Lok Sabha Question No. 200 (STARRED), answered on 2023-12-15
Subject: Screening of Cancer
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Vijayakumar (alias) Vijay Vasanth

## GOVERNMENTOFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OFHEALTH RESEARCH

## LOK SABHA STARRED QUESTION NO. 200 TO BE ANSWERED ON THE 15 TH DECEMBER, 2023

## SCREENING OF CANCER

## *200. SHRI VIJAYAKUMAR ALIAS VIJAY VASANTH:

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

- (a) whether it is a fact that Indian Council of Medical Research (ICMR) proposes to introduce/ implement measures to accelerate cancer screening measures and treatment in the country and if so, the details thereof;
- (b) whether it is a fact that only a few districts across the country are able to effectively implement cancer screening measures with the norms of the Government and if so, the details thereof;
- (c) whether it is a fact that the country is expected to witness a substantial 57.5 percent increase in cancer cases between 2020 and 2040 and if so, the details thereof;
- (d) whether it is also a fact that Accredited Social Health Activists (ASHAs) have the potential to play a crucial role in promoting and conducting home-based cancer screening in the country and if so, the details thereof; and
- (e) whether the Government is considering to harness the potential of ASHAs in the country and if so, the details thereof?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (DR MANSUKH MANDAVIYA)

- (a) to (e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 200 FOR 15 TH DECEMBER, 2023

(a) and (b) The Department of Health and Family Welfare, Government of India provides technical and financial support to the States/UTs under the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD). NP-NCD focuses on screening and diagnosis of oral cancer, breast cancer and cervical cancer. The programme includes the following,

- i. Strengthening infrastructure
- ii. Human resource development
- iii. Health promotion
- iv. Screening of 30 years and above population under Ayushman Arogya Mandir Scheme
- v. Early diagnosis and management
- vi. Referral to an appropriate level of healthcare facility

Population based prevention, screening and management initiative for NCDs including common cancers viz. oral, breast and cervical cancer is implemented in Ayushman Arogya Mandir as a part of comprehensive primary health care under National Health Mission (NHM). A total of 1,63,273 Ayushman Arogya Mandirs are operational across the country. A total of 18.46 Cr for oral cancer, 8.88 Cr for breast cancer and 4.96 Cr for cervical cancer are screened. The screened positive patients are referred to CHC NCD clinics and / or District Hospital NCD Clinics to get diagnosed and referred to appropriate facility for treatment. Under NP-NCD, 753 District NCD Clinics, 355 District Day Care Centres and 6237 Community Health Center NCD Clinics have been set up so far.

Department of Health Research (DHR) has established the DHR-ICMR Advanced Molecular Oncology Diagnostic Services (DIAMOnDS) Sub-scheme under which 18 centres are providing breast and lung cancer screening.

To generate awareness for Cancer prevention & treatment, following actions have been initiated: -

1. Preventive aspect of Cancer is strengthened under Comprehensive Primary Health Care through Ayushman Arogya Mandir Scheme, by promotion of wellness activities and targeted communication at the community level.
2. Public awareness creation through print, electronic and social media about promotion of healthy lifestyle including observation of National Cancer Awareness Day, World Cancer Day.
3. Healthy Eating is promoted through Food Safety and Standards Authority of India (FSSAI).
4. Fit India movement is implemented by Ministry of Youth Affairs and Sports.
5. Various Yoga related activities are carried out by Ministry of AYUSH.

Action taken by Government in respect of infrastructure are:

1. The Central Government implements Strengthening of Tertiary Care Cancer Facilities Scheme. 19 State Cancer Institutes (SCIs) and 20 Tertiary Care Cancer Centres (TCCCs) have been approved under the said scheme. The details are attached at Annexure 1.

2. National Cancer Institute at Jhajjar (Haryana) and second campus of Chittaranjan National Cancer Institute, Kolkata have also been setup.
3. All new AIIMS and 13 upgraded existing Government Medical Colleges/Institutions under Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) also focus on treatment of cancer. The details are attached at Annexure 2.

