Reversing Assam’s cancer burden

Assam’s rising cancer burden serves as a stark re-minder that stronger screening services and ac-cessible palliative care are essential for effective cancer management and improved quality of life for patients through better disease management. The “Assam Cancer Burden Profile-2026” published by the Indian Council of Medical Research (ICMR)-National Institute of NCD Epidemiology (NINE) reveals a worrying picture on both fronts. Data from this report indicates that the percentage of females ever undergoing a screening test for cervical, breast and oral cavity examination for cancer is critically low at 0.2%, and that of males ever undergoing a screening test for oral cavity for cancer is as low as 1.4%. A comprehensive review of cancer screening activities has become urgently necessary to identify critical gaps and increase awareness in order to reach all segments of vulnerable populations in the state. Delayed screening often leads to cancers being diagnosed at an advanced stage, when the disease has already spread to other organs, significantly complicating treatment and reducing the chances of successful outcomes. Roping in panchayats and other local bodies to intensify cancer screening across the state can be effective only when elected representatives are made aware of the importance of screening for early detection and treatment. The state has only 19 palliative care centres, which is far too few compared to the rising burden of cancer and the increasing challenges of disease management. Often the palliative care is sought only at the terminal stage, but palliative care experts insist that ideally palliative care should begin simultaneously with cancer treatment from the very beginning for better management of the disease to ease pain and distress and improve quality of life for both patients and their family members. While screening, detection, treatment, and care play a crucial role in early diagnosis and improved disease management, it remains important to address the underlying causes that drive the incidence of the disease. This calls for intensifying tobacco control, lifestyle modifications, and reducing environmental pollution for reducing cancer prevalence in the state. The ICMR-NINE report shows a high percentage of tobacco use (both smoking and smokeless) and alcohol consumption among males in the state has been increasing the cancer-risk burden among people aged 15 years and above. The persistence of such high-risk behaviour suggests that awareness campaigns against tobacco use and alcohol consumption have not yielded the desired impact, underscoring the need for more targeted and sustained interventions among different population groups. Such programmes must go beyond conventional messaging and focus on breaking the cycle of habitual use and dependence on these substances, particularly among youth and other vulnerable groups, through community engagement, sustained awareness, and counselling. While awareness campaigns in educational institutions are effective interventions, community oversight and support outside the educational campuses are equally important to protect students and young people from peer pressure and other behavioural risk factors. Raising awareness among young people can be a critical factor in breaking the intergenerational cycle of tobacco, alcohol, and other forms of substance abuse, as well as discouraging behavioural practices that increase cancer risk, thereby reducing the future burden of preventable cancer. Prioritising cancer prevention is pivotal to reducing disease prevalence and rising burden on the health budget, but providing the best treatment care must remain an essential focus of cancer management strategy. Making the treatment affordable and accessible is of paramount importance. The Supreme Court’s recent intervention against exorbitant prices of essential cancer medicines has raised hopes for continuing treatment for cancer patients from low and middle-income households. Equipping the government hospitals with modern equipment and an adequate number of medical, surgical, and radiation oncologists, nurses, and technicians can make the treatment more accessible. The initiative taken by the State Government to establish a Proton Beam Therapy Centre at Guwahati Medical College and Hospital is a visionary step to raise the bar of quality of cancer care provided in government hospitals, as such facilities are available only in a few top private cancer hospitals in India. Ironically, palliative care has not received due attention from the government and the society. Given the projected rise in the cancer burden in the state, the establishment of community-based and home-based palliative care networks covering all districts in the state, the establishment of community-based and home-based palliative care networks covering all districts on the line of successful models of palliative care adopted by the southern states, and the establishment of palliative care centres in government hospitals, can no longer be delayed. The community-based palliative care plays a vital role in strengthening psychological and emotional support for the patients suffering from life-limiting cancer, beyond hospital settings. Strengthening of the community and home-based palliative care also reduces the burdens of hospitals and keeps the beds free for cancer patients who need intensive and emergency care and specialised interventions. Assam cannot remain content documenting its cancer burden; the data must serve as a call to action for timely interventions on all fronts.