Debate on Making Cancer a Notifiable Disease

Debate on Making Cancer a Notifiable Disease

Why in the News? There is increasing advocacy for making cancer a notifiable disease in India, though the Union government resists this move, citing the non-communicable nature of cancer. The decision to classify snakebites as a notifiable disease in 2024, alongside global examples such as the US listing lead poisoning as a notifiable disease in 1995, challenges this viewpoint. This has prompted a re-examination of India’s stance on cancer notification.

What is a Notifiable Disease in India? A notifiable disease is one that must be legally reported to government authorities by healthcare providers for timely epidemiological monitoring, resource allocation, and early intervention. The Epidemic Diseases Act of 1897 governs the notification of epidemic diseases, which spread rapidly among large populations. The World Health Organization (WHO) requires the notification of certain diseases for global disease surveillance and control. Common notifiable diseases in India include tuberculosis, malaria, and Covid-19, due to their contagious nature. In contrast, the Ministry of Health and Family Welfare (MoHFW) has classified snakebites as notifiable despite being non-communicable.

The Debate on Making Cancer a Notifiable Disease Arguments in Favor:

• Better Data Collection: The National Cancer Registry Program (NCRP), which covers only 16% of India’s population, is criticized for lacking comprehensive data. The absence of real-time data prevents effective intervention. With better tracking, it is estimated that nearly 50% of cancer-related deaths could be prevented by controlling risk factors such as smoking, air pollution, and asbestos exposure.

• Cervical Cancer and Human Papillomavirus (HPV): Some cancers, like cervical cancer, are linked to HPV, a virus transmitted through contact. This has led experts to propose classifying cancer as a “documentable disease” to ensure mandatory data collection.

• State-Level Initiatives: 17 Indian states have already made cancer notifiable through administrative orders, emphasizing the need for a national mandate. States with high cancer incidence, such as Kerala and Mizoram, could greatly benefit from mandatory notification for better health interventions.

• Global Precedents: Countries like Australia and the United Kingdom mandate cancer registration, unlike India, where the NCRP registration remains voluntary.

Arguments Against:

• Non-Communicable Nature: Unlike infectious diseases, cancer is not contagious or an immediate public health threat. Mandatory notification is seen as unnecessary for a non-communicable disease.

• Privacy Concerns: Notifiable diseases often prioritize public health over individual privacy, which could deter people from seeking diagnosis and treatment. The social stigma attached to cancer might make individuals reluctant to report their condition, leading to delayed treatment.

• Healthcare Burden: Mandating notification could place unnecessary legal burdens on healthcare providers. Additionally, cancer treatment is long-term and personalized, whereas notifiable diseases typically involve emergency containment rather than ongoing management.

India’s Existing Cancer Surveillance Mechanism The National Cancer Registry Program (NCRP), under the Indian Council of Medical Research (ICMR), tracks cancer-related data, including demographics, diagnosis, treatment, and survival through Hospital-Based Registries (HBRs) and Population-Based Registries (PBRs). As of 2022, India had 269 HBRs and 38 PBRs, though coverage remains limited. In 2023, over 14 lakh cancer cases were reported, with 100 per 1 lakh people diagnosed.

How Can India Strengthen Cancer Surveillance?

1. Phased Notification Approach: Classifying high-risk cancers such as cervical and lung cancer as “documentable diseases” would facilitate mandatory data collection.

2. Integrate Digital Health Technologies: Link cancer data collection with the Ayushman Bharat Digital Mission (ABDM) to establish a centralized cancer registry. Platforms like CoWIN could also be used to integrate cancer screening records, ensuring targeted follow-ups and adherence to treatments.

3. Cancer Reporting Expansion: Increase the number of PBRs across India to expand cancer testing and related facilities. Implement universal screening for high-risk cancers and encourage local health workers (e.g., Accredited Social Health Activists) to report cases and conduct door-to-door awareness campaigns.

4. Improve Access to Healthcare: Expand cancer coverage under schemes like Pradhan Mantri Jan Arogya Yojana to provide free screening and treatment for low-income families, addressing the financial barriers to early diagnosis and care.

5. Reduce Stigma: Partner with spiritual leaders, influencers, and media figures to reduce the social stigma surrounding cancer. Promoting cancer survivors as "ambassadors" to share their stories could inspire early detection and help normalize screenings.

Drishti Mains Question: Discuss the merits and challenges of making cancer a notifiable disease in India. Should India implement a national-level mandatory cancer reporting system?

UPSC Civil Services Examination, Previous Year Questions (PYQs)

Prelims:

• Q. With reference to the treatment of cancerous tumors, a tool called cyberknife has been making news. Which of the following statements is incorrect? (2010)

• Q. RNA interference (RNAi) technology has gained popularity in recent years. Why? (2019)

Mains:

• Q. “Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze. (2021)

• Q. Appropriate local community-level healthcare intervention is essential to achieve 'Health for All' in India. Explain. (2018)

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