NATIONAL CANCER CONTROL PROGRAMME

By: Pooja PanchalMBA(PHI) 2nd Sem

Background:

The National Cancer Control Programme was initiated in the year 1975.

It was revised in the year 1984-85 with emphasis on primary prevention and early detection of cancer. Various schemes were introduced under the programme in order to strengthen cancer control activities in the country. Under the Xth Five Year Plan, the schemes have been modified to further augment the existing facilities. The focus is on covering the geographical gaps for providing comprehensive cancer care in the country.

Occurrence of Cancer in India :

Cancer is an important public health problem with 8 to 9 lakh cases occurring every year. At any point of time, it is estimated that there are nearly 25 lakh cases in the country. Every year about 4 lakh deaths occur due to cancer.

40% of the cancers in the country are related to tobacco use. Data from National cancer registry programme informs that leading sites of cancer among men are cancer of oral cavity, lungs, oesophagus and stomach and among women are cancer of uterine cervix, breast and oral cavity.

Cancers namely those of oral and lungs in males and cervix and breast in females account for over 50% of all cancer deaths in India

GOALS & OBJECTIVES OF NCCP: 1. Primary prevention of cancers by health education specially

regarding hazards of tobacco consumption and necessity of genital hygiene for prevention of cervical cancer. 

2. Secondary prevention i.e. early detection and diagnosis of cancers, for example, cancer of cervix, breast and of the oro-pharyngeal cancer by screening methods and patients’ education on self examination methods. 

3. Strengthening of existing cancer treatment facilities, which are woefully inadequate. 

4. Palliative care in terminal stage of the cancer.

National Cancer Registry Programme (NCRP): It is initiated for data base of cancer cases, in 1982 by ICMR. It gives a picture of the magnitude and patterns of cancer. There are two types of registries - Population Based Cancer Registry - Hospital Based Cancer Registries, which was started in January 1982. The Population-based registries take the sample population in a geographically defined area . The Hospital-based registries take the data from patients coming to a particular health institution. At present we have 21 Population-based registries and 6 Hospital-based registries all over the country. In 2001, data from all cancer registries and all medical colleges were collated for the “Development of an Atlas of Cancer in India” (www.canceratlas.india.org) to have an idea of patterns of cancers in several other parts of the country, including those not covered under the NCRP.

Development of Cancer in India:

 

Average Annual Crude (CR) and Age Adjusted Incidence Rates (AAR) per 100,000 population in Indian PBCRs during the time period indicated in parentheses is shown in next figure: 

Registry Males Females

CR AAR CR AAR

Bangalore(1997-99) 57.2 92.1 73.6 115.5

Bhopal(1997-99) 62.4 117.0 62.0 107.8

Chennai(1997-99) 88.2 112.3 101.9 124.4

Delhi(1997-99) 71.4 126.1 85.4 142.0

Mumbai(1997-99) 69.7 116.8 84.2 126.7

Ahemdabad(1993-97) 68.8 107.2 56.8 82.9

Kolkata(1998-99) 82.8 102.1 93.4 114.6

Pune(1993-97) 64.4 103.9 76.8 115.3

Thiruvananthapuram(1993-97) 73.9 87.8 73.9 81.1

Evolution of NCCP:

1975-76 National Cancer Control Programme was launched with priorities given for equipping the premier cancer hospital/instituti -ons. Central assistance at the rate of Rs.2.50 lakhs was given to each institution for purchase of cobalt machines.

1984-85 The strategy was revised and stress was laid on primary prevention and early detection of cancer cases.

1990-91 District Cancer Control Programme was started in selected districts (near the medical college hospitals).

2000-01 Modified District Cancer Control programme initiated.

2004 Evaluation of NCCP was done by National Institute of Health & Family Welfare, New Delhi.

2005 The programme was further revised after evaluation.

Steps Involved in Treatment:Diagnosis Death

Palliative Care Disease modifying Therapy Bereavement Support Supportive Care

Existing Schemes under National Cancer Control Programme (NCCP) as on 1st June 2008 {w.e.f 1st January 2005}:  1. Recognition of New Regional Cancer Centers (RCCs): to

enhance the cancer treatment facilities across the country and reduce the geographical gap in the country in the availability of cancer care facilities, New Regional Cancer centers are being recognized. A one-time grant of Rs. 5.00 crores is being provided for New RCC’s.

