Cancer wake-up call in Punjab
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"Fresh studies will have to be undertaken, especially for areas where cancer incidence is high," says Health Minister Madan Mohan Mittal.
The nearly 24,000 cases detected was in addition to over 33,000 deaths from cancer-related causes in the last five years — around 18 a day — and 84,453 people who showed cancer-like symptoms but who hadn't yet been diagnosed with the disease.
It is not that the actual number of cases has trebled between 2009 and 2012, when the latest survey was conducted. It is the detection, with the survey having been conducted on a scale never seen before. Data gatherers went from door to door in an exercise that covered nearly 98 per cent of the population in three months starting October 2012 — 2,64,84,434 people in 50,53,447 households in 12,603 villages and 217 cities and towns.
The government had undertaken the exercise amid widespread claims about cancer being on the rise, and following studies by PGIMER, Punjab Agriculture University and some NGOS that attributed the trend to industrialisation, lifestyle changes, population growth, higher life-spans and the rampant use of pesticide, insecticide, chemicals and heavy metals.
A pilot for the government study had counted 785 cases in Faridkot, again around three times the 245 of 2009, but that did not cause alarm until the final set of figures was compiled.
The 23,000-odd cases represent 90.1 affected people per lakh population. Nationwide, the rate is estimated at around 80. Deaths statewide were 125 per lakh, and the total 33,000-odd in five years would represent a very large share if one goes by a nationwide estimate of 4-5 lakh a year.
"This campaign was never intended to be a scientific study. In its first phase, which has culminated in the release of the report, its aim was to make people aware of the disease, to identify those who could be suffering from it," says health secretary Vini Mahajan.
For the suspected cases, the government is working out a treatment plan. "On World Cancer Day we will launch the second phase, which will entail taking the 85,000 persons found to be showing symptoms through a multiple-stage process of verification, followed by treatment," says Mahajan.
What the survey does not cover is distribution between men and women, or even which forms of cancer are commoner than others. It records an uneven region-wise distribution without going into the causes. "There is still no concrete evidence that points towards the cause of the disease being more widespread in one area and almost absent in others," says the health minister.
Malwa had 14,682 of the 33,318 deaths. Of these, 4,000 died in Ludhiana. The region reported 107.1 cancer cases per lakh, compared to 88.1 for Doaba and 64.7 for Majha.
The health department will support a number of studies aimed at finding out why incidence is higher in Malwa. "We have a tie-up with the Tata Memorial Centre in Mumbai. They will set up cancer registries in Mansa and Sangrur (in Malwa) and also in Mohali... But to arrive at concrete conclusions could take several years," Mahajan says.
Of possible causes, some specific to an area had been suggested earlier by Prof J S Thakur of PGIMER, now associated with the government survey too. A 2008 study on Talwandi Sabo and Chamkaur Sahib had revealed the presence of pesticides such as heptachlor, ethion, and chloropyrifos and heavy metals in samples of drinking water and concluded that these had led to a higher incidence of cancer.
"Multiple factors were responsible for significantly higher prevalence of cancer cases in Talwandi Sabo; therefore, a multi-pronged strategy to discourage the indiscriminate use of pesticides, tobacco and alcohol needs to be adopted," stated the 2008 study.
Among Malwa's districts, the latest study found Muktsar with 136.3 cancer cases per lakh, followed by Mansa, Bathinda and Ferozepur. Deaths too were highest in Muktsar, followed by Moga. Of suspected cases, the number of people showing symptoms was the highest in Moga, followed by Sangrur, Muktsar and Ferozepur.
In Doaba, incidence was highest in Kapurthala (99.1 per lakh), followed by Jalandhar and Hoshiapur. Deaths were highest in Jalandhar, followed by Kapurthala and Hoshiarpur, and suspected cases highest in Jalandhar, followed by Kapurthala.
In Majha, Amritsar had the highest incidence (81.2 per lakh) as well as deaths, while Tarn Taran had the most suspected cases.
The survey involved 40,000 field workers in an effort coordinated by 88, 800 and 4,000 people respectively at state, district and block levels.