Cancer trends and disparities in India: data needs for providing equitable cancer care
A partir des données de 42 registres indiens des cancers, cette étude analyse l'évolution de l'incidence de 28 types de cancers, des années de vie perdue ajustées sur l'incapacité et de la mortalité spécifique, sur la période 1990-2016
India, with a population close to 1·3 billion, and growing, is epidemiologically interesting and challenging for health-care planners. Regarding cancer burden, the population demographics, health policies, health-data recording, access to health care, and affordability have all improved substantially during the period between 1990 and 2016, as reported by The India State-Level Disease Burden Initiative Cancer Collaborators in their Global Burden of Disease paper in The Lancet Oncology. In addition to the heterogeneity in cancer incidence and outcomes between states, significant differences exist within each state, most prominently between urban and rural populations. Health data availability, access to health care, and affordability are poor and have remained almost static over the entire period in rural areas, while they have improved substantially in urban areas. The issues of access to health care and affordability are a direct result of zero health insurance coverage in more than 95% of the population in India. The federal government of India is currently rolling out in a phased manner the National Health Protection Scheme (NHPS, also known as Modicare).If properly implemented, this programme is likely to improve health-care access for the majority of the rural Indian population in the next decade.
The India State-Level Disease Burden Initiative Cancer Collaborators have used the best possible data-sourcing methods available so far for India. The first population-based cancer registry, based in Mumbai (previously named Bombay), started in June 1963, and the first rural population-based cancer registry, based in Barshi, Maharashtra, was established in 1987. Cancer data collection has improved over the years and the Indian Council of Medical Research (ICMR) now has a fully fledged National Centre for Disease Informatics and Research (NCDIR). However, verbal autopsy with poorly trained data collectors and coders could make the process challenging. The federal government of India has made it mandatory for all citizens to possess a unique national identification number (Aadhaar Act 2016) that is currently linked to all financial transactions. This number will eventually also be linked to all social security benefits, including Modicare, making it an excellent database for future health-services planning in the country.
It is heartening to note that the age-standardised incidence of the most common cancers (except breast cancer) has remained static over the past two and half decades, despite the assumption of under-reporting in the earlier part of this period. The incidence of cancer (except for cervical cancer, and except for the north-eastern state of Mizoram) is much lower than that in countries that can be said to be in a similar epidemiological transition as India (BRCS—Brazil, Russia, China, and South Africa), and substantially lower than in some developed countries with established prevention, screening, and early detection programmes.However, the increased incidence of breast cancer in India is worrying and requires serious attention. The decrease in cervical cancer incidence despite the absence of population-based screening is interesting and calls for planned epidemiological investigation. The uniformly high cancer mortality might reflect the poor access to early detection and curative services, and lack of affordability. In this context, a comparison between urban and rural populations within states would have been interesting. (...)
The Lancet Oncology , commentaire en libre accès, 2017