“Valley is well-equipped to deal with surge, say Oncologists, but some challenges of delayed diagnosis and lack of beds in hospitals exist”
Sheikh Mustafa
BARAMULLA: With 1640 new cancer patients detected in 2023, Kashmir Valley is witnessing a worrying trend. The statistics paint a grim reality and the percentage of people diagnosed with cancer is increasing by 10-12%.
In Kashmir’s premier medical institute, Sher-e-Kashmir Institute of Medical Sciences (SKIMS), alone, 27,727 cancer patients were registered between October-2016 to October-2022.
While definitive reasons remain under investigation, experts point to a complex interplay of factors, including smoking, lifestyle choices, environmental concerns, and limited healthcare facilities.
Internationally, roughly 300 people per 100,000 are diagnosed with cancer each year. In India, the rate is 100 per 100,000. In comparison to that the rate in Kashmir is slightly sobering at present 85 per 100,000 people, says Dr Maqbool Lone, the first oncologist and principal investigator to start population-based and hospital-based cancer registries in Jammu and Kashmir.
However, he fears, things may worsen in the coming years. “If the situation remains the same, the percentage will double,” says Dr Lone, who is a renowned Oncologist and Professor of the Oncology department at Government Medical College Baramulla.
He also warns that Kashmir is especially highly influenced due to strong myths prevalent in a society with strong social bonds, perpetuating ignorance about the disease. If no care is taken, cancer may become an epidemic in the next 5-10 years, he fears.
According to a 2022 report, India had an estimated 14,61,427 cancer cases, with a crude rate of 100.4 per 100,000. The World Health Organization’s (WHO) cancer agency, the International Agency for Research on Cancer (IARC), reported in 2022 that India had over 14.13 lakh new cancer cases and registered 9.16 lakh cancer related deaths.
Data paints a concerning portrait “According to a 2023 report by junior health minister Bharati Pravin Pawar, the incidence of cancer in India is projected to reach 15.7 lakh cases per year by 2025. An ICMR report projects that the number of Indians with cancer will increase from 26.7 million in 2021 to 29.8 million in 2025.”
The world Health Organization’s (WHO) International Agency for Research on Cancer (IARC) warns about a significant surge in cancer cases by 2050. There’s an estimated 77% increase in global cancer cases expected to take place by 2050, indicating that the number of new cancer cases will rise to more than 35 million. This is a significant increase compared to the approximated 20 million cases diagnosed in 2022. Factors such as tobacco, alcohol, obesity, and air pollution have been cited as major contributors to this projected rise.
The number are swiftly on the rise in Kashmir but they might conceal the larger picture in view of the lack of medical healthcare in rural and remote areas. However, Dr Lone maintains that the diagnosis may account for at least 85 percent of people. The larger problem is the late detection of cancer in majority of the cases.
Cancer Prevalence in Kashmir between 2015 and 2018. Source: Asian Journal of OncologyThe Common Cancers
Dr Maqbool Lone says that the pattern of cancer in Kashmir has changed, and now the Kashmiris are suffering from the same cancers that are common in other metropolitan cities and the rest of the world.
The top two cancers in Kashmir are lung cancer in males and breast cancer in females. However, cancers of the esophagus, stomach, colon, and rectum and GIT (gastrointestinal tract cancers) also constitute a significant portion. “These four cancers constitute about 30% of all cancers in Kashmir,” he added.
Smoking is one of the most common factors of lung cancer. The common causes for breast cancer is decline in breastfeeding, late marriages, hormonal intake to increase spacing between births, and obesity.”
Causes
Smoking Dr Maqbool says that “Smoking is a well-established cause of lung cancer and several other types, like throat and bladder cancer. Smoking harms DNA in cells, leading to uncontrolled growth and tumour formation.”
Bad lifestyle is a broad term that can encompass various factors contributing to cancer risk.
Lack of vegetable intake and high consumption of red meat also increases cancer risk. Vegetables provide protective antioxidants and fiber, while excessive red meat might contribute to colon cancer, says Dr Lone.
Besides this, sedentary lifestyle or lack of physical activity increases the risk of various cancers, including breast, colon, and endometrial cancer. Exercise helps regulate hormones and metabolism, reducing cancer risk.
Obesity is another big risk factor for several cancers due to its association with inflammation and hormonal changes.
Dr Lone emphasizes on the crucial issue of late diagnoses in Kashmir. “Early detection increases the chances of successful treatment and cure. Reaching later stages (3rd or 4th) limits treatment options and prognosis,” he added.
He reveals, “In Kashmir, around 60 to 70% of patients are diagnosed with cancer in the very late stages. They come at the stage of 3rd or 4th stage, when the disease is no longer curable. In the 3rd stage, we can prolong a patient’s life, and in the 4th stage, we can provide palliative care to make patients comfortable.”
Symptoms
He acknowledges that patients usually reach out too late because of absence of symptoms. While initially most cancers lack symptoms, Dr. Lone emphasizes that later stages present diverse signs depending on the affected organ. Breast cancer might manifest as lumps (breast/armpit), pain, nipple discharge, or changes in shape/texture.
Lung cancer can cause chest/rib pain, chronic cough (dry/phlegmy/bloody), frequent infections, shortness of breath, wheezing, fatigue, appetite loss, hoarseness, swollen lymph nodes, weakness, or weight loss.
Gastro-Intenstinal (GIT) cancers often result in poor appetite, unexplained weight loss, abdominal pain, discomfort above the navel, early satiety, heartburn/indigestion, nausea, vomiting (with/without blood), abdominal swelling, blood in stool, fatigue/weakness (anemia), jaundice, swallowing difficulties, or constipation/diarrhea. He reiterates that this is just a glimpse into the extensive list of potential symptoms.
Treatment Facilities & Awareness Drives
Dr Lone claims that Kashmir is by and large well equipped to fight cancer if the detections are early. “We have the best of treatments including Radiation Oncology, Medical Oncology, and Surgery – available. The two top government institutions, SKIMS (Sher-i-Kashmir Institute of Medical Sciences) and SMHS, (Shri Maharaja Hari Singh Hospital.) have good infrastructure, machines and doctors, and the doctor-patient ratio in the Oncology Department is absolutely fine,” he says.
“However, the only problem is that there is a lack of equipment and bed facilities, which is increasing the waiting time for patients to at least a month.” he adds. On the whole, he debunks the misconception that better treatment lies outside Kashmir, asserting that qualified doctors and standardized protocols are readily accessible within the region.
Dr Lone assures that the same treatment protocols followed in developed countries like in the United Kingdom and United States of America are also adhered to by oncologists in Kashmir, dispelling the myth of needing to travel for advanced care. He encourages patients to consider local options and consult with experienced oncologists in Kashmir for effective and accessible treatment.
Oncologists in Kashmir are also trying to combat the disease by conducting awareness programs every year. “Recently we held programs at (Sher-e-Kashmir University of Agricultural Sciences and Technology) SKUAST, GDC Chrar-i-Sharief and (Cancer Society of Kashmir) CSK Chanpora Srinagar. Cancer Society of Kashmir is also organising such programs,” revealed Dr Lone. He feels that generating awareness is important because “many people still take cancer lightly.”
While medical advancements and awareness drives offer some hope, the escalating numbers paint a complex picture, especially when patients reveal stark realities and raise crucial questions about access, affordability, and emotional support.
(This is Part-I of report on ‘Rise in Cancer cases in Kashmir’. The second and final part on the financial and emotional impact of the disease to follow. Part-II can be read here.)
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