Subject- Cancer Control Programme in Punjab The details of ...

Subject-
Cancer Control Programme in Punjab
The details of Cancer Control Programme in Punjab are summarized in
following headings-
1. No. of Cancer Patients
2. Risk factors
3. Steps taken by Punjab Government
4. What is needed
1. No. of Cancer Patients- The incidents of Cancer have shown some appreciable
increase in southern districts of Punjab namely Muktsar, Bhatinda, Faridkot and Mansa
in recent years.
(1) The Health Department conducted 2 surveys first in June 2005 and second in 2009
and the detailed figures are-
Cancer Survey 2005 by Health Department Punjab
Cancer survey 2005 Cancer Survey 2009
SN Name of District No. of cancer patients No. of cancer patients
1. Amritsar -- 253
2. Barnala -- 379
3. Bathinda 711 942
4. Faridkot 164 245
5. Fatehgarh Sahib -- 176
6. Ferozepur -- 473
7. Gurdaspur -- 559
8. Hoshiarpur -- 476
9. Jalandhar -- 377
10.Kapurthala -- 196
11.Ludhiana -- 771
12.Mukatsar 453 668
13.Moga -- 319
14.Mansa 420 342
15.Nawanshehar -- 141
16.Patiala -- 426
17.Ropar -- 200
18.SAS Nagar ( Mohali &
-- 133
village list)
19.Sangrur -- 383

20.Tarn Taran -- 279
Total 1748 7738
(2) PGI had conducted a study in Talwandi Sabo Block in 2002 and the number of
Cancer patients was found to be 125 per lac. If we extrapolate these figures then the
number of Cancer patients of the entire population of entire Bathinda District of 12.55
lac would be 1574. And for 4 districts namely Bathinda, Faridkot, Muktsar and
Mansa with a total population of 32 lacs, there would be 4012 patients of cancer who
needed urgent treatment. The PGI survey was much more detailed and was
conducted by Department of Community Medicines for one block. The house to
house survey was conducted by Health Department by ANMs and Multi Purpose
Health Workers and it is quite possible that in some of the villages they did not
capture the actual figures. The Health Department will have some of villages resurveyed,
then the correct picture might emerge.
(3) Roko Cancer Programme- A Roco Cancer Programme is in progress in Malwa belt
for detection of Breast Cancer in women. Survey report of three months of screening
is as below:-
(i) Total population covered 1,64,666
(ii) Women examined 9180
(iii) Mammography done 995
(iv)
Suspected cases of breast cancer in the
above population 76
Breast cancer being 15% of total cancer cases therefore total cancer cases in the above
population will be 76X 7 =532.
Taking this mean average total number of cases in Bathinda district with the population of
1255932 will be 4057.
Taking all these above three methods of calculating cancer cases in Bathinda district the
average is far above the National Levels. It may therefore be seen that the number of

cancer patients in these districts might vary from 100 to 200 which is much above the
average of 70 per lac population.
2. Risk factors-
The cancer cases of Bathinda were analyzed and the leading cases of cancer patients
were found to be as follows-
Leading sites of Cancer in District Bathinda
S.No. Male Female
Leading site Number Leading site Number
1 Oesophagus 28 Breast 68
2 Mouth 10 Cervix Uteri 60
3 Tongue 9 Ovary 13
4 Prostate 8 Myel Leuk 11
5 Myel Leuk 8 Oesophagus 10
6 Lymph.Leuk 8 Gallbladder 7
7 Conn. Tissue 7 Hypopharynix 4
8 Bladder 7 Tongue 4
9 Ractum 6 Oth.Skin 4
10 Oth. Skin 6 Conn.Tissue 4
Total 183 Total 241
Important Risk Factors causing cancer- The important risk factors causing cancer are-
According to epidemiological studies, 80-90% of all cancers are due to environmental
factors of which, lifestyle related factors are the most important and preventable. Causation of
cancer is multi-factorial.
(1) Environmental Factors: these are generally held responsible for 80-90% of all
cancers. The major environmental factors include:-
(2) Tobacco: Tobacco in various forms of usage of smoking, chewing etc. is the major
environmental cause of cancers of the lung, larynx, mouth, pharynx, esophagus, lip,
urinary bladder, pancreas, uterus, cervix, breast and kidney also. In India more than

40% of cancer cases are due to tobacco.. Smoking is by far the leading risk factor for
lung cancer. If a person doesn't smoke but breathes in the smoke of others (called
passive smoking or second hand smoke), he is also at an increased risk of lung cancer.
Smokeless tobacco i.e. snuff and chewing tobacco also contains 28 carcinogens i.e.
cancer causing agents..Other than lung cancer, tobacco use has also been linked to
Head and Neck Cancers, Urinary bladder & kidneys, Cervix & Breast, and Colon
(3) Alcohol: - excessive intake of alcoholic beverages is associated with esophageal and
liver cancer. Some studies have also suggested that beer consumption may be
associated with rectal cancer. It is estimated that alcohol contributes to about 3% of all
cancer deaths. Alcohol consumption is linked to the following cancers:
– Breast cancer in women
– Primary liver cancer
– Ovarian cancer
– Prostate cancer
– Thyroid cancer
(4) Dietary factors: smoked fish may be related to stomach cancer, lack of dietary fiber to
intestinal cancer, beef consumption to bowel cancer, high fat diet to breast cancer.
Food additives and contaminants may also be the causative agents.
(5) Occupational exposures: accounts for one to five % of all human cancers. These
include exposure to benzene, arsenic, cadmium, chromium, asbestos, polycyclic hydro
carbons.
(6) Viruses: Hepatitis B & C may lead to hepatic cancer. HIV virus may lead to Kaposi
Sarcoma. The Ebstein Barr virus is associated with Burkitt's lymphoma and
nasopharyngeal carcinoma. Hodgkin disease is also believed to be caused by virus.
(7) Parasites: Parasitic infections may increase the risk of cancer e.g. schistosomiasis in
Middle East producing carcinoma of the bladder.
(8) Others: environmental factors e.g. sunlight, radiation air pollution and water
pollution, medication; pesticides etc are related to cancer.
(9) Customs, habits & life styles: familiar examples are association between smoking
and lung cancer, tobacco & betel chewing & oral cancer etc.

