The facilities and challenges for cancer control in India.

India is a vast subcontinent with 845 million peoples occupying 2.5% of land mass of the earth, but carrying 15% of the world population. It is a multiracial society with widely varying cultures, habits, languages and many different ethnic groups. The pattern of cancer, therefore, mainly depends on their habits and life styles apart from other variations. Head, Neck & Esophagus cancers in the male and cervix and breast cancers in the females are the main cancers. All together they form nearly 60% of all cancers. The incidence rates are around 90/100,000 though this is an underestimate as cancer is not a notifiable disease in India. It is estimated that by the year 2,000 there will be six million cancer patients in India at any given time with nearly 2 million new patients annually. The over-all facilities for cancer treatment vary widely from metropolitan cities to rural areas where 70% of the Indian population lives. In major cities, good to excellent treatment facilities exist in comprehensive cancer centres--yet in the rural setting the facilities are sketchy at best or non-existent at worst. The Government of India in its national cancer policy has recognized regional cancer centres and consolidated other existing centres. There are 10 regional cancer centres thus identified, each one at a different level of development. For optimal requirements at least 600 teletherapy units, (existing 150--not always functional) 100 departments of surgical oncology and an equal number of medical oncology divisions are needed (existing 20). The demand for cancer treatment facilities are, therefore, very high with poor available facility. Nearly 50% of patients present late for treatment and therefore appropriate education in prevention and early diagnosis are important factors. The Government of India through Ministry of Health has identified cancer as a major health problem by the year 2,000 and hence planning by the National Cancer Plan is operative in many States. Major cancer institutions (like the Tata Memorial Centre) have taken a lead to intensify the public and professional educational activities and have developed rural modules for primary and secondary prevention. The author exemplifies this by actual on the spot activities of the rural centre and stresses that in a country like India, the need is to develop small community cancer centres with the rural cancer effort as the base so as to reach out to the community for early diagnosis of treatment.