NATIONAL CANCER

CONTROL
PROGRAMME
DR. SAMRAT DUTTA
Moderator : Prof. S. C. Sharma
Dept. of Radiotherapy,
Regional Cancer Centre ,PGIMER,
Chandigarh
 What is cancer?
• A group of abnormal tissue or mass , the
growth of which far exceeds , and is
uncoordinated with that of normal tissues
and persists in the same excessive
manner after cessation of stimuli which
evoked the change
Sir
Rupert Willis
 Problem statement
• WORLD
10 million new cases each year
4.7 million in developed countries
5.5 million in less developed countries
12% deaths worldwide
20 years time – no. of cancer deaths will rise
from 6 million to 10 million per year
 Indian scenario
• 2 .5 million cases each year
• 0.8 million – new cases each year
• 0.5 million – deaths each year
500 469,000
400
(in thousands)

263,480 443,000
300

200
229,660 Male Female
100

0
1985 1990 1995 2000 2005

Alarming ↑ due to
Demographic effect
Primary objectives of cancer treatment

• CURE

• PROLONGATION OF LIFE

• IMPROVEMENT OF QUALITY OF
LIFE
 WHO-UICC

COMPREHENSIVE CANCER CONTROL

RESEARC EARLY PATIENT

H DETECTION WELFARE
PREVENTIO TREATMEN CANCER
N T MONITORING

TitlQuo AD145
 Cancer Control: a complex
multidisciplinary effort
• Has to co-ordinate advances in early
diagnosis, prevention, therapy and
palliative care

• Develop them synchronously

Object:
Reduce no of cancer cases
Produce max possible cure
Look after morbidity during & after
treatment
 PLAN OF NCCP

ASSESS CANCER
SITUATION

DEFINE GOALS &

OBJECTIVES

IDENTIFY PRIORITY NEEDS

OUTLINE STRATEGIES NGO /

PARTNERSHIP
INTEGRATION WITH
ASSESS RESOURCES OTHER PROGRAMMES

BUDGET
SETTING ACHIEVABLE TARGETS
 PLAN OF NCCP

IMPLEMENTATION

PROGRAMME MONITORING

OUTCOME
EVALUATION
 WHO promotes the stepwise
implementation of interventions
according to the level of resources
Example: High Level
Mammography breast of
cancer screening resources
Middle
Cytology cervical cancer screening level of
Treatment of all curable tumours resources

Awareness of early signs & symptoms of Low level of

cervical & breast cancers plus adequate resources
diagnosis and treatment
Palliative care and prevention of the most Very Low level
prevalent cancer risk factors (e.g. tobacco) of resources
>80% of the Worlds Population
• 1st started in USA –
• Now out of 167 countries
50% have a cancer control plan
75% have national guidelines for
prevention
however, only a few countries have a
comprehensive programme including all
the objectives
Demographics of India
Total popln- 1027015247

Birth rate 22.32 /1000 live

births
Death rate 8.28 /1000 live
births
Popln growth rate 1.4%

Sex ratio 933 F / 1000

males
Urban popln 28%

Per capita income Rs

12,426
25% below poverty line
836 million people live on< Rs 20/
day
 NATIONAL CANCER
CONTROL PROGRAMME
• Rao Committee (1965) & Wahi Committee
(1971) laid down the framework of the Cancer
Research and Treatment Programme, which
was.initiated as a central sector project in 1975
(Wahi committee report – Agra- 1967-1973)

- to provide financial assistance for

procurring machinery & equipment reqd. for
detection & treatment of cancer
No stress on prevention
For 9 years nothing done
 NATIONAL CANCER
CONTROL PROGRAMME
• Revised in 1984- 4 major goals

• Primary prevention of tobacco related cancers

• Early detection of cancers of easily accessible sites

• Augmentation of treatment facilities

• Establishment of equitable pain control & palliative care

network & after care rehabilitation

Kerala – 1st state in India to formulate a cancer control

programme of own ( called 10 yr action plan ), with
same goals as national plan
 How it operates
N C C P
(ministry of health & family
welfare)
Regional Cancer Centre / Medical
College with oncology wing

Medical college without oncology

wing
District hospital

Primary health
centre
70-90% cancers are environmental

Lifestyle related factors are most important

30% cancers are curable by early detection & prompt

treatment
Common cancers in women – Cervix, breast and oral
cavity (52%)

Common cancers in men – Tobacco related (45%)

(Oral, lung, pharynx and oesophagus)

Over 75% of patients seek treatment at a late stage.