2. Strengthening of existing Regional Cancer Centers: A one-time grant of Rs.3.00 crores is provided to the existing Regional Cancer Centers to further strengthen the cancer care services.

 

Contd..3. Development of Oncology Wing: Government Hospitals &

Government Medical Colleges are provided with a grant of Rs. 3.00 crores for the development of Oncology Wing. 

4. District Cancer Control Programme: The DCCP will be implemented by a nodal agency, which may be a Regional Cancer Centre or Government Medical College or Government Hospital with radiotherapy facility. A cluster of 2-3 districts are taken up for prevention, early detection, minimal treatment and provision of supportive cancer care at district levels. A grant-in-aid of Rs. 90.00 lakhs spread over a period of 5 years is provided per DCCP proposal. 

5. Decentralized NGO Scheme: A grant of Rs. 8000/- per camp will be provided to the NGOs for IEC activities. The funds are released through a Nodal agency which could be a Regional Cancer Centre or Government Medical College or Government hospital with radiotherapy facilities.

Achievements (as on June 2008):

Regional Cancer Centers:As of now, there are 27 Regional Cancer Centers, including 6 NGOs, providing comprehensive cancer care services. Outreach and research activities in prevention and treatment of cancers are carried out by these centers.  Oncology wing:Support has been given to 82 institutes in both Government Medical Colleges and Government Hospitals for development of Oncology wing. At present there are 246 institutions with radiotherapy facilities across the country, including the 27 Regional Cancer Centers. District Cancer Control Programme:The District Cancer Control Programme, which has been developed to initiate awareness and early detection activities at the district level; are in place in 28 districts at present. 

IEC Activities:

Health education: Important tool for prevention and early detection of cancers.It is given importance in every scheme under the National Cancer Control Programme. The programme supports activities of health magazine ‘Kalyani’ and telecast by Prasar Bharti targeting especially those living in the most populous States. It is an interactive programme which provides an interface to the people with experts on various health and social issues.Kalyani is telecast in 9 capital Doordarshan stations-Bhopal, Bhubaneshwar, Dehradun, Guwahati, Jaipur, Lucknow, Patna, Raipur, Ranchi and 12 sub regional stations i.e. Gorakhpur, Varanasi, Bariely, Mau, Allhabad, Indore, Gwalior, Jagdalpur, Daltonganj, Bhawanipatna, Sambalpur & Muzaffarpur. IEC materials in the form of audio-video spots, posters, leaflets, flipcharts etc. have been developed. Advertisements have been given in the leading dailies for creating awareness about cancer among the general masses.

National Cancer Awareness Day: The birth anniversary of Nobel Laureate Madam Curie is being observed as National Cancer Awareness Day since 2001, to create more awareness about cancer. The theme for 2007 was “Detect Early, Save Life’.

Onconet- India:

  NIC has prepared the Detailed Project Report for Operationalisation of Onconet India. Under the project 25 RCCs will be linked with each other and also each RCC would in turn be linked to 4 peripheral centers thus facilitating telemedicine services and continued medical education. Telemedicine Services including tele-consultations, tele-referral, tele-pathology etc. will be provided.

The budget for the project is Rs.13.25 crores, which will be done in 2 phases.

Early detection, treatment, follow-up and management of cancer cases are the main services to be provided by this project.

Membership of IARC:

International Agency for Research on Cancer is a specialized agency of WHO to coordinate International Cooperation in Cancer Research. India has become a member of IARC at the 48th Session of the governing Council of IARC held in May 2006 at Lyon, France, which shall provide a fillip to cancer research in the country. So far IARC has provided technical and financial support for several cancer research and preventive projects in India.   

Budget Allocation:

The tentative budget for the 11th Five Year Plan is Rs.2400.00 crores.

The budget allocation for 2007-08 is Rs. 140.00 crore.