DR. MAHESWARI JAIKUMAR

CANCER CONTROL PROGRAMME

(INDIA)

• Is an important public health problem in India.• Nearly 7-9 lakh new cases occur

every year.• It is estimated that are 2-2.5

million cases of cancer in the country at any given point of time.

•More than 60% of these affected patients are in the prime of their life between the ages of 35 and 65 years.

GLOBAL OCCURRENCE

• 12 per cent of deaths are due to cancer.

• Second leading cause of death

OCCURRENCE IN INDIA• one among ten leading causes of

death

• 7 lakh new cases of cancer and 4 lakh deaths annually

• 15 lakh patients lack facilities for diagnosis, treatment and follow up

CAUSES

1.ENVIRONMENTAL FACTORS.2.GENETIC FACTORS

1.ENVIRONMENTAL FACTORS

1. Tobacco.2. Alcohol.3. Dietary Factors.4. Occupational Exposures.5. Viruses.

6.parasites.7.Custom, habits & life

styles.8.Others

2.GENETIC FACTORS

• E.g. Retinoblastoma.

• It is a complex inter relationship between environmental factors & the hereditary.

WARNING SIGNS OF CANCER

1. A lump or a hard area in the breast.

2. A change in wart or mole.3. A persistent change in digestive &

bowel habits.4. A persistent cough or hoarseness

5. Excessive loss of blood at the monthly period or loss of blood outside the usual dates.

6. Blood loss from any natural orifice.7. A swelling or sore that does not get

better.8. Un explained loss of weight.

COMMON SITES OF CANCERMALE Oral cavity Pharynx Larynx Prostate Rectum Lung

Ca ORAL CAVITY

FEMALE

• Cancers of oral cavity • Cervix • Breast

CANCER CONTROL PROGRAMME

1975-76

GOALS1. The primary prevention of

tobacco related cancers.2. Secondary prevention of

cancer of the uterine cervix, mouth, breast etc.; and

3. Tertiary prevention includes extension and strengthening of therapeutic services including pain relief on a national scale through regional cancer centres and medical colleges (including dental colleges).

• Palliative care in terminal stage cancer.

EXISTING SCHEMES UNDER NATIONAL CANCER CONTROL

PROGRAMME

1. DISTRICT CANCER CONTROL SCHEME ( DCCS)2. MODIFIED DISTRICT CANCER CONTROL

PROGRAMME( MDCCP)3. DEVELOPMENT OF ONCOLOGY WING

4. SETTING UP OF COBALT THERAPY UNIT (TELETHERAPY UNIT)

5. VOLUNTARY ORGANISATIONS SCHEME

6. NEW INITIATIVES

7.NATIONAL CANCER REGISTRY PROGRAMME (NCRP)

8. POST PARTUM CENTERS

9. REGIONAL CANCER CENTERS

10. TOBACCO REGISTRATION COUNSELLING

1. DISTRICT CANCER CONTROL SCHEME (DCDS) 1990-1991

OBJECTIVES:

• To prevent and control cancer through health

education and early case detection & treatment.

ACTIVITIES:

• 15 lakh to start the programme and then

Rs10,000 every year for four years.

2. MODIFIED DISTRICT CANCER CONTROL PROGRAMME( MDCCP)• 1990-1991

COMPONENTS:

1. Health Education

2. Early Detection

3. Training of Medical & Para-Medical Personnel

4. Palliative Treatment and pain relief

5. Coordination and monitoring.

• Pilot study done among age group 20-65 years in 60 blocks of U.P, Bihar, Tamil Nadu & West Bengal with 1200 workers.

• Health education about general ailments, cancer prevention and early detection.

• The data collected are analyzed and the project was completed in a year.

• National Cancer Awareness Day was observed on 7th November every year.

• only for Government Medical Colleges

• Rs.2.00 crores to purchase cobalt unit.

3. DEVELOPMENT OF ONCOLOGY WING

4. SETTING UP OF COBALT THERAPY UNIT (TELETHERAPY UNIT)

• Rs.1.50 crore for setting up of Cobalt Therapy Unit & 3 lakh for establishing mammography unit in Government & Non-governmental Organization

5. VOLUNTARY ORGANISATIONS SCHEME

• IEC activities and early detection of cancer. financial assistance up to Rs.5.00 lakh

• Linkage with the Regional Cancer Centre (or Medical College/ District Hospital).

• The NGOs should be registered under the Societies Registration Act, 1860 and are charitable organizations

6. NEW INITIATIVES

• WHO funding under the biennium pattern.

• In 1998-1999, 16 workshop/training programmes organized

• Supplied the Pap Smear Kits and Can scan software to 12 Regional Cancer Centers with Morphine tablets.

In 2000-20011.Outreach activities by medical colleges

2.Training of personnel

3.Supply of Morphine

4.Telemedicine and supply of computer hardware and software.

5. IEC activities.

6. Modified District Cancer Control Programme

7. National Cancer Awareness Day

8. Cyto pathologists and cyto technicians in Pap Smear technology

9. Participation in Health Melas and distribution of health education material

• Postage stamp on National Cancer Awareness Day

• Telecast of a health magazine 'Kalyani”and anti tobacco items with Prasar Bharti

In 2002-03 • Screening OPD for cancer at Vardhman

Mahavir Medical College

7.NATIONAL CANCER REGISTRY PROGRAMME (NCRP) 1982

CANCER REGISTRATION:

• Collection and classification of information on all cancer cases in order to produce statistics on the occurrence of cancer and to provide a framework for assessing and controlling the impact of cancer on the community.

