NATIONAL CANCER CONTROL PROGRAMME

INTRODUCTION
Cancer is a group of more than 200 diseases characterized by uncontrolled and unregulated
growth of cells .there are considerable geographic variations in incidence of certain type of
cancer , due to lifestyle in a particular region. JAPANESE have a high incidence of stomach
cancer ( attribute to the habit of eating raw fish ) where as French males have a higher incidence
of esophageal cancer ( due to heavy drinking ) In northern part of India there is high incidence of
oral cancers due to the habit of tobacco chewing .

The stem cells are viewed as the target or the origin of cancer development . the
deoxyribonucleic acid (DNA) of the stem cell is substituted or permanently rearranged .when
this happens , the stem cell is mutated . once the cell is mutated ,one of three things can occur

1. The cell can die , either from the damage resulting from the mutation or by initiating a
programmed cellular sucide called APOPTOSIS
2. The cell can recognize the damage and repair itself
3. The mutated cell can survive and pass along the damage to its daughter cells. Mutated
cells that survive have the potential to become malignant (i.e cells with invasive and
metastatic potential)

A common misconception regarding the characteristics of cancer cells is that the rate of
proliferation is more rapid than that of any normal body cell. In most situations, cancer cells
proliferation at the same rate as the normal cells of the tissue from which they originate. The
difference is that proliferation of the cells is indiscrimination and continuous . in this way with
each cell division creating two or more offspring cells, there is continuous growth of a tumor
mass : 1 2 4 8 16 and so on . This is termed the pyramid effect . the time required for a tumor
mass to double in size is known as its doubling time

Two types of normal genes that can be affected by mutation are proto-oncogenes and tumor
suppressor genes .

Proto-oncogenes are normal cellular genes that are important regulators of normal cellular
processes . mutations that alter the expression of proto-oncogene’s can activate them to function
as oncogenes (tumor – inducing genes ) these protooncogenes has been described as the genetic
lock that keeps the cell in its mature functioning sate . when this lock is unlocked as may occur
through exposure to carcinogens (agent that cause cancer) or oncogenic virus , genetic alterations
and mutations occur . The abilities and properties that the cell had in fetal development are again
expressed .

Tumor suppressor genes functions to regulate cell growth . mutations that alters tumor
suppressor genes render them inactivate resulting in a loss of their tumor – suppressing action

1
A/c to national cancer institute (2009)
Cancer refers to a class of disease in which a cell or a group of cells divide and replicate
uncontrollably , intrude into adjacent cells and tissues ( invasion) and ultimately spread to other
parts of the body than the location at which they arose ( metastasis).

HISTORY OF CANCER
From the period 3000 B.C to 800 B.C the ancient Egyptian mixed medicine and religion treated
patients for several forms of cancer.
The foundation of modern science were laid in 17th century when abnormalities of lymph were
considered as primary cause of cancer as lymph node enlargement were frequently found
associated with cancer
First cancer statistics was collected in mid 19th century
The era of 1895 to 1929 saw radiation being used as treatment . cancer research accelerated as
Rontgen described X-rays, Curies isolated radium , and Muller observed abnormalities of cancer
cells
Genetic explanation of cancer was put forward in 20th century
A viral cause of cancer in 1911 was also put forward and physical chemical carcinogens were
conclusively identified
Chromosomal abnormalities were also identified as possible cause of cancer. Prolonged exposure
to sun causing skin cancer was also observed
National cancer institute act was passed in 1937. This act authorized annual funding on cancer
research
By 1996, p53 tumor suppressor genes and the protein encodes emerged as the most charmed
topics of biochemical world. This has been planned to be used as a tool for early diagnosis also

2
CLASSIFICATION OF CANCER
Tumor can be classified according to anatomic site , histology ( grading ) and extent of disease
(staging)

Comparison of benign and malignant neoplasm

Characteristics Benign Malignant
Encapsulated Usually Rarely
Differentiated Normally Poorly
Metastasis Absent Capable
Recurrence Rare Possible
Vascularity Slight Moderate to marked
Mode of growth Expansive Infiltrative and expansive
Cell Fairly normal, similar to Cells abnormal , become more
Characteristics Parent cells Unlike parent cells

Anatomical site classification :

Carcinomas ( malignant ) : Carcinoma is the general term used to indicate a malignancy .this
originates from embryonal ectoderm (skin and glands ) and endoderm( mucous membrane lining
of the respiratory track , gastrointestinal rack )Adenocarcinoma is the term used to indicate a
malignancy in the epithelial cells lining of glandular tissues ( that specializes in secreating
substance into the body ex : mammary glands )

