Praful B Desai, professor emeritus and former director of the Tata Memorial Cancer Research Institute, Mumbai, spoke to Leena Chakrabarti on the increasing incidence of cancer in India
Is the incidence of cancer on the rise?
The increase is both real and apparent. Every year eight million new cases of cancer are being reported worldwide, according to the latest estimates of the World Health Organisation ( who) , 60 per cent of whom can be found in the developing countries. As life expectancy increases, so do the number of cancer patients. This is because the risk of cancer increases as one grows older.
The apparent increase is due to increased literacy and awareness among the people, wider media coverage and availability of sophisticated technology for the early diagnosis of cancer.
What does your work experience tell you?
Having worked at the Tata Memorial Institute for the past 40 years, I have seen a steady rise in cancer cases in the 1980s and 1990s. In the 80s, proven new cancers were around 14,000 per year out of around 25,000 patients. Today, proven cancer patients number 16,000 per year out of nearly 26,000 patients visits. According to the Indian Council of Medical Research ( icmr ), every year there are one million new cancer patients in India.
What are the common forms of cancer?
The most frequent cancers in India pertain to the mouth and throat, among the males, and breast and cervix (uterus) cancers among the females.
Does the National Cancer Registry Project (NCRP) show that there has been an increase in breast cancer?
The number of breast cancer cases for both 1997 and 1998 were the same: nearly 180,000. Therefore, the so-called "increase" in breast cancer is more apparent than real. I do not think there is any scientific evidence of increasing susceptibility of females to breast cancer.
The NCRP record on cancer cases is calculated using data only collected from five urban registration centres and a rural one. Why?
The attempts made by the ncrp since early 1980s are laudable. Efficient cancer registry requires good training, a reasonable amount of infrastructure, funding and trained personnel. The ncrp has made a very good beginning and has laid a sound foundation. Now it is up to the states to improve and consolidate on this data for a more accurate record.
Can we correlate the incidence of breast cancers to pesticides and high levels of pesticides in breast milk?
Some reports state that pesticides are entering the foodchain and affecting human health. However, there is no conclusive scientific data to link pesticides with breast cancer.
Do you think worsening environmental degradation is responsible for the increasing incidence?
Rise in industrial activity, without appropriate environmental safeguards, is contributing significantly to the incidence of cancer. Environmental degradation is increasing in developing countries, where strict enforcement of regulation for industries hardly exists. The most common form of external pollution is from vehicular emissions which are responsible for chronic lung damage in the form of emphysema, chronic bronchitis and lung cancer. However, the worst form of pollution is tobacco -- smoking and chewing.
Is passive smoking more dangerous than active smoking?
Passive smoking is unhealthy. But it is wrong to state that passive smoking is more dangerous than active smoking. Active smoking is the worst form of direct pollution to the human system.
What are the other causes of cancer, apart from tobacco?
Cancer can be caused by excessive radiation exposures, environmental factors, genetic and hereditary susceptibility. The emphasis on tobacco is simply because it is the single most important cause which can be prevented by creating proper awareness of its ill effects.
Do you think there will be an increase in lung cancers in India given the fact that automobile companies are flooding the market with diesel vehicles?
Increasing vehicular population is a major cause for concern. This is bound to increase in future. However, what is worrying is the poor enforcement of regulations and laws. The suspended particulate matter emanating from a diesel engine is worse than that emitted from a petrol engine. New diesel models emit the worst form of toxic pollutants.
Do you think the government should ban diesel cars?
I do not think that the government will ban diesel but an attempt to meet safety standards can surely be enforced. Only if polluting vehicles are impounded with heavy fines, will one see some change.
What is the status of funding for cancer research projects in India today?
There is enough money for good cancer research. However, there is a paucity of good research projects and research facilities in the country.
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