REGIONAL INITIATIVES
could do very little from the perspective of achieving a cure. to train VHNs (village health nurses) in the visual and digital
The only solution was to detect cancer at the earliest possible detection of an abnormal cervix was undertaken in 1991–92
time after its initiation, when modern machines, sophisticated by the Cancer Institute (WIA) and was funded by the ICMR.
techniques and medical and surgical expertise could be put to One hundred and one VHNs were trained, 6,450 eligible
effective use. Detecting cancer early, however, was indeed a women screened and in 985 of them, an abnormal cervix was
formidable task, but several projects undertaken in the 1960s detected. All cancers and pre-cancers were referred to the
demonstrated that it was possible to achieve this goal. Institute for treatment free of charge. The project concluded
that the VHN is competent and capable of being trained in the
The need for early detection: The Chingleput Survey visual detection of an abnormal cervix with a concordance rate
1962–64 of over 90%.
Between 1961 and 1963, the first ever field survey of cancer
in the country (I had the privilege of conducting it myself) was South Arcot District Level Programme 1992
carried out. The survey data was revealing as 10,775 The District level Cervical Cancer Early Detection Programme
individuals in five taluk towns (that supervise land holdings and in South Arcot District was initiated in 1992 and funded by the
other administrative matters) in the Chingleput district were Government of India. The objective of this plan was to
examined, 67 cancers and 63 oral pre-cancers were detected. integrate the screening and education programme with the
The majority of the 67 invasive cancers were cervical cancers State’s permanent health infrastructure and delivery system,
(27) or cancers of the buccal mucosal (24). Of the cervical since this could significantly reduce cost. The project led to
cancers, 69.5% were early and 30.4% late, just the reverse of the training of 258 medical officers, 672 village health nurses
the hospital series. and 30 block health educators. Almost 60,000 (59,314)
women were screened and 8,514 pap smears were performed
World Health Organization (WHO) Cancer Control for those with an abnormal cervix on visual inspection.
Project at Kanchipuram 1969
Based on the data from the Chigleput district, we requested a National effort
grant from the Indian Council for Medical Research (ICMR) in It was only in the 1960s that the government of India awoke
1963 to extend our survey over a larger region. and realized that cancer was a growing health problem and
Unfortunately, the application was turned down. We then that cancer control was a national problem requiring a national
submitted a proposal to WHO in Geneva, for the effort. It constituted the Rao Committee in 1965 and the Wahi
establishment of a cancer control project at Kanchipuram. Committee in 1971, which, together, laid out a broad framework
The WHO was not particularly enthusiastic but its Norwegian for cancer treatment and research. Ten years later (1982), as a
expert adviser, Dr R Eker, was impressed by the potential of part of the National Cancer Control Program (NCCP), the
the proposal. This led to lengthy correspondence, resulting in ICMR (Indian Council for Medical Research) initiated the
the many obstacles that had to be overcome, but after five National Cancer Registry Project (NCRP) with three
years the project did come to Kanchi in 1969. This was the the demographic registries (at Bombay, Madras and Bangalore) and
first international WHO Cancer Control Project in the world. three hospital registries (at Trivandrum, Dibrugarh and
Dr Eker of the Norwegian Cancer Centre was the Coordinator Chandigarh). Today, there are 26 demographic registries in the
and I was nominated as the Principal Responsible Officer. NCRP: 21 urban, three rural, two covering small state
The South-East Asia Regional Office of WHO however, had populations and five hospital cancer registries. An attempt to
the final say in the matter. The contractual obligations could publish an atlas of cancer for India following a low-cost
only be between WHO and a government and not with a strategy delivered mixed results and could not be sustained.
voluntary institution like ours. Dr Eker resigned. After nearly The data provided by the NCRP formed the core of the
five years of toil and labour, we were unceremoniously NCCP in 1986 (20 years after the Kanchipuram Cancer
dropped. Despite this, the Institute volunteered to train Control Project, 1968). The objectives were the primary
medical officers for the project and provided cytological prevention of tobacco-related cancer (40% of cancers in men
screening for over three years, at which time, the government were tobacco-related) the secondary prevention of cervical,
of Tamil Nadu converted the Institute into a cancer centre. breast and oral cancer (these constituted 50% of all cancers in
women) and strengthening of therapeutic services through
Feasibility project 1991–92 the establishment of regional cancer centres and
It was on the basis of this background that the feasibility study strengthening of the health system. Palliative care was added
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