 Sarcomas: originates from embryonal mesoderm ( connective tissue , muscle ,bone and
fat)
 Blastomas : Originates in embroyonic tissues of organs
 Lymphomas : These affects lymph nodes
 leukemias these effects blood
 Myeloma : Originates in bone marrow

Mixed types :
These have two or more components of the cancer ex: carcinoma, adenosquamous carcinoma

Histologic classification : (grading)

For many tumor types , four grades are used to evaluate abnormal cells based on the degree to
which the cells resemble the tissue of origin tumours that are poorly differentiated have worse
prognosis than those that are closer in appearance of the normal tissue of origin

 Grade 1: well differentiated cells with slight abnormality

 Grade 2 – cells are moderately differentiated and slightly more abnormal
 Grade 3 – cells are poorly differentiated and very abnormal

3
  Grade 4 – cells are immature and primitive and undifferentiated

Extent of disease : (Staging)

The most commonly used method uses classification in terms of tumor size (T), the degree of
regional spread or node involvement (N), and distant metastasis (M). This is called the TNM
staging. For example, T0 signifies no evidence of tumor, T 1 to 4 signifies increasing tumor size
and involvement and T is signifies carcinoma in situ or limited to surface cells. Similarly N0
signifies no nodal involvement and N 1 to 4 signifies increasing degrees of lymph node
involvement. Nx signifies that node involvement cannot be assessed. Metastasis is further
classified into two – M0 signifies no evidence of distant spread while M1 signifies evidence of
distant spread.

Stages may be divided according to the TNM staging classification.

Stage 0 indicates cancer being in situ or limited to surface cells while

Stage I indicates cancer being limited to the tissue of origin.

Stage II indicates limited local spread,

Stage III indicates extensive local and regional spread while

Stage IV is advanced cancer with distant spread and metastasis

BURDEN OF DISEASES
:

World :
The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million
deaths in 2018. One in 5 men and one in 6 women worldwide develop cancer during their
lifetime and one in 8 men and one in 11 women die from the disease. Worldwide cancers of the
lung, female breast, and colo rectum are the top three cancer types in terms of incidence, and are
ranked within the top five in terms of mortality . Together, these three cancer types are
responsible for one third of the cancer incidence and mortality burden worldwide.
India: cancer has become one of the 10 leading causes of death in india
One woman dies of cervical cancer every 8 minutes in India
As many as 2,500 persons die every day due to tobacco-related diseases in India

4
 Estimated number of people living with the disease: around 2.25 million

 Every year, new cancer patients registered: Over 11,57,294 lakh

 Cancer-related deaths: 7,84,821

Total deaths due to cancer in 2018

 Total: 7,84,821
 Men: 4,13,519
 Data from population based registries under National Cancer Registry Programme
indicate that the leading sites of cancer are oral cavity amongst men and cervix, breast
and oral cavity among women . Oral and esophageal cancers are amongst the highest in
the world and cancers of colorectal and prostate are lowest .
 WHO has estimated that 91 % of oral cancers in India .
Report of National cancer registries and Atlas of cancer in India .

 One in about 15 men and one in about 12 women in the urban areas could develop cancer
in their lifetime
 Breast cancer and cervical cancers are commonest among females .
 Cancer lung is commonest out of all tobacco related cancers in men .
 Age adjusted incidence rate of esophageal cancer in women of Bangalore is one of the
highest (8.3 /1,00,000) in the world
 Cancer of tongue in males in Bhopal ( 8.8/1,00,000) is the highest in the world.
 Gall bladder cancer in Delhi women is one of the highest (8.9/1,00,000) in the world .

Risk factors :

Factors /class % of cancer deaths in 35-64 yrs caused by

factors
Tobacco 30-40
Alcohol 3-10
Diet Not known
Reproductive and sexual behavior 10
occupation 6-8
Pollution 2
Industrial products 1
Medicines etc 1
Geophysical factors 3

5
Genetic factors
The department of Biotechnology has initiated a “people of India “ project to characterize the
genetic make up of the groups with reference to their ethnicity. It is expected that this research
will lead to the identification of suitable genetic markers that indicate cancer susceptibilities of
different populations.

Infections :
Heptitis viruses (B and C) , Human Papilloma Virus ( HPV) , Human T Cell Leukamia virus I
and II .

Other causative Factors :

 Tobacco
 Diet ( in India dietary habits may be responsible for about 10 to 20 % of cancers.)
 Pesticides (increase incidence of cancer in Punjab particularly Malwa region a cotton belt
where at least 15 different pesticides sprays. Due to high coast of cancer treatment in
state people go to nearby states such as Rajasthan and Delhi . As 70- 199 patients going
to Bikanair daily using a particular trained ferried from Bhatinda to Bikanair locally
named as “cancer train” .
 Education , socioeconomic status and health facilities
Lack of knowledge and many belief systems such as cancer are incurable leading to late
presentation and poor treatment compliance. Lack of trained oncologist , supporting staff
, family dislocation for cancer treatment to a new city , cost of medical burden make the
compliance to treatment poor .