 NATIONAL CANCER
CONTROL PROGRAMME
• Revised in 1984- 4 major goals

• Primary prevention of tobacco related cancers

• Early detection of cancers of easily accessible sites

• Augmentation of treatment facilities

• Establishment of equitable pain control & palliative care

network & after care rehabilitation

Kerala – 1st state in India to formulate a cancer control

programme of own ( called 10 yr action plan ), with
same goals as national plan
 OBJECTIVE 1 of NCCP:
PRIMARY PREVENTION –
greatest public health potential
most cost effective
Priority to Tobacco control –
most imp identifiable cause of cancer
( 34% of cancers in India are due to tobacco )
40-50% in men
20% in women
added burden of tobacco chewing-
khaini, mawa, mishri,mainpuri
tobacco
112 million persons smoke tobacco
96 million use it in smokeless form
 Measures taken
• Legislative action
• Education of youths & adults
• Multisectoral comprehensive approach

Legislative action
Cigarette act (1975)-
cigarette smoking is injurious to
health

Prevention of food adulteration rules

(1990)
 Legislative action contd..
Cigarette & other tobacco products act
(2003)
prohibition of ….
……1. smoking in public places
2. direct /indirect advertisement of cigarettes &
other tobacco products
3.sale of cigarettes & other tobacco products to
persons <18 yr age
4. sale of tobacco near educational institutions

Mandatory depiction of statutory warning & depiction

of tar & nicotine contents along with max
permissible limits on tobacco packs
 Education against tobacco
• use
Propagation of anti tobacco measures by
mass media, pamphlets, posters, stickers,
health magazines (kalyani)
Propagation in rural areas by village level workers against
tobacco chewing , use of ghutka & pan masala & use of
snuff
Main focus- school children & adolescents
(Most susceptible age of tobacco initiation is early
adulthood- 15- 24yrs)
school teachers – role models
tobacco as a topic in NCERT books
31ST MAY- NO TOBACCO DAY
ICMR sponsored anti tobacco health education and oral
screening
 Tobacco cessation clinics in
India
initiated by SEARO of WHO in 18 centres
all over India
have reported 16 % quit rates at 6 wks
post intervention
Combined with behaviour therapy – 35%
quit rates
 Multisectoral comprehensive
approach
• Total tobacco employment >35.59 lakhs
• Tobacco provides avg 10% India’s excise
revenue of which 88% contributed by cigarettes
• India 3rd largest tobacco producer in world
- reduction of tobacco crop with rehabilitation
of workers
- regulation of tobacco production
- economic & agroindustrial restructuring
- keeping price of tobacco products high
• What have we achieved till date ?
2 large nation wide surveys for prevalence of tobacco use –
urban and rural areas
1- male 2 -
female
urban rural

30.00% 40.00%

20.00% 30.00%
1987-88 1987-88
20.00%
10.00% 1993-94 1993-94
10.00%
0.00% 0.00%
1 2 1 2

Kerala- 2 prog 1993- 94

1 lakh tobacco free homes & similar prog in 6000 schools
- wins ‘ world no tobacco award of WHO in Bangkok

Chandigarh 1st city in India to be declared tobacco

free in 2007
why the problem persists
?
• Tobacco addiction deep rooted & very
difficult to control as immediate harmful
effects are not seen
• Strong industry
• Large rural population involved
• Taxation very low level & even not
effectively collected for all tobacco
products except for cigarettes
 Secondary prevention
• Cancer registration
• Early detection & screening
CANCER
REGISTRATION
Principal objective:
1. To generate authentic data on
magnitude of problem
2. To undertake control measures
3.To promote human resource
development in cancer epidemiology
 Cancer registration
• Data collection started in Bombay- 1964
• 1980- data collection as a continuous basis
• 1982- impetus by starting of NCRP

Population Hospital
based based
Epidemiology & public Taking into
health in mind
account clinical
Gives true incidence & care & hospital
exact prevalence
administration
NATIONAL CANCER REGISTRY PROGRAMME
(Indian Council of Medical Research)