To facilitate accessible and affordable healthcare and treatment, the following steps have been taken: -

1. Under Pradhan Mantri Jan Arogya Yojana (PMJAY), health insurance cover of Rs. 5 lakhs per family per year for secondary or tertiary care hospitalization to 12 Crore beneficiary families is provided. The Health Benefit Package (HBP) 2022 provides treatment corresponding to a total of 1,121 treatment packages comprising of 1,949 procedures across 27 different specialties for NCDs. 549 procedures are related to cancer. As of 7th December 2023, a total of 35.07 lakh hospital admissions amounting to Rs 6572.25 Crores have been authorized through a network of 1980 hospitals.
2. Financial assistance is provided to poor patients belonging to families living below poverty line, suffering from major life-threatening diseases including cancer under Umbrella scheme of Rashtriya Arogya Nidhi (RAN) and Health Minister's Discretionary Grant (HMDG). Financial assistance up to a maximum of Rs. 1,25,000/- is provided under HMDG to defray a part of the treatment cost and the maximum financial assistance provided under the Umbrella Scheme of RAN is Rs. 15 lakhs.
3. 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, to make available Cancer drugs at a substantial discount vis-à-vis the Maximum Retail Price.

Indian Council of Medical Research (ICMR) has identified the topic - measures to accelerate cancer screening, early diagnosis and treatment- as a National Health Research Priority and initiated research in these topics. It is aimed to improve coverage and quality of cancer screening through existing health care system using accepted and validated methods.

(c) As per the Indian Council of Medical Research -National Cancer Registry Programme (ICMR - NCRP), the estimated incidence of cancer cases is increasing in the country for the year (2020-2022) and the details are given below.

| Estimated incidence of cancer cases (2020-2022) - Both Sexes   | Estimated incidence of cancer cases (2020-2022) - Both Sexes   | Estimated incidence of cancer cases (2020-2022) - Both Sexes   | Estimated incidence of cancer cases (2020-2022) - Both Sexes   |
|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|
| Year                                                           | 2020                                                           | 2021                                                           | 2022                                                           |
| Estimated incidence of cancer cases in India                   | 13,92,179                                                      | 14,26,447                                                      | 14,61,427                                                      |

The incidence of cancer cases is projected to increase from 14.61 lakhs in 2022 to 15.7 lakhs in 2025.

(d) and (e): The Accredited Social Health Activist (ASHAs) does risk assessment of individuals in the age groups of thirty years and above by using Community Based Assessment Checklist (CBAC) forms and bring the individuals to Ayushman Arogya Mandir (AAM) for screening of common NCDs (hypertension, diabetes, oral cancer, breast cancer and cervical cancer). Community follow up of identified individuals has been carried out by ASHA by making visits for lifestyle changes, treatment compliances, and encouraging patients to go to the health care centres for regular follow-up of cancer. The continuity of care is ensured through AAM- Sub Health Centres, AAM- Primary Health Centres, District Hospitals and other tertiary care institutions in both rural and urban areas. Training Module has been developed for ASHAs and regular training has been conducted on screening of common NCDs.

*****

## Table of SCIs/TCCCs:

|   S No | State            | Name of the Institute                                                 | SCI / TCCC   |
|--------|------------------|-----------------------------------------------------------------------|--------------|
|      1 | Andhra Pradesh   | Kurnool Medical College, Kurnool                                      | SCI          |
|      2 | Assam            | Gauhati Medical College &Hospital, Guwahati                           | SCI          |
|      3 | Bihar            | Indira Gandhi Institute of Medical Sciences, Patna                    | SCI          |
|      4 | Chhattisgarh     | Chhattisgarh Institute of Medical Sciences, Bilaspur                  | SCI          |
|      5 | Delhi            | Lok Nayak Hospital                                                    | TCCC         |
|      6 | Gujarat          | Gujarat Cancer Research Institute, Ahmedabad                          | SCI          |
|      7 | Goa              | Goa Medical College, Panaji                                           | TCCC         |
|      8 | Haryana          | Civil Hospital, Ambala Cantt                                          | TCCC         |
|      9 | Himachal Pradesh | Indira Gandhi Medical College, Shimla                                 | TCCC         |
|     10 | Himachal Pradesh | Shri Lal Bahadur Shastri Medical College, Mandi                       | TCCC         |
|     11 | Jammu&           | Sher-i-Kashmir Institute of Medical Sciences, Srinagar                | SCI          |
|     12 | Kashmir          | Government Medical College, Jammu                                     | SCI          |
|     13 | Jharkhand        | Rajendra Institute of Medical Sciences, Ranchi                        | SCI          |
|     14 | Karnataka        | Kidwai Memorial Institute of Oncology (RCC), Bengaluru                | SCI          |
|     15 |                  | Mandya Institute of Medical Sciences, Mandya                          | TCCC         |
|     16 | Kerala           | Regional Cancer Centre, Thiruvananthapuram                            | SCI          |
|     17 |                  | Government Medical College, Kozhikode                                 | TCCC         |
|     18 | Madhya Pradesh   | G.R. Medical College, Gwalior                                         | TCCC         |
|     19 |                  | Netaji Subhas Chandra Bose Medical College, Jabalpur                  | SCI          |
|     20 | Maharashtra      | Rashtrasant Tukdoji Regional Cancer Hospital& Research Centre, Nagpur | TCCC         |
|     21 |                  | Government Medical College, Aurangabad                                | SCI          |
|     22 |                  | Vivekanand Foundation &Research Centre, Latur                         | TCCC         |
|     23 | Mizoram          | Mizoram State Cancer Institute, Aizawl                                | TCCC         |
|     24 | Nagaland         | District Hospital, Kohima                                             | TCCC         |
|     25 | Odisha           | Acharya Harihar Regional Cancer Centre, Cuttack                       | SCI          |
|     26 | Punjab           | Government Medical College, Amritsar                                  | SCI          |
|     27 |                  | Civil Hospital, Fazilka                                               | TCCC         |
|     28 | Rajasthan        | S P Medical College, Bikaner                                          | TCCC         |
|     29 |                  | SMS Medical College, Jaipur                                           | SCI          |
|     30 |                  | Jhalawar Medical College &Hospital, Jhalawar                          | TCCC         |
|     31 | Sikkim           | Multispecialty Hospital at Sochygang (Sichey), near Gangtok, Sikkim   | TCCC         |
|     32 | Tamil Nadu       | Cancer Institute (RCC), Adyar, Chennai                                | SCI          |
|     33 | Telangana        | MNJ Institute of Oncology &RCC, Hyderabad                             | SCI          |
|     34 | Tripura          | Cancer Hospital (RCC), Agartala                                       | SCI          |
|     35 | Uttar Pradesh    | Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow     | TCCC         |
|     36 | Uttarakhand      | Government Medical College, Haldwani                                  | SCI          |
|     37 | West Bengal      | Government Medical College, Burdwan                                   | TCCC         |
|     38 |                  | Murshidabad Medical College &Hospital, Berhampore, Murshidabad        | TCCC         |
|     39 |                  | Sagore Dutta Memorial Medical College and Hospital, Kolkata           | TCCC         |

