Lok Sabha Question No. 4412 (UNSTARRED), answered on 2019-07-19
Subject: Effective Management of Cancer Cases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Badruddin Ajmal

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

LOK SABHA UNSTARRED QUESTION NO. 4412 TO BE ANSWERED ON 19 TH JULY, 2019

## EFFECTIVE MANAGEMENT OF CANCER CASES

## 4412. SHRI M. BADRUDDIN AJMAL:

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

- (a) whether there is shortage of cancer specialists and diagnostic/treatment facilities f management of cancer cases in the country and if so, the details thereof;
- (b) the schemes/programmes being implemented by the Government for the prevention of cancer in State/UT - wise;
- (c) whether cancer survival rate in India is among the lowest in the world, and if so, thereof and the reasons therefor; and
- (d) the estimated number of cancer patients along with the number of attributable deaths rep in the country during each of the last three years and the current year, State/UT - wise?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE ( SHRI ASHWINI KUMAR CHOUBEY)

(a)& (b): Cancer is being diagnosed and treated at various levels in the Government he care  system.  While  doctors  with  D.  M.  (Medical  Oncology),  M.Ch  (Surgical  Oncology)  an M.D. (Radiation Oncology) treat Cancer patients in higher level tertiary care hospitals, Cancer i also being treated in hospitals by other Doctors such as General Surgeons, Gynecologists Surgeons etc., depending on the type and site of Cancer.

Diabetes,

To support the States/UTs for interventions upto dist rict level, the Government of India is implementing National Programme for Prevention and Control of Cancer, Cardiovascular  Diseases  and  Stroke  (NPCDCS)  under  National  Health  Mission  (NHM).  The focus  under  the  programme  is  on  common  Non - Communica ble  Diseases  (NCDs),  namely hypertension, diabetes and three common cancers (oral, breast and cervical).

In  addition,  population  based  prevention,  control,  screening  and  management hypertension, diabetes and common cancers (oral, breast and cervical) has been rolled out in more  than  215  districts  under  NHM.  Screening  of  common  NCDs  including  three  common cancers is also an integral part of service delivery under Ayushman Bharat -Health and Wellness Centre.

The Government of India is also implementing 'Strengthening of Tertiary Care Cancer facilities' Scheme under NPCDCS to assist to establish/set up State Cancer Institutes (SCI) and Tertiary Care Cancer Centres (TCCC) in different parts of the country. Oncology is one of the focus  areas  in  case  of  new  AIIMS  and  many  upgraded  institutions  under  Pradhan  Mant Swasthya Suraksha Yojna (PMSSY). Setting up of National Cancer Institute at Jhajjar (Hary and 2nd campus of Chittranjan National Cancer Institute, Ko lkata has also been approved. All these will enhance the capacity for prevention and treatment of cancer in the country.

(c): The cancer survival rate is generally believed to depend upon amongst others, sta diagnosis,  stage  of  initiation  of  treatme nt,  type  and  site  of  cancer,  correct  and  complete treatment. Cancer can be diagnosed and treated at various levels in the Health care system

According  to  an  article  'Global  surveillance  of  trends  in  cancer  survival  2000 - 14 (CONCORD - 3): published in LANCE T, there are differences in survival rates across countri The study estimates 5 -year survival for breast cancer as 88.2% in Canada, 68.78% in Thailand 76.5 % in Poland and 66.1% in India.

However,  the  coverage  of  population  in  the  study  is  reported  to vary  from  higher coverage in European Countries while it is reported to cover about 0.1 % of population i The study has indicated various reasons for variations in survival rate of cancer.

(d): As per Indian Council of Medical Research's data, the estimated number of incidence of cancer  cases  and  related  deaths  reported  during  the  last  three  years,  state/UT - wise,  are  at Annexures I andII, respectively.