14 Population Based

6 Hospital Based
■
CHANDIGARH

DELHI SIKKIM
DIBRUGARH
GUWAHATI

SILCHAR IMPHAL
AHMEDABAD BHOPAL MIZORAM

KOLKATTA

MUMBAI
ICMR HEAD QUARTERS
BARSHI NCRP COORDINATING UNIT

CHENNAI POPULATION BASED REGISTRY

BANGALORE
POPULATION BASED RURAL REGISTRY

HOSPITAL BASED REGISTRY

THIRUVANANTHAPURAM
 Cancer registration
contd…
• Reporting of cancer cases to registries
- still voluntary
- rural areas – facilities suboptimal
- population coverage 40% only
Periodic based surveillance needed
In a hospital ideally there should be ONE
registration for cancer cases
No exact incidence & prevalence data in
our country- only approximation
Majority of cancer in our
country are from easily
accessible sites
- ca cervix
- ca breast
- ca lung
- oral cavity cancers
- ca colon
 Early detection &
screening
• Best way to control- to detect
early
•Screening
SCREENINGis the presumptive identification of unrecognized
disease or defects by means of tests, examination, or
other procedures that can be applied rapidly
Source: WHO. NCCP, 1995

PREREQUISITES FOR SCREENING

Highly acceptible inexpensive highly applicable
to large popln
Simple & noninvasive high sensitivity & specificity
SCREENING OF
CANCERS OF
CERVIX ,BREAST
ORAL CAVITY
• Population screening successful in
reducing morbidity & mortality in countries
with high level resources
• Our problem- screening of an
asymptomatic population in a large
country with limited resources
• Hence only screening of high risk cases
Disease Burden Of cervical cancer in
India
Commonest cancer among women
New cases = 1.26 lakh /year
Deaths = 0.7 lakh /year
(Globocan 2002; Shanta et al 2000)

Chennai

Delhi
Age-adjusted
Bangalore
incidence rate
Bhopal

Mumbai

Trivandrum

0 10 20 30 40
Rates per 100000
 Screening for cervical
cancer
13% cancers if cervix can be potentially screened &
treated successfully
• Pap Smear Screening
• Visual Inspection of Cervix
• Visual Inspection of Cervix after magnification
• Visual Inspection of Cervix after acetic acid, lugol’s iodine
• HPV detection

Regardless of method of Screening, it is important to

establish and run an efficient network for this purpose.
 Limitations of Pap Smears
for National Screening
Programs
• Pap smear-based programs require complex logistics,
advanced training, and well managed program
implementation for adequate testing to occur.
• These elements are not available outside large cities in
many low-resource settings.
• Even in large cities, quality pap smears are possible but
ongoing supervision, refresher training and continued
supplies are necessary.
• Cytology is not viable as a nationally accessible
screening method in Low Resource Settings.
• Visual inspection of the cervix after application of 4-
5% acetic acid (VIA) is a simple, inexpensive test that
is provided by trained health workers.

World Health Organization (WHO) supported a study in

India between 1988 and 1991 in which unmagnified
visual inspection with acetic acid washing was evaluated
as a "down staging" technique.

sensitivity specificity
VIA 93.4% 85.1%
PAP 72.1% 91.6%
VIA+VILI 78.8% 82.1%
Early detection of cervical neoplasia in Mumbai, WHO Bulletin 2004
VIA effective adjunct to the Papanicolaou
smear for cervical cancer screening
• Non-invasive, easy to perform and
inexpensive
• Can be performed by all levels of healthcare
workers, in almost any setting
• Results are available immediately
• Initial treatment can be provided at the time
of the examination
• All system requirements are available locally
• Approach suitable for lowest-resource
settings
• Successful in Kerala

Primary target of programme – to offer once in a

lifetime screening for all women at 40 yrs of age
 Barriers to women’s
participation
• Little understanding of cervical cancer
• Limited understanding of female reproductive
organs and associated diseases
• Lack of access to services
• Shame and fear of a vaginal exam
• Fear of death from cancer
• Lack of trust in health care system
• Lack of community and family support
• Concept of “preventive care” is foreign
 Screening for breast
• Data from HBCR- cancers
• 15 % - localized state
75 % - lymph nodes at presentation
10 % have mets at presentation
 Screening for breast
•
cancers
Breast cancer screening programs involving imaging
techniques expensive
• hence cannot be adopted in developing countries like
India as a routine public health measure

Breast cancer would be best tackled through an early

detection programme using Clinical Breast
Examination (CBE) performed by trained paramedical
personnel such as female health workers

Screening by CBE can be potentially as effective as

screening by Mammography
( Once a month 10 days after menstrual
period )
 Patient with a lump in
breast
(detected by BSE )
Clinical examination by health care
professional

Refer to higher centre for investigation

Reassurance- al lumps need not be
cancer

Malignant lump-

Benign lump- prompt referral for app

reassurance t/t
 Screening- to reduce
mortality & thus improve
survival
• Breast self examination propagated
through
print & electronic media
health care professionals

Postage stamp on
BSE
• Rs. 285 Crores has been allocated for the NCCP under the tenth
plan.

