Lok Sabha Question No. 2706 (UNSTARRED), answered on 2023-08-04
Subject: Nasopharyngeal and Gallbladder Cancer cases in North-East Region
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Pradyut Bordoloi

## GOVERNMENT OFINDIA MINISTRYOF HEALTH AND FAMILYWELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2706 TO BE ANSWERED ON 4 th AUGUST, 2023

## NASOPHARYNGEALAND GALLBLADDER CANCER CASES IN NORTH-EAST REGION

## 2706. SHRI PRADYUT BORDOLOI:

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

- (a) whether the Government plans to address the rising Cancer cases in the North-East and if so, the details thereof;
- (b) the specific opportunities for collaboration between the Government, private sector and civil society to address the rising Cancer cases in the North-East;
- (c) the specific risk factors for nasopharyngeal Cancer in the North-East;
- (d) the steps taken/proposed to be taken by the Government to address the risk of Arsenic in potable water increasing the risk of Gallbladder Cancer along with the specific Cancer incidence rates in each State of the North-East;
- (e) the update on the status of establishing PET-CT scan facilities in Government hospital BBCI in North-east including the reasons behind the delay despite assurances; and
- (f) the outline of their strategy for ensuring affordable Cancer treatment to North-east Indians?

## ANSWER THE MINISTER OFSTATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (PROF. SATYA PAL SINGH BAGHEL)

(a) to (f): As per the Indian Council of Medical Research- National Centre for Disease Informatics and Research (ICMR-NCDIR) National Cancer Registry Programme (NCRP), the estimated number of incidences of cancer cases in the North East States is given below:

| Estimated incidence of cancer cases in Nort East States - (ICD10: C00-C97) - (2020-2022) - both sexes   |   Estimated incidence of cancer cases in Nort East States - (ICD10: C00-C97) - (2020-2022) - both sexes |   Estimated incidence of cancer cases in Nort East States - (ICD10: C00-C97) - (2020-2022) - both sexes |   Estimated incidence of cancer cases in Nort East States - (ICD10: C00-C97) - (2020-2022) - both sexes |
|---------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------|
| State                                                                                                   |                                                                                                    2020 |                                                                                                    2021 |                                                                                                    2022 |
| Arunachal Pradesh                                                                                       |                                                                                                    1035 |                                                                                                    1064 |                                                                                                    1087 |
| Assam                                                                                                   |                                                                                                   37880 |                                                                                                   38834 |                                                                                                   39787 |
| Manipur                                                                                                 |                                                                                                    1899 |                                                                                                    2022 |                                                                                                    2097 |
| Meghalaya                                                                                               |                                                                                                    2879 |                                                                                                    2943 |                                                                                                    3025 |
| Mizoram                                                                                                 |                                                                                                    1837 |                                                                                                    1919 |                                                                                                    1985 |
| Nagaland                                                                                                |                                                                                                    1768 |                                                                                                    1805 |                                                                                                    1854 |
| Sikkim                                                                                                  |                                                                                                     445 |                                                                                                     465 |                                                                                                     496 |
| Tripura                                                                                                 |                                                                                                    2574 |                                                                                                    2623 |                                                                                                    2715 |

The Department of Health & Family Welfare, Government of India, provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of NonCommunicable Diseases (NP-NCD), as part of National Health Mission (NHM), based on the proposals received from the States/UTs and subject to the resource envelope. Cancer is an integral part of NP-NCD. The programme focusses on strengthening infrastructure, human resource development, health promotion & awareness generation for Cancer prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the Non-Communicable Diseases (NCDs), including Cancer. For activities upto District level and below, states are given financial assistance under NHM in the ratio of 60:40 (90:10 in case NE and hilly states). The infrastructure status related to NP-NCD Programme in North -Eastern Region till 31 st March 2023:

| S. No.   | State/UT          | No. of Facilities (Cumulative till March-2023)   | No. of Facilities (Cumulative till March-2023)   |
|----------|-------------------|--------------------------------------------------|--------------------------------------------------|
| S. No.   | State/UT          | District NCD Clinics                             | CHCNCD Clinics                                   |
| 1        | Arunachal Pradesh | 25                                               | 53                                               |
| 2        | Assam             | 33                                               | 178                                              |
| 3        | Manipur           | 16                                               | 18                                               |
| 4        | Meghalaya         | 11                                               | 28                                               |
| 5        | Mizoram           | 8                                                | 10                                               |
| 6        | Nagaland          | 11                                               | 15                                               |
| 7        | Sikkim            | 4                                                | 2                                                |
| 8        | Tripura           | 7                                                | 22                                               |
| Total    | Total             | 115                                              | 326                                              |

