2. Cancer
• It may be regarded as a group of disease
characterized by : (a) abnormal cell growth, (b)
ability to invade adjacent tissue & even distant
organs, and (c) eventual death of the affected
patients if tumor progressed beyond a critical
stage.
• At the beginning of the century, cancer was the
sixth most common cause of death worldwide,
but now it’s the 2nd leading cause.
• There are wide variations in distribution of
cancers around the globe, eg. Stomach cancer
in Japan, cervical cancer in Columbia, and
cancers of oral cavity in SEARs.
3. Mortality due to cancer : Worldwide vs. India
Cancer Site Deaths
Lung (1st ) 1.4 million
Stomach 740,000
Liver 700,000
Colorectal (3rd ) 610,000
Breast (2nd ) 460,000
Cancer Site Deaths (/ 100,000)
Liver 13.49
Lung (2nd ) 6.49
Oral (1st ) 4.82
4. • India accounts 86% of the world's oral cancer cases
18 cases/100,000 (IIPH, feb.2011).
6. What is Oral cancer..?
Cancer that starts in the mouth is oral
cavity cancer
– Includes lips
– Inside lining of cheeks (buccal mucosa)
– Gingiva (gums)
– Floor of the mouth
– Anterior 2/3rds of the tongue
– Hard palate
7. Major Risk Factors for Oral Cancer
are:
Tobacco use - 90%
Alcohol use - 75-80%
Age over 40
UV – exposure – 30%
association with lip
cancer.
9. Tobacco
• Approx. 90% of oral cancers in SEARs are
linked to tobacco smoking or chewing.
• The risk of oral cancer increases with the :
amount and duration both.
• Smokers have 6 times greater risk of
developing oral cancer than nonsmokers.
• Tobacco users who regularly use alcohol are
at greatest risk.
• All tobacco types are associated with oral
cancer, for example: cigarettes / cigars / pipes
/ snuff / chew / quid.
10. • Indigenous forms of smoking are : bidi, chutta
(epidermoid Ca of hard palate - Andhra
Pradesh), chilam, hookah. It can also be
inhaled as snuff.
• Most common form of tobacco chewing in India
is betal quid : betal leaf, arecanut, lime &
tobacco (36 times higher in non chewers).
• It is common for the poor people to rub with
thumb – flakes of sun dried tobacco and slaked
lime to form a mixture (khaini), which is then
put in mouth at frequent intervals during the
day.
11. • The areca nut
contains three
main alkaloids:
Arecoline, Arecaidine
and Guvacine which
has vasoconstricting
properties.
• The betel leaf
chewed with it
contains eugenol,
also vasoconstrictor.
12. Symptoms
• The most common symptom is a sore in the
mouth that bleeds easily and does not heal.
• Other symptoms include:
– Pain in the mouth that does not go away
– A lump or thickening in the cheek
– A white or red patch on the gums, tongue,
tonsil, or lining of the mouth
– A sore throat or a feeling that something is
caught in the throat
– Difficulties in chewing, swallowing, or moving
the tongue or jaw (late symptoms)
13. Oral cancer often precedes by a pre cancerous
stage (leuko/erythoplakia), which can be detected
upto 15 yrs .
• 5- 20 % of oral leukoplakia will turn malignant
• 10 -20% of submucous fibrosis will turn
malignant
15. Prevention
Primary prevention : -
• Tobacco Control – if tobacco habits are
eliminated from the community, a great deal of
reduction in oral cancer incidence can be
achieved.
a) behavior modification
b) counseling
c) health education
d) legislative measures
18. Tobacco Ban – Implications
• India 3rd largest producer of tobacco
• 900,000 employed in growing and curing
industry and 3.4 million in manufacturing
• 97.7 million dollar trade surplus
• Smokeless tobacco $ 1 billion annually = 0.2 %
of the gross national product
“Only industry that has had a constant
growth for last few decades”
19. Conclusion
• Banning tobacco- difficult but useful
• Behavioural modifications
- do have an impact
- however, time consuming
- sustained effort required
• Nonetheless tobacco counseling must
be pursued (national & individual)
20. Other methods of primary prevention
• Limiting Alcohol consumption
• Improve diet : fruits and vegetables
• Maintaining good oral hygiene
• Control of STDs
• Prompt treatment of conditions like Lichen
planus, candidiasis.