• Can Scan software package for early detection of breast

cancer was supplied to 11 Regional cancer centres in
1999- 2000.

• 11 lakh Pap Smear kits for early detection of cancer

cervix supplied to 12 Regional cancer centres 1998-99.

• Training of trainers programme regarding awareness, prevention,

early detection & treatment in Breast and cervical cancers at Tata
Memorial Hospital and CNCI (RCC) Kolkatta in 1999.

• Orientation training workshops for cytopathologists regarding quality

assurance of Pap smear test carried out at 5 RCCs namely
KMIO Bangalore, GCRI Ahmedabad, RCC Gwalior,
RCC Thiruvananthapuram, TMH Mumbai.
 Screening for oral cavity
cancers
• 10 – 15 % patients present on early stage
• M:F 2:1
• Ca tongue in males in Bhopal (8.8 / 100000) is highest in
all continents
 Screening for oral cavity
cancers
• Disease occurs in poor - majority illiterate
• Not bothered for oral cavity examination

Oral examination followed by indirect/ direct laryngoscopy

if needed is the standard procedure followed

Smokers are also routinely investigated for

pulmonary lesions by simple x-ray of the chest.
 efficacy of screening by visual
inspection of the oral cavity in
detecting early stages of oral cancer
and in reducing mortality
• Good participation rates for screening (~90%)
• Moderate compliance to referral (~62%)
• A significant detection of oral cancer at early
stages (stage I & II) by visual inspection (41.5%
vs. 23.5%)
• Significant (34%) reduction in oral cancer mortality
among individuals with tobacco/alcohol habits
• Risk of disease extremely low among persons
with no tobacco/alcohol habits
• Potential to prevent 37,000 oral cancer deaths
world-wide
 Key targets for effective cancer control
on India
area Short term targets (for Long term targets
next 5 yrs ) (subsequent 5
yrs)
Reverse Focus :13-21 yr males Focus: 13-25
trends in male
tobacco 13- 21
Reduce new tobacco
use females in
users by 2% per year
endemic areas
Reduce new
tobacco users by
5 % per yr
Early Goal:detect in early Goal : detect in
detectio stage I/II early stage I/II
n of 40% of all oral & cervix 75% of all oral &
cancers in that popln cervical cancers
 Key targets for effective cancer control on
India
area Short term Long term targets
targets (for next (subsequent 5 yrs)
5 yrs )
Demonstrate redn Goal: reduce or Goal: reduce incidence
in population stabilise incidence Cervix : 5% redn yr
incidence Cervix: 2% redn per yr H& N : redn /yr
H& N :stabilise Breast , lung &
Breast, lung& oesophagus: stabilise
oesophagus: limit rise
<5%/yr
Demonstrate redn Goal :reduce or Goal : reduce or stabilise
in popln mortality stabilise mortality mortality
Cervix : 5% redn per yr Cervix : 7% redn per yr in
H&N :stabilise mortality popln
in popln H& N : 7% redn /yr in
popln
Breast,lung & oesophagus:
stabilise mortality
Augmentation
of treatment
facilities
 Augmentation of treatment
facilities
Current Infrastructure Inadequate
• 1.5 Beds/1000
• 0.5 allopathic doctors/1000
• Large dependence on unregistered and
alternative medicine practitioners
• Cancer Beds No reliable
information
• Treatment centres:
Regional Cancer Centres : 25
teletherapy units :400
brachytherapy units :138
25 Regional cancer
centres
+Srinagar

+Imphal

+Kancheepuram
 Augmentation of treatment
•
facilities
Enhancement of cancer treatment & control
services through regional cancer centres,
medical colleges with / without oncology wings