| States                                                                                                              | 2016                                                                                                                | 2017                                                                                                                | 2018                                                                                                                |
|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|
| Jammu &Kashmir                                                                                                      | 15652                                                                                                               | 16480                                                                                                               | 17351                                                                                                               |
| Himachal Pradesh                                                                                                    | 8029                                                                                                                | 8348                                                                                                                | 8679                                                                                                                |
| Punjab                                                                                                              | 32474                                                                                                               | 33781                                                                                                               | 35137                                                                                                               |
| Chandigarh                                                                                                          | 1274                                                                                                                | 1335                                                                                                                | 1398                                                                                                                |
| Uttaranchal                                                                                                         | 12381                                                                                                               | 12995                                                                                                               | 13640                                                                                                               |
| Haryana                                                                                                             | 30611                                                                                                               | 32049                                                                                                               | 33558                                                                                                               |
| Delhi                                                                                                               | 20015                                                                                                               | 20899                                                                                                               | 21821                                                                                                               |
| Rajasthan                                                                                                           | 82836                                                                                                               | 86675                                                                                                               | 90686                                                                                                               |
| Uttar Pradesh                                                                                                       | 245231                                                                                                              | 257353                                                                                                              | 270053                                                                                                              |
| Bihar                                                                                                               | 130628                                                                                                              | 137656                                                                                                              | 145051                                                                                                              |
| Sikkim                                                                                                              | 479                                                                                                                 | 485                                                                                                                 | 490                                                                                                                 |
| Arunachal Pradesh                                                                                                   | 1272                                                                                                                | 1292                                                                                                                | 1313                                                                                                                |
| Nagaland                                                                                                            | 1300                                                                                                                | 1309                                                                                                                | 1318                                                                                                                |
| Manipur                                                                                                             | 2998                                                                                                                | 3082                                                                                                                | 3168                                                                                                                |
| Mizoram                                                                                                             | 1652                                                                                                                | 1687                                                                                                                | 1723                                                                                                                |
| Tripura                                                                                                             | 2199                                                                                                                | 2229                                                                                                                | 2260                                                                                                                |
| Meghalaya                                                                                                           | 3311                                                                                                                | 3376                                                                                                                | 3442                                                                                                                |
| Assam                                                                                                               | 31825                                                                                                               | 32177                                                                                                               | 32530                                                                                                               |
| West Bengal                                                                                                         | 107906                                                                                                              | 112466                                                                                                              | 117220                                                                                                              |
| Jharkhand                                                                                                           | 40959                                                                                                               | 43071                                                                                                               | 45289                                                                                                               |
| Orissa                                                                                                              | 49674                                                                                                               | 51763                                                                                                               | 53936                                                                                                               |
| Chhattisgarh                                                                                                        | 31817                                                                                                               | 33477                                                                                                               | 35223                                                                                                               |
| Madhya Pradesh                                                                                                      | 89315                                                                                                               | 93754                                                                                                               | 98403                                                                                                               |
| Gujarat                                                                                                             | 73551                                                                                                               | 77097                                                                                                               | 80820                                                                                                               |
| Daman &Diu                                                                                                          | 440                                                                                                                 | 504                                                                                                                 | 579                                                                                                                 |
| Dadra &Nagar Haveli                                                                                                 | 497                                                                                                                 | 542                                                                                                                 | 591                                                                                                                 |
| Maharashtra                                                                                                         | 132726                                                                                                              | 138271                                                                                                              | 144032                                                                                                              |
| Telangana                                                                                                           | 41939                                                                                                               | 43784                                                                                                               | 45713                                                                                                               |
| Andhra Pradesh                                                                                                      | 58072                                                                                                               | 60475                                                                                                               | 62978                                                                                                               |
| Karnataka                                                                                                           | 73511                                                                                                               | 76867                                                                                                               | 80381                                                                                                               |
| Goa                                                                                                                 | 1726                                                                                                                | 1801                                                                                                                | 1881                                                                                                                |
| Lakshadweep                                                                                                         | 89                                                                                                                  | 96                                                                                                                  | 104                                                                                                                 |
| Kerala                                                                                                              | 42004                                                                                                               | 44566                                                                                                               | 47382                                                                                                               |
| Tamil Nadu                                                                                                          | 80999                                                                                                               | 83554                                                                                                               | 86180                                                                                                               |
| Pondicherry                                                                                                         | 1596                                                                                                                | 1687                                                                                                                | 1783                                                                                                                |
| Andaman & Nicobar Islands                                                                                           | 429                                                                                                                 | 443                                                                                                                 | 458                                                                                                                 |
| Total                                                                                                               | 1451417                                                                                                             | 1517426                                                                                                             | 1586571                                                                                                             |
| Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                     | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                     | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                     | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                     |
| *Projected cancer cases for India were computed using a projected incidence rates and the population (person-years) | *Projected cancer cases for India were computed using a projected incidence rates and the population (person-years) | *Projected cancer cases for India were computed using a projected incidence rates and the population (person-years) | *Projected cancer cases for India were computed using a projected incidence rates and the population (person-years) |

Estimated Mortality of cancer cases in India, State/UT - All sites - (2016 to 2018)* - Both sexes

