Prevention and Treatment of Cancer in India

Abstract

cervix cancer. Data from three large randomized trials (conducted in India) have shown the efficacy of screening once in a lifetime with HPV DNA, as well as that one-time screening with visual inspection with acetic acid (VIA) by trained nurses and four-time screening with VIA by trained primary health workers reduces mortality due to cervical cancers. Prevention of cervical cancers with twodose HPV vaccination and early detection of precancerous cervical lesions of the eligible population through screening and their appropriate treatment with a singlevisit ‘screen-and-treat’ approach appears promising for lowand middle-income countries, including India. For advanced cervical cancer, concurrent chemoradiation (CCRT) is currently the standard approach and results in a 5-year overall survival rate of 66% and a diseasefree survival of 58%. Potential approaches to improve the outcome could be the use of weekly paclitaxel and carboplatin for 4–6 weeks as dose-dense chemotherapy prior to CCRT, adjuvant chemotherapy after CCRT in patients with positive lymph nodes, larger tumor volume and those with stage III–IVA disease. For patients with early-stage disease (FIGO IA2–IIA), short-course chemotherapy prior to surgery is associated with improved outcome in many studies. Bevacizumab, an inhibitor of vascular endothelial growth factor, is associated with improved survival in patients with recurrent/metastatic cervical cancer. Whether bevacizumab and other similar novel agents targeting molecular pathways could be used Lowand middle-income countries continue to struggle with poverty, endemic infections (e.g. tuberculosis and malaria), nutritional deficiencies, etc. With changing lifestyle, industrialization/urbanization and improved life expectancy, these countries now face challenges of a rising incidence of non-communicable diseases, mainly cardiovascular diseases, cancer, diabetes mellitus, stroke and chronic respiratory diseases. India is passing through this epidemiological transition. Data from 29 populationbased cancer registries (covering approx. 10% of the population) indicate that the overall incidence of cancer in India is low compared to that in high-income countries [1] . With diverse ethnicities, cultural backgrounds, food habits and economic conditions, the incidence and prevalence of cancer are also diverse in different geographic regions. The five most common cancers among males are lung, head and neck, prostate, stomach and large bowel. In women, these are breast, cervix, ovary, oral and stomach cancer. Due to a lack of population-based screening programs or preventive health strategies, most patients present with advanced disease, thus leading to increased mortality and reduced survival. For cervical cancer, various screening options like cytology, visual-based screening and testing for high-risk HPV are available. Several cross-sectional studies have looked at the comparative efficacy of different screening tests. In this supplementary issue, Mishra et al. [this issue, pp. 1–7] review preventive strategies for Published online: July 28, 2016