• Correcting ill - fitted dentures and other
conditions causing chronic irritation.
• Protection from excessive UV – exposure.
21. Secondary prevention
• Oral cancers are easily accessible for inspection
allowing early detection.
• If detected early (pre – cancerous lesions), can be
easily treated or cured.
• The pre – cancerous lesions can be detected upto 15
years, prior to becoming invasive carcinoma.
• Regular annual oral cancer examinations after age
40.
• The primary health care workers are in a strategic
position to detect oral cancers at an early stage
during home visits. They can prove to be a vital link &
key instrument in control of oral cancer in countries
like India.
22. • Leukoplakias can be cured by cessation of
tobacco smoking.
• Radiation therapy and surgery are the main
methods of treatment for oral cancer.
Surgery : An operation to remove cancer cells.
Radiotherapy : Uses high-energy rays to shrink
or kill cancer cells.
23. • In advanced cancer, chemotherapy may
be used in combination with either
treatment.
– Chemotherapy - Uses anticancer drugs
that attack cancer cells and normal cells.
The drugs are usually given by injection or
by mouth.
5-year localized survival rate is 82%
5-year overall survival rate is 59%
24. NATIONAL CANCER CONTROL
PROGRAMME:
• National Cancer Control Programme was
started in 1975-76. Its Goals & Objectives
are: -
1. Primary prevention of cancers by health
education regarding hazards of tobacco
consumption and necessity of genital
hygiene for prevention of cervical cancer.
25. 2. Secondary prevention by early detection and
diagnosis of cancers, for example, cancer of
cervix, breast cancer and the oro-pharyngeal
cancer by screening methods and patients‘
education on self examination methods.
3. Strengthening of existing cancer treatment
facilities, which were inadequate.
4. Palliative care in terminal stage cancer.
26. Strategies
• Prevention and early detection of cancers
through district cancer control activities and
strengthened IEC campaign.
• To promote ‘centre of excellence’ in the field of
cancer management with support to existing
RCC of proven track record by providing
financial assistance.
• To augment comprehensive cancer facilities
across the country through institutional capacity
building in new and existing regional cancer
centers and through new & existing oncology
wings.
27. • Development of early diagnostic facilities in
district hospitals.
• Encouraging PPP.
• Increase capacity for palliative care.
• Promote cancer research relevant to India.
• Capacity building & training of all personnel in
cancer prevention & early detection to be done for
all categories in phased manner.
• Health education to general public through
various audio- visual means regarding early
detection of cancer.
• Promote innovation in cancer care and
indigenization of cancer treatment equipments.
28. Organizational structure
• It is a two level committee : Central
govt. & state govt. with linkage through
the central council of health.
• The full time officer in charge of cancer
control is an oncologist who heads the
cancer control cell at the DGHS.
29. Schemes under the program
1. Financial Assistance to Voluntary
Organisations:
• This scheme is meant for IEC activities and
early detection of cancer.
• Under the scheme financial assistance upto
Rs.5 lakh is provided to the registered voluntary
organisations recommended by the State
government for undertaking health education
and early detection activities in cancer.
• A linkage with the Regional Cancer Centre (or
Medical is now mandatory by the NGO
concerned.
30. 2. District cancer control scheme :
• It is known that a large number of cancer cases can be
prevented with suitable health education and early case
detection.
• Accordingly the scheme for district projects regarding
prevention, health education, early detection and pain relief
measures was started in 1990-91.
• Under this scheme one time financial assistance of Rs.15.00
lakh is provided to the concerned State Government for each
district project selected under the scheme with a provision of
Rs.10.00 lakh every year for the remaining four years of the
project period.
• The project is linked with a Regional Cancer Centre or an
institution having good facilities for treatment of cancer
patients. The patients are provided treatment at the concerned
Regional Cancer Centre or the nodal institution.