| States                                                                                                                                        | 2016                                                                                                                                          | 2017                                                                                                                                          | 2018                                                                                                                                          |
|-----------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------|
| Jammu &Kashmir                                                                                                                                | 7925                                                                                                                                          | 8345                                                                                                                                          | 8788                                                                                                                                          |
| Himachal Pradesh                                                                                                                              | 4048                                                                                                                                          | 4210                                                                                                                                          | 4378                                                                                                                                          |
| Punjab                                                                                                                                        | 16423                                                                                                                                         | 17084                                                                                                                                         | 17771                                                                                                                                         |
| Chandigarh                                                                                                                                    | 646                                                                                                                                           | 678                                                                                                                                           | 709                                                                                                                                           |
| Uttaranchal                                                                                                                                   | 6245                                                                                                                                          | 6556                                                                                                                                          | 6883                                                                                                                                          |
| Haryana                                                                                                                                       | 15491                                                                                                                                         | 16219                                                                                                                                         | 16983                                                                                                                                         |
| Delhi                                                                                                                                         | 10127                                                                                                                                         | 10573                                                                                                                                         | 11039                                                                                                                                         |
| Rajasthan                                                                                                                                     | 41848                                                                                                                                         | 43795                                                                                                                                         | 45829                                                                                                                                         |
| Uttar Pradesh                                                                                                                                 | 123985                                                                                                                                        | 130134                                                                                                                                        | 136579                                                                                                                                        |
| Bihar                                                                                                                                         | 66040                                                                                                                                         | 69607                                                                                                                                         | 73361                                                                                                                                         |
| Sikkim                                                                                                                                        | 242                                                                                                                                           | 245                                                                                                                                           | 248                                                                                                                                           |
| Arunachal Pradesh                                                                                                                             | 649                                                                                                                                           | 659                                                                                                                                           | 670                                                                                                                                           |
| Nagaland                                                                                                                                      | 667                                                                                                                                           | 672                                                                                                                                           | 676                                                                                                                                           |
| Manipur                                                                                                                                       | 1500                                                                                                                                          | 1542                                                                                                                                          | 1585                                                                                                                                          |
| Mizoram                                                                                                                                       | 841                                                                                                                                           | 859                                                                                                                                           | 878                                                                                                                                           |
| Tripura                                                                                                                                       | 1125                                                                                                                                          | 1140                                                                                                                                          | 1156                                                                                                                                          |
| Meghalaya                                                                                                                                     | 1710                                                                                                                                          | 1744                                                                                                                                          | 1777                                                                                                                                          |
| Assam                                                                                                                                         | 16206                                                                                                                                         | 16383                                                                                                                                         | 16561                                                                                                                                         |
| West Bengal                                                                                                                                   | 54443                                                                                                                                         | 56750                                                                                                                                         | 59154                                                                                                                                         |
| Jharkhand                                                                                                                                     | 20671                                                                                                                                         | 21741                                                                                                                                         | 22864                                                                                                                                         |
| Orissa                                                                                                                                        | 25035                                                                                                                                         | 26091                                                                                                                                         | 27190                                                                                                                                         |
| Chhattisgarh                                                                                                                                  | 16030                                                                                                                                         | 16868                                                                                                                                         | 17751                                                                                                                                         |
| Madhya Pradesh                                                                                                                                | 45110                                                                                                                                         | 47358                                                                                                                                         | 49713                                                                                                                                         |
| Gujarat                                                                                                                                       | 37182                                                                                                                                         | 38983                                                                                                                                         | 40873                                                                                                                                         |
| Daman &Diu                                                                                                                                    | 229                                                                                                                                           | 263                                                                                                                                           | 303                                                                                                                                           |
| Dadra &Nagar Haveli                                                                                                                           | 254                                                                                                                                           | 276                                                                                                                                           | 301                                                                                                                                           |
| Maharashtra                                                                                                                                   | 67035                                                                                                                                         | 69843                                                                                                                                         | 72762                                                                                                                                         |
| Telangana                                                                                                                                     | 21126                                                                                                                                         | 22058                                                                                                                                         | 23033                                                                                                                                         |
| Andhra Pradesh                                                                                                                                | 29244                                                                                                                                         | 30458                                                                                                                                         | 31725                                                                                                                                         |
| Karnataka                                                                                                                                     | 37052                                                                                                                                         | 38747                                                                                                                                         | 40523                                                                                                                                         |
| Goa                                                                                                                                           | 870                                                                                                                                           | 908                                                                                                                                           | 948                                                                                                                                           |
| Lakshadweep                                                                                                                                   | 45                                                                                                                                            | 48                                                                                                                                            | 53                                                                                                                                            |
| Kerala                                                                                                                                        | 21062                                                                                                                                         | 22348                                                                                                                                         | 23761                                                                                                                                         |
| Tamil Nadu                                                                                                                                    | 40796                                                                                                                                         | 42091                                                                                                                                         | 43422                                                                                                                                         |
| Pondicherry                                                                                                                                   | 802                                                                                                                                           | 848                                                                                                                                           | 895                                                                                                                                           |
| Andaman & Nicobar Islands                                                                                                                     | 217                                                                                                                                           | 224                                                                                                                                           | 232                                                                                                                                           |
| Total                                                                                                                                         | 732921                                                                                                                                        | 766348                                                                                                                                        | 801374                                                                                                                                        |
| Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                                               | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                                               | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                                               | Ref: Three-year Report of the PBCRs: 2012-2014, Bengaluru, 2016                                                                               |
| *Projected mortality cases for India were computed by applying Mumbai Mortality/Incidence (MI) ratio to the projected incidence cancer cases. | *Projected mortality cases for India were computed by applying Mumbai Mortality/Incidence (MI) ratio to the projected incidence cancer cases. | *Projected mortality cases for India were computed by applying Mumbai Mortality/Incidence (MI) ratio to the projected incidence cancer cases. | *Projected mortality cases for India were computed by applying Mumbai Mortality/Incidence (MI) ratio to the projected incidence cancer cases. |