OBJECTIVES• To generate data on magnitude of

cancer• To undertake epidemiological

investigations• Promote human resource

development in cancer epidemiology.

TYPES

• POPULATION BASED: [Bombay , Bangalore , Madras, Kolkatta, Thiruvananthapuram, Karunagapally and Ambillikai].

• HOSPITAL BASED: [Chandigarh, Dibrugarh & Trivandrum].

USES1.Continued assessment of the levels of

cancer

2. Provision of facilities & equipment needed

3. Evaluation of the effect of early diagnosis and treatment.

4. Epidemiological and laboratory studies

5. Evaluation of removal of initiators and promoters from the environment.

6. Helps in generation of hypothesis in aetiology of various cancers.

7. To carry out research studies.

8. Planning for health services for combating the disease.

9. Assessing the survival of cancer.

10. Cost-effective utilization resources in activities of Control

Programme .

• sale of cigarette to age of 18 yrs.

• sale of cigarette near the educational institutions etc.,

• Mandatory depiction of statutory warning ( Pictorial)

• Mandatory depiction of tar and nicotinic contents along with maximum permissible limit

8. POST PARTUM CENTERS

• early detection of cervical cancer at postpartum centers

9. REGIONAL CANCER CENTERS

• 14 RCC with 250 beds

ACTIVITIES:perform diagnostic, therapeutic, rehabilitation, education, training, cancer registration and research functions

LIST OF RCC1.Kidwai Memorial Institute of

Oncology, Bangalore.2.Gujrat Cancer 7 Research Institute,

Ahmedabad.3.Cancer Hospital & Research

Institute, Gwalior.4.Cancer Institute, Chennai

5. Regional Cancer Center, Thiruvanathapuram.

6. Regional Center for Cancer Research & Treatment Society, Cuttack.

7. Dr. B.B Cancer Institute, Guwahati.8. Chittaranjan National Cancer

Institute, Kolkatta.

9. Institute Rotary Cancer Hospital (AIIMS).

10. Tata Memorial Hospital, Mumbai.

11. Kamala Nehru Memorial Hospital, Allahabad.

12. MNJ Institute of Oncology, Hydrabad.

13.R.S.T. Cancer Hospital, Nagpur.

14.Indira Gandhi Institute of Medical Sciences, Patna.

15.Acharya Harihar Tulsi Das Regional Cancer Centre, Bikaner (Raj).

16.Indira Gandhi Medical College, Shimla.

17. Post Graduate Institute of Medical Sciences, Rohtak.(Har).

18. Pt. J.N.M. Medical College & RCC, Raipur.

19. JIPMER, Puducherry.

10. TOBACCO REGISTRATION COUNSELLING

“The Cigarettes and other Tobacco products Act 2003” passed in April, 2003

The important Provisions are Prohibition of:

• smoking in public place• direct and indirect advertisement

• sale of cigarette to age of 18 yrs.

• sale of cigarette near the educational institutions etc.,

• Mandatory depiction of statutory warning ( Pictorial)

• Mandatory depiction of tar and nicotinic contents along with maximum permissible limit

IX PLAN FOCUS1. Identification of IEC activities so

that people seek care at the onset of symptoms.

2. Provision of diagnostic facilities in primary and secondary care level so that cancers are detected at early stages when curative therapy can be administered.

3. Filling up of the existing gaps in radiotherapy units in a phased manner so that all diagnosed cases do receive therapy without any delay as near to their residence as feasible.

4. IEC to reduce tobacco consumption and avoid life style which lead to increasing risk of cancers.

ROLE OF HEALTH CARE SYSTEM• REGIONAL CANCER CENTRE• Health Promotion/Home Care/Early

Detection/Pain• Relief/Palliative Care/Comprehensive Cancer

treatment/• Organise screening programmes/Cytology training/• Basic and applied research/Training of all

categories of• personnel/Cancer Registries/Epidemiology

• MEDICAL COLLEGE HOSPITAL• Health Promotion/Home Care/Early

Detection/• Pain Relief/Palliative Care/• Treatment of common

cancers/Training of• medical officers/paramedical

personnel

• DISTRICT HOSPITAL

• Health Promotion/Home Care/• Early Detection/Pain Relief/• Palliative Care/Treatment of

common cancers

• TALUK HOSPITAL/SUB DISTRICT HOSPITAL

• Health Promotion/Home Care/Early Detection/• Pain Relief/Palliative Care

CANCER CONTROL

1. PRIMARY PREVENTION.

2. SECONDARY PREVENTION.

PRIMARY PREVENTION.• Control of tobacco & alcohol consumption.

• Personal hygiene.

• Reduction of radiation exposure.

• Measures to reduce occupational exposures.

• Immunization.

• Quality of food, drugs & cosmetics

• Prevention of air pollution.

• Treatment of pre cancerous lesions.

• Legislation.

• Cancer education.

2. SECONDARY PREVENTION

1. cancer registration.

2.Early detection of cases.

3.Treatment.

CANCER SCREENING• Screening for cancer cervix.• Cancer screening for breast

cancer.• Cancer screening for lung cancer.