Till 2 decades ago

Gross Examination, Light microscopy and clinical

information only – for diagnosis and treatment plan

Today pathologic diagnosis in multimodal

Histochemistry, electron microscopy Cytogenetics,

molecular genetics

have added new dimension to diagnosis

Plays an important role in improved survival and

Tailor treatment to specific tumour type

 Augmentation of treatment
facilities
• Multidisciplinary approach to cancer
treatment essential- made available at
all regional cancer centres
Changing concepts and advances in
Surgical Oncology
Conceptual change from widest removal possible
Avoid mutilation

Stress on conservation and functional rehabilitation

without compromise on disease eradication

Minimally invasive surgery

 Augmentation of treatment
facilities
• Cancer chemotherapy
• Essential drug list for cancer chemotherapy & services for
common cancers made available

• Advanced facilities for high intensity chemotherapy for

leukaemia & other cancers where chemotherapy mainstay
of treatment provided at regional cancer centres
 Radiotherapy facilities
• Still mainstay of treatment in India
• 1st cobalt 60 teletherapy unit (Eldorado A)-1956
Cancer Institute , Chennai- 20
1st linear accelerator – 1976
Cancer Institute , Chennai- 20
Now cobalt units- 290
linear accelerators- 37
For 1,027,015,247 persons spread over 62 cities
 Radiotherapy
• Actual requirement :
facilities
• 8 lakh cases diagnosed / year
• per year 1 machine can treat 600 patients
• Hence we require at least 1400 machines
• We have- only 400
• Deficit- 1000

• Hence
long waiting lists of patients ,
long distances of travelling to reach treatment centres
along with
added costs of travelling, stay & treatment
OPTIMAL STRATEGIES REQUIRED

1. Patients for palliative treatment & curative

treatment need to be identified in the beginning
of treatment plan

palliation can be achieved in minimum machine

time

2. Limited grants- Rs 5 crore at given at one time

toRCC
which machine to buy ?
 Cobalt 60 LINAC
Cost of machine Rs 2 crore Rs 3.5- 4 crore
Annual maint Rs 10 lakhs Rs. 20 lakhs
cost for 10 yrs
Cost of spare Rs 10 lakhs Rs 20 lakhs
parts for 10 yrs
Source Every 7 yrs Rs 35 ---------
replacement lakhs for 12,000
curie with added
burden & cost of
source disposal
Total maint cost Rs 55 lakhs Rs 40 lakhs

Total life > 25 yrs 15 yrs

 Co60 LINAC
Dose Rate 280 cGy/min 150-200
falling (400-600) cGy constant

Pdd 57.5% 62.5 – 67.50%

Penumbra Significant Negligible

Field size 4x4 0x0

35 x 35 40 x 40

Build up 0.5 cm below skin 6 Mev – 1.2 cm

15 Mev →2.7 cm
E’beam -- +
Whole Body difficult Effective
Irradiation
Radiation hazard + -
• IDEAL MACHINE- LINEAR ACCELERATOR
• If treatment centre is at remote area where maintenance is a
problem
- COBALT machine is ideal

IDEAL MANPOWER

Radiation oncologist -1 for 400-600 patients

Medical physicist -1 for 600-700 patients
(1 for each machine)

Technicians - 2-3 for 40 patients in a day

( 2 persons sitting together)

- brachytherapy, simulator etc---

1 each

reserve- additional 25%

 Financial support
• To strengthen cancer treatment facilities
• For cobalt unit installation
Rs 1.00 crore for charitable organisations
Rs. 1.5 crore for govt. institutions
for procurement of equipments
This is 1 time grant at present
For development of oncology wings in govt.
medical college hospitals
Central assisstance of Rs 2.00 crore for equipment
purchase
State govt./ institution- for civil works & manpower
• OUR ACHIEVEMENTS
• 1st successful
indigenous telecobalt
unit of INDIA at TATA
MEMORIAL CANCER
CENTRE-
BHABHATRON
developed by Dept. of
Atomic Energy
Marketed by Panacea
installed in 2005
• New version of low energy linear accelerator developed by
SAMEER
( society for applied microwave electronics engineering & research)
installed 1st at Wardha

Further attempts for integrated 6 Mv LINAC – proposal under Jai

Vigyan National Science & Technology Mission
Palliative care
&
Rehabilitation
 Palliative care
• WHO defines - Active total care of patient whose
disease is not responsive to treatment
• All patients should get appropriate psychological
& spiritual support in addition to medical /
nursing interventions
4 cardinal principles
• NON- MALEFICENCE
• BENEFICENCE
• PATIENT AUTONOMY
• JUSTICE
• Aims- “to put life into their days and not just days
into their life’’
 Pain statistics in India
• 1 million people in India experience cancer pain everyday
• at diagnosis – 20-50% patients
• with advanced disease 75% patients