Table 1: Cancer Treatment Facility is approved in all New AIIMS

|   Sl. | AIIMS       |   Sl. | AIIMS     |
|-------|-------------|-------|-----------|
|     1 | Bhopal      |    12 | Bathinda  |
|     2 | Bhubaneswar |    13 | Guwahati  |
|     3 | Jodhpur     |    14 | Bilaspur  |
|     4 | Patna       |    15 | Deoghar   |
|     5 | Raipur      |    16 | Jammu     |
|     6 | Rishikesh   |    17 | Kashmir   |
|     7 | Raebareli   |    18 | Madurai   |
|     8 | Mangalagiri |    19 | Rajkot    |
|     9 | Nagpur      |    20 | Bibinagar |
|    10 | Kalyani     |    21 | Manethi   |
|    11 | Gorakhpur   |    22 | Darbhanga |

Table 2: List of Govt. Medical Colleges/Institutions taken up for upgradation for cancer treatment

|   Sl. | State            | Name of Govt Medical College                                                      | Facility                                         |
|-------|------------------|-----------------------------------------------------------------------------------|--------------------------------------------------|
|     1 | Jharkhand        | RIMS Ranchi                                                                       | Oncology Block                                   |
|     2 | Punjab           | Govt Medical College Amritsar                                                     | Oncology                                         |
|     3 | Himachal Pradesh | Rajendra Prasad Govt. Medical College, Tanda                                      | Oncology                                         |
|     4 | Karnataka        | Karnataka Institute of Medical Sciences, Hubli                                    | Medical Oncology                                 |
|     5 | Rajasthan        | SP Medical College, Bikaner                                                       | Surgical Oncology                                |
|     6 | Rajasthan        | RNT Medical College, Udaipur                                                      | Radiotherapy/Oncology                            |
|     7 | Telangana        | Kakatiya Medical College, Warangal                                                | Medical Oncology                                 |
|     8 | Uttar Pradesh    | Govt Medical College, Gorakhpur                                                   | Surgical Oncology                                |
|     9 | Uttar Pradesh    | M.L.N Government Medical College, Allahabad                                       | Surgical Oncology                                |
|    10 | Uttar Pradesh    | LLRM Medical College, Meerut.                                                     | Radiotherapy                                     |
|    11 | Uttar Pradesh    | Govt Medical College, Agra                                                        | Radiation /Medical Oncology                      |
|    12 | Bihar            | Patna                                                                             | Radiotherapy (equipment)                         |
|    13 | Kerala           | Sree Chitra Tirunal Institute of Medical Sciences &Technology, Thiruvananthapuram | Imaging Services and Interventional Radiotherapy |