A population-based initiative for prevention, control and screening for common NCDs i.e. diabetes, hypertension and common cancers has been rolled out in the country under NHM and also as a part of Comprehensive Primary Health Care. Under the initiative, persons more than 30 years of age are targeted for their screening for the three common cancers i.e oral, breast and cervical. Screening of these common cancers is an integral part of service delivery under Ayushman Bharat -Health and Wellness Centres.

Preventive aspect of Cancer is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about Cancer and for promotion of healthy lifestyle includes observation of National Cancer Awareness Day& World Cancer Day and use of print, electronic and social media for continued community awareness. Furthermore, healthy eating is also promoted through Food Safety and Standards Authority of India (FSSAI). Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by Ministry of AYUSH. In addition, NP-NCD gives financial support under NHM for awareness generation (IEC) activities for Cancer to be taken by the States/UTs as per their Programme Implementation Plans (PIPs).

The Central Government implements Strengthening of Tertiary Cancer Care Centres Facilities Scheme in order to enhance the facilities for tertiary care of cancer. 19 State Cancer Institutes (SCIs) and 20 Tertiary Cancer Care Centres (TCCCs) have been approved under the said scheme. Seventeen facilities are functional so far. Out of which, five institutes in North -East are approved.

1. Gauhati Medical College & Hospital, Assam (SCI)
2. State Cancer Institute, Aizwal, Mizoram (TCCC)
3. District Hospital, Kohima, Nagaland (TCCC)
4. Multispecialty Hospital at Sochygang, Sikkim (TCCC)
5. Cancer Hospital, Agartala, Tripura (SCI)

There is also focus on Oncology in its various aspects in case of AIIMS in Guwahati, Assam under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY). The Government of Assam and Tata Trusts entered into an MoU to develop a step-down cancer care model named Distributed Cancer Care Model (DCCM) with a vision to create patient centric cancer institutions to deliver standardized and affordable care closer to patient ' s home. National Cancer Grid, Tata Memorial Centre is offering technical assistance to various hospitals in North-East apart from directly working with the State Governments.

Cancer is diagnosed and treated at various levels in the health care facilities. The treatment in Government Hospitals is either free or highly subsidized for the poor and needy. Treatment of Cancers is also available under Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (PMJAY). Besides, quality generic medicines are made available at affordable prices to all, under Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) in collaboration with the State Governments. Affordable Medicines and Reliable Implants for Treatment (AMRIT) Pharmacy stores have been set up in some hospitals/institutions, with an objective to make available Cancer drugs at a substantial discount vis-àvis the Maximum Retail Price.

As per a study conducted by National Centre for Disease Informatics Research (NCDIR), the risk factors associated with nasopharyngeal cancer are smoked food, smoked and smokeless tobacco, poorly ventilated houses, consumption of nitrosamine-containing food items, lack of fruit intake and Ebstein Barr Virus. The gall bladder cancer incidence [Age-Adjusted Rate (AARs) -7.9 in men and 16.2 in woman] was highest in Kamrup Urban District of Assam

The International Agency for Research on Cancer (IARC) has classified arsenic and arsenic compounds as carcinogenic to humans and has also stated that arsenic in drinking-water is carcinogenic to humans. High Arsenic in ground water is found in small pockets of many States like Assam, Bihar, Jharkhand, UP and West Bengal. The mainstay of combating ground water contamination is by provision of safe drinking water, which is done under Jal Jeevan Mission in all the States/UTs.

As informed by Tata Memorial Hospital, the order for a PET-CT scan machine for Bhubaneswar Borooah Cancer Institute (BBCI) has been awarded and turnkey incorporated with necessary changes in the building as per updated Atomic Energy Regulatory Board norms.