• 80-90% of pain can be relieved by W.H.O. analgesic

ladder
Pain is caused by-
• The cancer – 85% of patients
• Anticancer treatment- 17%
• General illness & debility
associated with disease- 9%
• Concurrent disorders- 9%
Treatment of cancer related
pain
• Thorough assessment Strong opoids +/-
non opoid +/- adj
• Treatment of underlying cancer
• Analgesics - W.H.O. ladder Weak opoid +/-
nonopoid+/-adj
• Physical therapy
• Psychological therapy Nonopoids +/-
• Lifestyle modification adj
• Treatment of other causes of suffering which
may cause or aggravate pain- social,
cultural,spiritual
 1996-1998
National narcotics
policy analysis &
simplification of state
narcotics rules

Shanti avedna ashram 1986

1992 Pain relief &

morphine availability as
priority by NCCP
• RCC Kerala- 1st institution in India to
manufacture and supply liquid morphine (1988)
• Morphine tablets made available since 1991
• 1st workshop on morphine availability in
Thiruvananthapuram ,June 24 , 1998

Present level of morphine consumption 10 kg

expected to go up 25 kg annually

State level programme ---- to network all

palliative care centres and to make available
pain relief nearer to homes of patients
implemented
 Rehabilitation & palliative
care
• >75% cases present in advanced stages
• Palliative care & pain relief essential to provide
good quality life
• Majority of patients by the time of reaching
hospital are in great economic distress- cost of
prolonged treatment & travelling expenses
• Half way homes & hospices through NGO are
attached to RCC to render palliative care
services
 HOSPICE
CENTRES
•CHANDIGARH
27 hospices
1 in India
NEW DELHI 3
UTTAR PRADESH 1 ASSAM 1

WEST BENGAL 1
MADHYA PRADESH 2

MAHARASHTRA 3 ORISSA 1
GOA 1
ANDHRA
PRADESH

1
KARNATAKA 4
TAMIL NADU 4

KERALA 27
 REGIONAL CANCER CENTRE

HOSPICE HOME CARE

 REHABILITATION
SERVICES
• Physical restoration services
• Psycosocial and community adjustment
• Special project for young cancer patients
• Vocational services
• Rehabilitation of rural cancer patients
• Rehabilitation research
 REHABILITATION
SERVICES
• Physical restoration services
Cancer surgery can result in loss of speech, loss/ limitation of mobility
of arm or leg – acute sense of loss, adjustment problems often
alarming and catastrophic

Necessary counselling and guidance by

social workers to patients and families

Restoration of max functional capacity

physiotherapy
Prosthesis & appliances

Presently-
Manufacturing of these items in India at cheaper rates
Certain centres prosthetic and appliances are prepared by
cancer patients trained for such jobs
Assistance from self help groups IAL, OAI , ICRRP
 REHABILITATION
• SERVICES
Vocational services
In India many cancer patients are illiterate
unable to continue heavy manual work
Many cases when only earning member head of family affected --- whole
family dehabilitated & disintegrated
Even when physical ailment under control – socioeconomic consequences
unsolved & distressing
Rehab.- variety of vocational services every yr to nearly 500 patients
to suit individual & family needs
Younger patients- succesfully placed in regular jobs
Older persons- helped for self employment from nationalised
banks / voluntary donors
Direct dependants of patients with advanced disease- accepted for training
& job placement
 REHABILITATION
SERVICES
Special project for young cancer patients
• Counselling
• Family assistance
• Recreational activities
• Scholarships for higher education
• Nutritional help
• Economic assistance for medicines
• Training for sheltered work , job placement
 REHABILITATION
SERVICES
Rehabilitation of rural cancer patients
• Vast majority are from rural areas
• Most unable to continue heavy farming jobs
further
• 1990-1991 pilot project by Indian Cancer
Society in collaboration with National Institute
of Handicapped Research in Washington-
training in several cottage based industries-
grocery, poultry farming, leather work,
horticulture,dairy farming
• Every year >200 rural patients given
employment assisstance at rehab . centres
 Existing schemes under
NCCP
• Financial assistance to voluntary
organisations
meant for IEC activities and early detection of
cancer
Financial assistance upto Rs 5 lakh provided to
registered voluntary organisations
recommended by state govt
A linkage with the RCC (or med college / district
hospital ) is now mandatory by NGO concerned
 Existing schemes under
•
NCCP
District cancer control scheme
launched in 1991 in selected districts

