |
| Mizoram                   |    1652 |
| Tripura                   |    2199 |
| Meghalaya                 |    3311 |
| Assam                     |   31825 |
| West Bengal               |  107906 |
| Jharkhand                 |   40959 |
| Orissa                    |   49674 |
| Chhattisgarh              |   31817 |
| Madhya Pradesh            |   89315 |
| Gujarat                   |   73551 |
| Daman &Diu                |     440 |
| Dadra &Nagar Haveli       |     497 |
| Maharashtra               |  132726 |
| Telangana                 |   41939 |
| Andhra Pradesh            |   58072 |
| Karnataka                 |   73511 |
| Goa                       |    1726 |
| Lakshadweep               |      89 |
| Kerala                    |   42004 |
| Tamil Nadu                |   80999 |
| Pondicherry               |    1596 |
| Andaman & Nicobar Islands |     429 |
| Total                     | 1451417 |

| Estimated Mortality of cancer cases in India State/UT-wise - All sites - (2016)- Both sexes   | Estimated Mortality of cancer cases in India State/UT-wise - All sites - (2016)- Both sexes   |
|-----------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------|
| States                                                                                        |                                                                                               |
| Jammu &Kashmir                                                                                | 7925                                                                                          |
| Himachal Pradesh                                                                              | 4048                                                                                          |
| Punjab                                                                                        | 16423                                                                                         |
| Chandigarh                                                                                    | 646                                                                                           |
| Uttaranchal                                                                                   | 6245                                                                                          |
| Haryana                                                                                       | 15491                                                                                         |
| Delhi                                                                                         | 10127                                                                                         |
| Rajasthan                                                                                     | 41848                                                                                         |
| Uttar Pradesh                                                                                 | 123985                                                                                        |
| Bihar                                                                                         | 66040                                                                                         |
| Sikkim                                                                                        | 242                                                                                           |
| Arunachal Pradesh                                                                             | 649                                                                                           |
| Nagaland                                                                                      | 667                                                                                           |
| Manipur                                                                                       | 1500                                                                                          |
| Mizoram                                                                                       | 841                                                                                           |
| Tripura                                                                                       | 1125                                                                                          |
| Meghalaya                                                                                     | 1710                                                                                          |
| Assam                                                                                         | 16206                                                                                         |
| West Bengal                                                                                   | 54443                                                                                         |
| Jharkhand                                                                                     | 20671                                                                                         |
| Orissa                                                                                        | 25035                                                                                         |
| Chhattisgarh                                                                                  | 16030                                                                                         |
| Madhya Pradesh                                                                                | 45110                                                                                         |
| Gujarat                                                                                       | 37182                                                                                         |
| Daman &Diu                                                                                    | 229                                                                                           |
| Dadra &Nagar Haveli                                                                           | 254                                                                                           |
| Maharashtra                                                                                   | 67035                                                                                         |
| Telangana                                                                                     | 21126                                                                                         |
| Andhra Pradesh                                                                                | 29244                                                                                         |
| Karnataka                                                                                     | 37052                                                                                         |
| Goa                                                                                           | 870                                                                                           |
| Lakshadweep                                                                                   | 45                                                                                            |
| Kerala                                                                                        | 21062                                                                                         |
| Tamil Nadu                                                                                    | 40796                                                                                         |
| Pondicherry                                                                                   | 802                                                                                           |
| Andaman & Nicobar Islands Total                                                               | 217 732921                                                                                    |

State-wise Release of fund under  N C D  Flexi Pool during the year 2017-18 (UP to 30.06.17 )

(Rs. in Lakhs)

| Si. No.   | State/UT         |   Amount Released |
|-----------|------------------|-------------------|
| 1         | Chhattisgarh     |              1167 |
| 2         | Madhya Pradesh   |              4174 |
| 3         | Odisha           |              1536 |
| 4         | Himachal Pradesh |               509 |
| 5         | Jammu &Kashmir   |              1146 |
| 6         | Gujarat          |              2487 |
| 7         | Haryana          |               593 |
| 8         | Karnataka        |              1661 |
| 9         | West Bengal      |              1945 |
| 10        | Pondicherry      |               112 |
| Total     | Total            |             15330 |

State-wise funds released for setting up/establishing State Cancer Institutes (SCIs) and Tertiary  Care  Cancer  Centres  (TCCCs)  under  Tertiary  Care  of  Cancer  component  of National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS):

