CANCER CALLS FOR A COHERENT HEALTH SYSTEM RESPONSE

As India shapes and strengthens its Ayushman Bharat programme, cancer care has to be firmly positioned amid its range of publicly financed healthcare services

- K SRINATH REDDY

Cardiovascular disease, manifesting principally as heart attacks and brain strokes, is the leading cause of death globally. In India too, it emerged in recent decades as the top cause of adult deaths. However, an international collaborative study of 200,000 people in 27 countries reported in 2019 that cancer recently overtook cardiovascular disease in high-income countries. The study noted cardiovascular disease remained the leading cause of death in low- and middle-income countries (LMICs).

Cancer is growing as a major cause of disease, disability, and death in LMICs too, though it trails cardiovascular disease in the list of killer diseases. The rise in cancer burden in these countries is both due to increasing incidence of new cancers and the inability of health services to provide timely detection and treatment.

Cancer cases are rising due to higher levels of population exposure to unhealthy diets, physical inactivity, air pollution, environmental toxins, tobacco products, and alcoholic beverages. An Indian Council of Medical Research study projected a 12.8 percent increase in the incidence of cancer cases in India between 2020 and 2025. In 2022, India had 14.1 lakh new cancer cases and 9.1 lakh deaths due to cancer. These estimates are likely to be short of the real cancer burden.

Decline in cardiovascular mortality rates in high-income countries over the past four decades happened not only due to better diets, less smoking, and more exercise but also due to many life-saving treatments. Effective therapies emerged from basic and clinical research. They were widely applied, resulting in many deaths being averted. While many behavioral risk factors are common to cancer and cardiovascular disease, highly effective treatments were less visible and impactful in the cancer arena until recently.