Aim- prevention and early detection at doorstep of rural

community

5 components-
• health education
• early detection
• training of medical & paramedical personnel
• palliative t/t & pain relief
• coordination & monitoring
However little enthusiasm among states to continue
 Modified DCCP
Primary objectives
• To collect data demographics (sp. Of women)
• awareness level about personal hygeine
• availability & quality of primary health care facilities
• to teach women BREAST SELF EXAM
• to do VIA
• To integrate prevention & early detection activities
with existing health set up
• To find a cost effective strategy for creating
awareness
• Started in
Modified DCCP
Uttar Pradesh 20 rural blocks
Bihar 20
West Bengal 10
Tamil Nadu 10
For each block - 20 female health workers
( 1 for every 100 women)
For every 10 blocks – 5 medical officers, 1 consultant doctor

FINANCIAL GRANT-
EARLIER
Rs 15 lakh for each project district in
1st year
Rs 10 lakh / year thereafter for 4 years
NOW
• Rs. 17 lakhs as recurring expenditure per year with
provision
for manpower deployment, IEC, training, etc
• Rs. 5 lakhs as non-recurring expenditure for the first
year
 Existing schemes under
NCCP
• Assistance for regional research & treatment
centres
• 25 regional cancer research & treatment centres
recognised by govt. of India
• earlier a recurring grant of Rs 75 lakhs being
given to 15 of these RCC
• Now- 1 time grant of Rs 3 crore to all existing
RCC
• In addition CNCI (Kolkata ) & IRCH (AIIMS) also
funded under NCCP
 Existing schemes under
NCCP
• Role of international agencies
WHO has promoted NCCP in India
major areas of contribution
• Tobacco control
• Palliative care
• Human resources development
INDIA can become a model to the world for
cancer control at low resource settings
 Revised plan of NCCP
• WHY ?
Results of previous plan disappointing -
no improvement in cancer treatment results
80% coming at late stages
Earlier plan activities focussed on district plans
separately rather than an overall national effort
Treatment was not uniformly available
Requirement to bridge the gaps and synchronize
with the 11th 5 yr plan (2007- 2011)
 Revised plan of NCCP
• Current programme has 5 schemes
 assistance to new RCC
 strengthening of existing RCC
 assistance to develop oncology
wings in medical colleges
 decentralized NGO scheme
 DCCP- modified
Latest plan approved in 2004
implementation from April 1,2008
• The NGO scheme is meant to extend financial assistance to
NGOs working for cancer.
• The NGO scheme will be implemented through the Nodal
Agency - RCC or a Govt Medical College with Radiotherapy
facilities or Govt Hospital with Radiotherapy facility.
• State Government will recommend the names of the Nodal
Agency
• The NGO will implement the activities by means of
organizing
of camps at periodic intervals in a well-defined
geographical area.

• The interval at which the camps will be held will be

decided on
the basis of capability of the NGO.
• The camps will be held in rural areas or at work places
like factoriesEach camp should cater to a minimum of 100
patients
• For every 50 patients expected, one medical officer should
be available in the camp.
 New initiatives
• IEC activities

• Outreach activities by medical colleges for increasing

awareness & early detection
• Cancer atlas
• Training of cytopathologists & cytotechnicians in quality
assurance in PAP smear
• National Cancer Awareness Day- 7th Nov
• Supply of morphine
• Telemedicine & supply of computer hardware & software
• Onconet- proposal worth Rs 9.82 crores for linking up
RCC amognst themselves & with each 5 peripheral
centres

• among developing countries India 1st member nation of

IARC , Lyon France since May 2006
 Conclusions
• Generate reliable mortality data & some mortality data for
common cancers across the country

• Establish an effective system of monitoring pattern of

carcinogenic exposure ..sp tobacco, industrial, viral

• Identify more effective , simple affordable & effective screening

methods

• Build consensus for minimum acceptible standards of care

considering afforfability,compliance,toxicity & efficacy rather
than guided & funded as per the western standard of care
regimens
• Availability of palliative care & morphine
should be developed more for advanced
incurable cancers

• Strengthen RCC, medical colleges, DCCP

• Rigorous & regular audit of performance

at all levels of planning &
implementation