## (1) Funds released during the financial year 2014-15:

| No.   | State/UTs      | Name of the Institute                                  | SCI/ TCCC   |   Amount Released (in Crore) |
|-------|----------------|--------------------------------------------------------|-------------|------------------------------|
| 1     | Karnataka      | Kidwai Memorial Institute of Oncology(RCC), Bangaluru  | SCI         |                        67.5  |
| 2     | Kerala         | Government Medical College, Kozhikode                  | TCCC        |                        25.03 |
| 3     | Tripura        | Cancer Hospital(RCC), Agartala                         | SCI         |                        55    |
| 4     | Gujarat        | Gujarat Cancer Research Institute, Ahmedabad           | SCI         |                        67.5  |
| 5     | West Bengal    | Government Medical College, Burdwan                    | TCCC        |                        22.24 |
| 6     | Jammu& Kashmir | Sher-i-Kashmir Institute of Medical Sciences, Srinagar | SCI         |                        47.25 |
| 7     | Tamil Nadu     | Cancer Institute (RCC) Adyar, Chennai                  | SCI         |                        67.38 |
| Total | Total          | Total                                                  | Total       |                       351.9  |

## (2) Funds released during the financial year 2015-16:

| S No.   | State/UTs        | Name of the Institute                                             | SCI/ TCCC   |   Amount Released (in Crore) |
|---------|------------------|-------------------------------------------------------------------|-------------|------------------------------|
| 1       | Himachal Pradesh | Indira Gandhi Medical College, Shimla                             | TCCC        |                       14.87  |
| 2       | Bihar            | Indira Gandhi Institute of Medical Sciences, Patna                | SCI         |                       33.06  |
| 3       | Mizoram          | Civil Hospital, Aizawl                                            | TCCC        |                       14.64  |
| 4       | Uttar Pradesh    | Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow | TCCC        |                       11.43  |
| 5       | Rajasthan        | S P Medical College, Bikaner                                      | TCCC        |                       17.123 |
| 6       | Karnataka        | Mandya Institute of Medical Sciences                              | TCCC        |                       17.257 |
| 7       | Telangana        | MNJ Institute of Oncology& RCC, Hyderabad                         | SCI         |                       18.12  |
| Total   | Total            | Total                                                             | Total       |                      126.5   |

## (3) Funds released during the financial year 2016-17:

| S No   | State/ UTs   | Name of the Institute                                                  | SCI/ TCCC   |   Amount Released (in Crore) |
|--------|--------------|------------------------------------------------------------------------|-------------|------------------------------|
| 1      | Kerala       | Regional Cancer Centre, Thiruvananthapuram                             | SCI         |                      46.957  |
| 2      | Punjab       | Govt. Medical College, Amritsar                                        | SCI         |                      51.58   |
| 3      | Delhi        | Lok Nayak Hospital                                                     | TCCC        |                      25.4    |
| 4      | Punjab       | District / Civil Hospital, Fazilka                                     | TCCC        |                      20.119  |
| 5      | Odisha       | Acharya Harihar Regional Cancer Centre, Cuttack                        | SCI         |                      35.829  |
| 6      | Nagaland     | District Hospital, Kohima                                              | TCCC        |                      13.23   |
| 7      | Haryana      | Civil Hospital, Ambala Cantt                                           | TCCC        |                       9.2253 |
| 8      | West Bengal  | Murshidabad Medical College & Hospital, Berhampore, Murshidabad        | TCCC        |                      10.9793 |
| 9      | Maharashtra  | Rashtra Sant Tukdoji Regional Cancer Hospital& Research Centre, Nagpur | TCCC        |                      15.3196 |
| 10     | Rajasthan    | SMS Medical College, Jaipur                                            | SCI         |                      40.6683 |
| 11     | Assam        | Gauhati Medical College &Hospital, Guwahati                            | SCI         |                       8.43   |
| Total  | Total        | Total                                                                  | Total       |                     277.738  |

## (4) Funds released during the financial year 2017-18 (till date):

| S No   | State/ UTs     | Name of the Institute                                    | SCI/ TCCC   |   Amount Released (in Crore) |
|--------|----------------|----------------------------------------------------------|-------------|------------------------------|
| 1      | Rajasthan      | Jhalawar Medical College &Hospital, Jhalawar             | TCCC        |                       19.755 |
| 2      | Maharashtra    | Government Medical College & Cancer Hospital, Aurangabad | SCI         |                       43.515 |
| 3      | Madhya Pradesh | G. R. Medical College, Gwalior                           | TCCC        |                       18.9   |
| 4      | Maharashtra    | Vivekananda Foundation &Research Centre, Latur           | TCCC        |                       20.25  |
| Total  | Total          | Total                                                    | Total       |                      102.42  |

| No. of SCI                          |      13 |
|-------------------------------------|---------|
| No. of TCCC                         |  16     |
| Total funds released (Rs. in Crore) | 858.558 |