31. 3 ) Financial assistance for Cobalt unit
installation:
• To strengthen the cancer treatment facilities,
the financial assistance of Rs. 1 crore for
charitable organisations and 1.5 crore for
government institutions is provided for
procurement of teletherapy, brachytherapy
equipments etc. This is one time grant at
present.
32. 4. Development of Oncology Wings in
Govt. Medical College Hospitals:
• This scheme has been initiated to fill up the
geographical gaps in the availability of cancer
treatment facilities in the country.
• Central assistance is provided for purchase of
equipments, which include a cobalt unit beside other
equipments. The civil works and manpower are to be
provided by the concerned State Government/
Institution.
• The quantum of central assistance is Rs.2 crore per
institution under the scheme. The scheme provides
one time grant only.
33. 5. Assistance for Regional Research and
Treatment Centres:
• There are 19 Regional Cancer Research and
Treatment Centres recognised by Government
of India.
• A recurring grant of Rs.75 lakhs is being given to
15 of these RCCs.
• In addition CNCI, Kolkatta and IRCH, AIIMS are
also funded under NCCP.
34. New Initiatives
• Outreach activities by medical colleges for
increasing awareness and early detection of
cancer.
• Training of personnel in early detection and
awareness of cancer.
• Supply of Morphine
• Telemedicine and supply of computer hardware
and software.
• IEC activities.
• Modified District Cancer Control Programme
• National Cancer Awareness Day (7th november)
35. • Training of cytopathologists and cytotechnicians
in the quality assurance in Pap Smear
technology.
• Participation in Health Melas and distribution of
health education material.
• Postage stamp depicting 'Breast Self
Examination' was brough out by Department of
Posts on National Cancer Awareness Day
• Telecast of a health magazine 'Kalyani' in the
current year with cancer and anti tobacco items
under the agreement with Prasar Bharti &
MOHFW.
36. National Cancer Registry Program
• Objectives :
To generate authentic data on magnitude of cancer
problem in India.
To undertake epidemiological investigations and
advice control measures.
Promote human resource development in cancer
epidemiology.
37. • Population based registers :
There are six in numbers ; 5 in urban area (Delhi,
Bhopal, Mumbai, Bangalore, Chennai) and one in rural
area (Barshi in Maharashtra)
• Hospital based registers :
At Chandigarh, Banglore, Mumbai, Chennai, and
Thiruvananthpuram, six hospital based registers are
maintained.
A total of 3.3 % population is covered by these
registers (12.85 urban and 0.06% in rural)
These registers generate annual report which indicate
the annual incidence of particular cancer in population,
which helps in planning and evaluation of cancer
control.
38. National Tobacco control program
• MOHFW has recommended that a
comprehensive Anti – tobacco program
should be implemented as part of NCCP with
following strategies :
Education of the public.
Practice of tobacco control.
Advocacy of tobacco control.
39. Major efforts for tobacco control in India
• Warnings on cigarette packages/
advertisements.
• Warning on smokeless tobacco products.
• Cabinet guidelines for smoking in public places.
• Comprehensive legislation on tobacco control.
• Multi - Sectoral approach for tobacco control.
• Community education on tobacco.
• Expert committee on health hazards of pan
masala containing tobacco.
40. TOBACCO CONTROL ACT, 2003
• Scope of Act : -
The Act is applicable to all products containing
tobacco in any form i.e. Cigarettes, Cigars,
Cheroots, bidis, gutka, pan masala (containing
tobacco) khaini, mawa, mishri, snuff etc. as
detailed in the schedule to the Act.
The Act extends to whole of India.
41. MAIN PROVISIONS OF THE ACT
• Prohibition of smoking in public places.
Implement from 2, Oct, 2008.in the hole of India.
• Prohibition of advertisement, sponsorship and
promotion of tobacco products.
• Prohibition of sale of tobacco products near
educational institutions.
• Regulation of health warning in tobacco products
packs.
• Regulation of tar and nicotine contents of
tobacco products.