(10) Genetic factors: genetic influences have long been suspected e.g. retinoblastoma
occurs in children of the same parent, Mongols are more likely to develop cancer
(leukemia) than normal children. However genetic factors are less conspicuous and
more difficult to identify.
3. Steps taken by Punjab Government- The State Government has taken or is taking the
following steps to deal with the Cancer cases in the State-
(1) Population Based Cancer Registry- The State Government has been pursuing the case
for sanction of Population Based Registry. Indian Council of Medical Research has now
agreed to sanction this registry in Government Medical College Patiala. This is a Five
Year Project costing Rs. 45 lacs. The date of cancer patients would be maintained.
(2) Hospitals Based Cancer Registry - Hospitals Based Cancer Registry has been
sanctioned in PGI.
(3) Upgradation of Medical Colleges- The 3 Government Medical Colleges in the State
have been Rs. 2 Crore and Rs. 3 Crore by the Government of India under Cancer Control
Programme and the facilities are being upgraded.
(4) Cash Assistance- A sum of Rs. 25 lacs was sanctioned for treatment of Cancer patients
in Bathinda District. An amount of Rs. 17.92 lacs has been spent by the Deputy
Commissioner, Bathinda for the year 2009.
(5) Punjab State Illness Fund- Cancer patients belonging to BPL families can be given upto
Rs. 1.5 lac for treatment of Cancer patients in Government Hospitals.Rs. 18.25 lac has
been spent cancer cases.
(6) Roko Cancer- An agreement was signed with a NGO namely Roko Cancer in February,
2010 for one year for screening of women for breast cancer. The NGO has deployed an
Mobile Medical Unit for Memography for screening of Cancer patients in the 4 districts of
Mukatsar, Mansa, Bathinda and Faridkot. The details of their work have been given in
para –(3 ) of Roko Cancer Programme.
(7) Reverse Osmosis- The State Government has spent a sum of Rs. 34 Crore for installation
of Reverse Osmosis Systems (RO) in villages of the 4 districts where the quality of

drinking water is not good. 340 villages have already been covered and more villages
will be covered under this scheme in this year.
(8) ONCONET Service- Telemedicine- is to be established by Government of India Regional
Cancer Centre, PGI will be connected to four District Hospitals namely Hoshiarpur,
Sangrur, Bathinda and Muktsar for this service.
(9) Max Hospitals at Bathinda and Mohali- The State Government has provided fund and
land to Civil Hospitals for construction of hospitals by Max Hospital Care under Public
Private Participation. The 2 Hospitals will be ready by 31/12/2010. The State of art
Facilities for treatment of Cancer patients would be available at both these hospitals.
4. What is needed- The facilities available for Cancer patients are inadequate. The State
Government requires the followings things to do-
(1) Financial Assistance to Cancer patients- At present except for BPL families
there is no Government scheme under which financial assistance can be provided to the
cancer patients. The Government scheme as explained in the next paragraph is grossly
inadequate. Approximate a sum of Rs. 40 Crore is required for treatment of cancer
patients and therefore a permanent fund should be set up for treatment of cancer patients.
There are approximately 4000 cases at the rate of 125 cases per lac of population in
these 4 districts.
(2) Punjab Illness Fund- This fund is contributed by Government of India and the
State Government in the ratio of 2:1. We have about Rs. 1.5 Crore of amount in the
year but this scheme has two limitations- first only BPL families are eligible for financial
assistance under this scheme that that too only for Rs. 1.25 lac. Second limitation is that
financial assistance is given for treatment in Government Hospitals only. BPL families
are very limited in number and other poor people are deprived of this financial assistance.
The Government medical colleges in the State are not well equipped and even today large
number of patients in these districts go to Bikaner for treatment. It is requested that the
eligibility criteria under Punjab Illness Fund which is a Government of India scheme
should be relaxed and the reputed hospitals like DMC Ludhiana, CMC Ludhiana and
Oswal Cancer Hospital Ludhiana should be allowed.

(3) Upgradation of District Hospitals- The Government of India is formulating a
scheme for upgradation of selected District Hospitals for treatment of Cancer. It is
requested that guidelines for this scheme may be finalized at the earliest and the District
Hospitals in these 4 districts should be upgraded under this scheme.
(4) Reverse Osmosis System- To provide safe drinking water RO systems and
amount of Rs. 57.50 Crore @ Rs.10.00 lacs per village is required to be provided for the
remaining 575 villages of four districts.
(Satish Chandra)
Principal Secretary Health and Family Welfare
28/6/2010