Tackling Cancer in India: Strategies and Goals of the National Cancer Control Programme

Cancer has emerged as a major public health challenge in India, with an estimated 1.25 million new cases diagnosed each year and approximately 2.8 million people living with the disease at any given time. In response to this growing burden, the Indian government launched a comprehensive framework to address cancer prevention, detection, and treatment across the nation.

The birth and evolution of cancer control in India 🔗

The National Cancer Control Programme was initiated in 1975 by the Ministry of Health and Family Welfare as a centrally sponsored scheme. Initially, the programme focused on equipping premier cancer hospitals and institutions with essential equipment, including cobalt machines for radiotherapy treatment.

A significant revision came in 1984-85 when the strategy shifted to emphasize primary prevention and early detection of cancer. This marked a fundamental change in approach, recognizing that preventing cancer and catching it early could save more lives than treatment alone. The programme underwent further modifications in 1990-91 with the introduction of district-level cancer control initiatives, bringing services closer to communities. After a comprehensive evaluation in 2004, the programme was revised again in 2005 to address emerging challenges and incorporate lessons learned from implementation.

Primary prevention: addressing tobacco-related cancers 🔗

Tobacco use remains the single largest preventable cause of cancer in India. Approximately 2,500 people die every day from tobacco-related diseases in the country. The NCCP recognized this critical link and prioritized tobacco control as a cornerstone of cancer prevention.

According to the World Health Organization, 91% of oral cancers in South-East Asia are directly attributable to tobacco use, making it the leading cause of oral cavity and lung cancer in India. The programme has implemented extensive health education campaigns to raise awareness about the dangers of tobacco consumption, targeting both smoking and smokeless tobacco products that are widely used across the country.

The prevention strategy extends beyond tobacco to address other modifiable risk factors including alcohol consumption, unhealthy diet, and lack of physical activity. These efforts align with the understanding that many cancers share common risk factors that can be addressed through lifestyle modifications and health promotion activities.

Secondary prevention: screening for cervical and breast cancers 🔗

Early detection through screening can dramatically improve survival rates for certain cancers. The NCCP has placed special emphasis on cervical and breast cancers, which are among the most common cancers affecting women in India. One woman dies of cervical cancer every 8 minutes in India, highlighting the urgent need for effective screening programmes.

For cervical cancer, the programme promotes screening through methods such as visual inspection with acetic acid (VIA) and Pap smears at primary health centers. These cost-effective screening methods can identify precancerous lesions before they develop into invasive cancer. However, screening coverage remains low, with only 1,965 per 100,000 women aged 30-49 years having undergone cervical screening according to recent surveys.

Breast cancer screening focuses on clinical breast examination and promoting breast self-awareness among women. The programme has established mammography facilities at district hospitals and cancer centers for high-risk individuals. Despite these efforts, only about 13% of eligible women have undergone breast cancer screening, indicating significant gaps in awareness and access.

Building infrastructure: regional cancer centers 🔗

A cornerstone of the NCCP is the establishment of Regional Cancer Centers across India. So far, the programme has supported 85 oncology wings in medical colleges including 27 tertiary cancer centers distributed across different regions of the country. These centers serve multiple purposes beyond just providing treatment.

Regional Cancer Centers function as hubs for comprehensive cancer care, offering specialized diagnosis, surgery, radiotherapy, and chemotherapy services. They also serve as training centers for oncologists, nurses, and allied healthcare professionals, helping to build the skilled workforce needed to address India’s cancer burden. Additionally, these centers conduct research, maintain cancer registries, and support district-level cancer control activities in their catchment areas.

To fill geographical gaps in treatment availability, the programme has supported the development of oncology wings in government medical college hospitals. Each institution receives central assistance for purchasing equipment, including teletherapy units and other essential oncology equipment. However, challenges remain in achieving adequate coverage, with current radiotherapy machine availability at 0.41 per million population, significantly below the WHO recommended standard.

District-level initiatives and community outreach 🔗

Recognizing that cancer care cannot be limited to tertiary centers, the NCCP introduced district-level cancer control schemes starting in 1990-91. These initiatives focus on prevention, health education, early detection, and basic pain relief measures at the district level. Financial assistance is provided to state governments for implementing district projects that bring cancer services closer to communities.

Community outreach has been strengthened through mobile screening vans equipped with basic diagnostic facilities to reach remote and underserved areas. The programme trains Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) to identify potential cancer cases during routine community visits. This grassroots approach helps in early detection and timely referral of suspicious cases to appropriate facilities.

Leveraging technology: telemedicine and digital health 🔗

Technology has become an increasingly important tool in expanding cancer care access. The NCCP now incorporates telemedicine services to connect patients in remote areas with oncologists at regional centers. Some Regional Cancer Centers have established satellite telemedicine facilities for conducting follow-up consultations, reducing the need for patients to travel long distances for routine care.

Digital tumor boards allow multidisciplinary discussion of complex cases across different centers, enabling doctors to collaborate on treatment planning regardless of location. E-learning platforms provide continuous education for healthcare providers on cancer management, helping to maintain quality standards across the network of cancer care facilities. These telemedicine initiatives became particularly crucial during the COVID-19 pandemic, ensuring continuity of cancer care despite healthcare disruptions.

Integration with broader health initiatives 🔗

Given that cancer shares common risk factors with other non-communicable diseases, the government integrated the NCCP with the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in 2008. This integration allows for more efficient use of resources and a comprehensive approach to addressing non-communicable diseases.

The integrated programme has strengthened 100 districts across 21 states for cancer care services and supported the establishment of 65 tertiary cancer care centers throughout the country. It has also established NCD cells for monitoring programme implementation and promoting awareness about cancer and available services. Under the current plan, significant funding has been allocated for establishing state-level cancer centers and strengthening existing facilities.

Persistent challenges and the way forward 🔗

Despite significant progress, the NCCP faces several challenges. Infrastructure gaps persist, with uneven distribution of cancer care facilities and rural areas remaining particularly underserved. There are insufficient numbers of oncologists, radiation therapists, and specialized nursing staff to meet the growing demand. Financial barriers continue to pose problems, with high out-of-pocket expenses for cancer treatment leading to catastrophic health expenditure for many families.

The cancer mortality rate in India is 68% of the annual incidence, meaning only about 30% of cancer patients survive five years or longer after diagnosis. This highlights the urgent need for improving early detection and treatment outcomes. Many patients, especially in rural areas, present with advanced-stage disease due to lack of awareness, limited access to screening, and delays in seeking care.

Moving forward, the programme needs to strengthen primary healthcare systems to better identify and refer potential cancer cases. Improving cancer registration and data quality is essential for planning and resource allocation. There is also a need to enhance community awareness about cancer symptoms, risk factors, and the importance of early detection. Expanding access to affordable treatment and strengthening palliative care services for advanced-stage patients remain critical priorities.

What do you think? How can community health nurses contribute more effectively to early cancer detection in rural areas? What innovative approaches could help overcome the barriers to cancer screening participation among vulnerable populations?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC4264276/
2. https://cancerindia.org.in/statistics/
3. https://bmccancer.biomedcentral.com/articles/10.1186/s12885-022-10387-9
4. https://journals.lww.com/indianjcancer/fulltext/2022/59010/prevalence_and_determinants_of_breast_and_cervical.9.aspx
5. https://www.rcctvm.gov.in/telemedicine.php
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC9941912/