Actions You and the Government Can Take

Newsreel Asia Insight #105
Jan. 16, 2024

A new study published in the Lancet medical journal has brought to light a distressing reality: over 225,000 Indians died from cancer in one year due to preventable causes. This statistic places India second to China in such deaths, calling for immediate action at both individual and governmental levels.

The study was a collaborative international effort, and focused on cancer deaths attributable to four key risk factors: tobacco smoking, HPV infection, alcohol consumption and excess body weight, as reported by IndiaSpend.

Tobacco smoking emerged as the leading cause of preventable cancer deaths in India, responsible for more than 110,000 deaths – or nearly half of all cancer deaths in the country – in 2020, according to the World Health Organization (WHO). Tobacco, in its various forms, contains harmful chemicals that can cause mutations in body cells, leading to cancer. The study reveals a worrying trend of tobacco use, especially in rural areas.

According to the Global Adult Tobacco Survey India (2016-17), nearly 267 million adults in India, aged 15 years and above, which constitutes 29% of the adult population, were tobacco users.

Further, India ranks among the nations with the lowest rates of smoking cessation. According to a previous report by “The International Commission to Reignite the Fight Against Smoking,” fewer than 20% of male smokers in India successfully quit, as reported by The Hindu.

Human Papillomavirus (HPV or a group of viruses) emerged as the second largest preventable cause of cancer deaths in India, leading to 89,000 deaths. It is linked to various cancers, with women being particularly susceptible to HPV-related cervical cancer.

HPV infection occurs mainly through skin-to-skin contact, most commonly through sexual activity. This includes vaginal, anal and oral sex. HPV can be transmitted even when an infected person has no visible symptoms, making it one of the most common sexually transmitted infections. Some types of HPV can cause warts on different parts of the body, like the hands or feet, while others are more likely to cause genital warts or lead to certain types of cancer, such as cervical cancer, anal cancer, and cancers of the throat, penis and vagina.

Cervical cancer ranks as the most common cancer among Indian women and the second most prevalent worldwide, according to a recent study published in the Indian Journal of Medical and Paediatric Oncology. Current data shows that each year in India, there are about 132,000 new cases and 74,000 deaths due to cervical cancer. This represents nearly one-third of cervical cancer deaths globally.

Alcohol consumption was linked to over 41,000 deaths. Alcohol can cause several health issues, including liver diseases and cancers, particularly in the digestive system.

The National Family Health Survey-5 (NFHS-5) for 2019-21 revealed that alcohol consumption is more prevalent in rural areas of India than in urban areas, as reported by The Indian Express. The survey showed that while 1% of women aged 15 and over consume alcohol, this figure is significantly higher for men at 19% in the same age group. A closer look at the data indicated that 1.6% of women in rural areas drink alcohol, compared to 0.6% in urban areas. For men, the figures are 19.9% in rural areas and 16.5% in urban areas.

Arunachal Pradesh emerged as the state with the highest percentage of both male (53%) and female (24%) alcohol consumers. Following Arunachal Pradesh, Sikkim had the second-highest percentage of female drinkers at 16%. In terms of male alcohol consumption, Telangana followed Arunachal Pradesh with 43%. Additionally, high levels of alcohol consumption among men (40% and above) were noted in the upper Brahmaputra region of Assam, certain districts in Jharkhand, the Bastar region of Chhattisgarh, and the Chhota Nagpur region spanning Jharkhand and Odisha.

Obesity and overweight, increasingly prevalent in India, were responsible for around 8,000 cancer deaths. These conditions are linked to various cancers, including breast and gastrointestinal cancers.

The NFHS-5 data indicated a rise in obesity among Indians from 2015-16 to 2019-21. Nearly one in four individuals was overweight, an increase from the previous one in five, as reported by India Today.

Obesity is determined using the Body Mass Index (BMI), with a BMI over 30 classified as obese and a BMI between 25 and 29.9 as overweight. The survey showed that obesity in men aged 15 to 49 had risen to 23% from 19%, and in women from 21% to 24%.

The survey also revealed a direct correlation between age and obesity for both genders, with the proportion of thin individuals decreasing and that of obese individuals increasing with age. For instance, 41% of men aged 15-19 were thin, dropping to 8% in the 40-49 age group. Conversely, obesity in the same age groups rose from 7% to 32%. This trend was mirrored in women.

The survey found that as household wealth increased, the proportion of thin individuals decreased, and the proportion of obese individuals rose. State-wise, Bihar had the highest percentage of thin men, while Delhi and Tamil Nadu had the highest percentage of obese men. For women, Jharkhand and Bihar had the highest proportion of thin individuals, whereas Puducherry and Chandigarh had the highest proportion of overweight women.

How should we respond to these statistics on cancer prevalence in India?

Quitting tobacco is the single most effective step you can take. Seeking assistance from smoking cessation programs and gaining awareness about the health risks linked to smoking can be effective strategies.

Reducing alcohol intake is also crucial. Moderation is key, and being aware of the risks associated with excessive drinking can help in making informed choices.

For women, regular screenings for cervical cancer and getting the HPV vaccine are crucial. These steps can detect precancerous conditions early and prevent the development of cancer.

Maintaining a healthy weight through a balanced diet and regular exercise is essential. Obesity is a growing concern and tackling it can significantly reduce cancer risk.

The government’s role in combating this crisis is crucial. Implementing stricter tobacco control measures, including higher taxes on tobacco products, is essential. India’s current taxation on tobacco products falls short of the WHO’s recommended levels. Increasing taxes can deter tobacco use, especially among the youth and economically disadvantaged groups.

Strengthening regulations around alcohol sale and consumption, and running awareness campaigns about the risks of excessive drinking, can help reduce alcohol-related cancer deaths.

Some public health experts suggests that the government should prioritise the inclusion of the HPV vaccine in the Universal Immunisation Programme.

There is a dire need also to enhance cancer care facilities across the country, especially in rural and underserved areas. Increasing the number of oncologists and healthcare professionals trained in cancer care, and ensuring equitable distribution of these resources, can significantly improve early detection and treatment outcomes.

Continued investment in cancer research and a robust national cancer registry are essential for understanding the disease’s prevalence and trends. This data can inform policy decisions and healthcare strategies.

The time to act is now, for a healthier future for all.