It’s time India makes cancer screening and prevention a cultural practice
By Dr Rita Issac, Senior Consultant & Director of Population Research, Karkinos Healthcare
Recently, Fortune India magazine’s online edition published an article titled ‘Why Cancer Is the New Cardiology for Hospital Chains’. Have you ever wondered why this scenario is being discussed widely? This is because India has emerged as the world’s third-largest country with cancer burden, due to which oncology is now competing with cardiology in diagnosis, care, and management at leading healthcare chains.
This is mainly because cancer screening and early detection programmes in India are not as prevalent and widespread as they should be, especially when compared with the developed countries. In developed countries, the culture of cancer screening is more established and the healthcare systems in these countries prioritize preventive care, including cancer screening, to detect diseases at an early stage and improve treatment outcomes.
Infact, young women in their mid-20s are encouraged to participate in cervical cancer screening programmes making their country’s preventive health systems work at scale. Unfortunately, India has not incorporated this kind of early detection or screening at any age group nor has the country implemented screening practices as mandatory within communities.
Why is India a laggard in bringing mass cancer screening to its healthcare practices?
Developed countries invest in public health campaigns and educational initiatives to raise awareness about the importance of cancer screening. They promote regular screening guidelines and inform the public about the benefits of early detection. Many high-income countries have some form of universal health coverage or insurance to make cancer screening affordable. Cancer is an expensive disease to detect and to treat, therefore policy making for cancer screening programmes should consider economic factors in its design and implementation.
Considering the population density in our country and the increasing cancer incidence rates, that has a direct economic impact on the country and hampers its progress, India must adopt cancer screening and deploy this at a faster scale. India launched its screening program for most common cancers in 2010 under the NPCDCS program. However, due to competing priorities for health-care expenditures as well as shifting political and economic situations in the nation as a whole, the process of early detection and treatment of cancers has not received its due attention. Listed below are a few points, which I consider that India can adopt by emulating the developed countries’ cancer screening practices.
Access to healthcare: Developed countries generally have better access to healthcare services, including cancer screening facilities. The healthcare infrastructure is well-developed, and people have easier access to screening programmes and specialized cancer centres. Whereas, many people in India, particularly in the rural areas and lower socioeconomic groups, may not be aware of the importance of cancer screening and its potential benefits. A lack of awareness about early detection, treatment options and access to care can lead to a reduced demand for cancer screening services. As mentioned before, a significant portion of the Indian population resides in rural areas where healthcare infrastructure is extremely limited. Hence, access to cancer screening facilities and follow-up care can be challenging, leading to lower screening rates. This is where India must invest in quality healthcare facilities at primary care centres that focus on screening and continuum of care, all within the same health system with established specialised care at various levels, gathering community trust.
Regular screening programmes and healthcare coverage: In developed countries the government steps forward in organising national or regional cancer screening programmes, which offer free or subsidised screenings for specific cancers such as breast, cervical, colorectal, and prostate cancer. These programmes target certain age groups or high-risk populations and aim to increase screening participation rates. Many developed countries also have universal or near-universal healthcare coverage, ensuring that a large portion of the population can access cancer screening services without financial barriers. India, sadly, lacks such practices. But, in the last many years, the Indian Health Ministry has woken up to this need and has made several efforts to make cancer screening more widespread.
Physician/Clinician awareness: Healthcare providers, be it doctors, surgeons, nurses, or allied staff, should actively engage in promoting cancer screening and recommend appropriate tests to their patients based on age, family history, and other risk factors. Regular screening should become a culture in India. However, physicians or GPs themselves need to be made aware of cancer screening programmes that can be advocated to their patients.
Follow-up care and sustained care: This process is a necessity to ensure that citizens who appeared for screening, and those stratified under low-risk cancer susceptibility, must be periodically monitored to ensure that they do not progress to high-risk cancers. For individuals who have been treated for cancer, regular follow-up visits with healthcare providers can help detect any signs of cancer recurrence at an early stage.
Karkinos’ digital oncology platform concept for early detection and follow-up of cancer care
It is evident that India urgently needs a renewed commitment to cancer prevention, treatment and care that recognises the growing challenges, and opportunities to overcome them, including the advanced developments in cancer care. India needs to scale up its healthcare practices to make people realize that screening for common cancers is as essential and as common as screening for the presence of cholesterol, high blood sugar and high blood pressure. Robust infrastructure and widespread, risk-agnostic cancer screening programmes have to be performed vigourously in the country to bring a significant change in the rising cancer incidence. Both public and private enterprises and the state health departments have the responsibility to roll out as many effective screening programmes as possible to see tangible benefits.
Karkinos Healthcare is an organization, started in 2020, from the private sector, trying to redefine cancer care and offering a new face/dimension to cancer care continuum in India. The organisation stresses on delivering early cancer detection and conducting community cancer screening programmes across the length and breadth of the country. Realizing the potential of technology to integrate the prevalent health systems and to improve cancer care, Karkinos Healthcare follows a Distributed Cancer Care Network Model (DCCN) powered by a digitally-equipped war room like Command Centre.
The DCCN’s function is to connect with various healthcare service providers- both private and non government organisations -small and large- capable of supporting citizens and patients with cancer screening, detection, treatment, and follow-up care. By bringing these service providers into a network, care is delivered closer to the person’s home negating the need for long distance travel seeking care and interventions. Starting from a centre that can provide care for screening and early detection to progressively more complex care, Karkinos, therefore, creates a mesh or connected network of experts and care centres that ensures that all levels and aspects of care along with right guidance and support from virtual tumour board is available to the patient within the network of Karkinos.
Karkinos’ Risk Assessment Surveys are widely disseminated through various online and offline modes that identify people who are susceptible to cancer. This, based on risk stratification, is followed by preliminary cancer screening. If the person is screened to be positive then the next steps of care are administered via a digitally-mediated patient navigation system. The command center ensures that the person does not drop out of the treatment pathway at any point of time. Thus, an end-to-end cancer care is provided to those in need.
The most important service is the large community-based cancer screening programme that is made accessible to all demographics of India. We need to create community trust in such network-based screening programmes that cover a wide set of population, closer to the people’s comfortable locations. When carried out on a big scale, these innovative cancer prevention and care programmes will ultimately bring about the necessary cultural shift in healthcare practices and move our nation closer to reducing cancer rates in the future.