EVOLUTION OF NCCP :( NATIONAL CANCER CONTROL PROGRAMME )

1975-76 Cancer Control Programme was launched with priorities given for equipping the
premier cancer hospital/institutions. Central assistance at the rate of Rs.2.50 lakhs was given to
each institution for purchase of cobalt machines.
1984-85 This was renamed as the National Cancer Control Programme in 1985 The strategy was
revised and stress was laid on primary prevention and early detection of cancer cases.
1990-91 District Cancer Control Programme was started in selected districts (near the medical
college hospitals).
2000-01 Modified District Cancer Control programme initiated.
2004 :Revised NCCP was done by National Institute of Health & Family Welfare, New Delhi.

6
Principles Essential To A National Cancer Control Programme Based On Quality
Management (ISO, 1997):

GOAL ORIENTATION :
This continuously guides the processes towards improving the health and quality of life of the
people covered by the programme
FOCUSED ON THE NEEDS OF THE PEOPLE,
which implies focusing on the target population while addressing the needs of all stakeholders
and ensuring their active involvement

SYSTEMATIC DECISION-MAKING PROCESS,

Based on evidence, social values, and efficient use of resources, that benefits the majority of the
target population
SYSTEMIC AND COMPREHENSIVE APPROACH,
Meaning that the programme is a comprehensive system with interrelated key components at the
different levels of care, sharing the same goal, integrated with other programmes, to the health
system and tailored to the social context rather than a vertical programme operating in isolation
LEADERSHIP THAT CREATES CLARITY AND UNITY of purpose, and that encourages
team building, broad participation, ownership of the process, continuous learning, and mutual
recognition of efforts made PARTNERSHIP, enhancing effectiveness through mutually
beneficial relationships, built on trust and complementary capacities, with partners from different
disciplines and sectors,

CONTINUOUS IMPROVEMENT, INNOVATION AND CREATIVITY

To maximize performance, and to address social and cultural diversity, and the new needs and
challenges presented by a changing environment.
In order to cater to the changing needs of the disease the programme has undergone three
revisions with the third revision in December 2004.

Objectives :

 Primary prevention of cancer by health education regarding hazards of tobacco

consumption and necessity of genital hygiene for prevention of cervical cancer .
 Secondary prevention by early detection and diagnosis of cancer , for example , cancer of
cervix , breast cancer and the oropharyngeal cancer by screening methods and patients
education on self examination methods.
 Strengthening of existing cancer treatment facilities, which were inadequate.
 Palliative care in terminal stage cancer .

7
Under the revised programme, the primary focus is on correcting the geographic imbalance in
the availability of cancer care facilities across the country. The scope of the programme and the
quantum of assistance under the various schemes have been increased.

There are 5 schemes under the Revised Programme:

1. Regional cancer center scheme :

The existing regional cancer centers are being further strengthened to act as referral centers are
being further strengthened to act as referral centers for complicated and difficult cases at the
tertiary level .
One time asssistance of 3 crores during the plan period is provided to regional cancer centers
except TMH Mumbai and IRCH (AIIMS) for strengthening and to the CNCI , Kolkata on the
approved pattern of funding .

Role of the RCC

a. The RCCs should provide Comprehensive cancer treatment services.
b. There should be a mechanism in place or proposed, to spread awareness in the community
and among health personnel regarding common cancers and their early detection/ prevention.
c. The institution should undertake training of medical officers and health workers, in early
detection and prevention of cancers and supportive care.
d. Training of medical officers and health workers, in early detection and prevention of cancers
and supportive care should be undertaken by the institution.
e. A referral linkage should be developed between the RCC and the hospitals under the DCCP so
as to ensure continuity in the treatment chain.
f. Outreach and research activities in prevention and treatment of cancers should also be carried
out.
g. The RCC will have to undergo periodic monitoring and evaluation to ensure satisfactory
functioning.

Eligibility Criteria for the new RCCs

a. The institute should be a Government Hospital or a Government Medical College Hospital
with Radiotherapy facilities. Autonomous institutions supported by the State or Central
Government will also be considered for sanction in the absence of any suitable government
institution in the region.
b. The hospital should have at least 300 general beds of which 50 beds are exclusively for
cancer treatment or the institution may be a 100-bedded hospital exclusively for cancer
treatment.
c. The institute should have provided cancer treatment for the previous three years.

8
 d. The institute should be well equipped with radiotherapy facilities. There should be well-
developed departments of Surgery, Gynaecology, ENT and Radiation Oncology with well-
developed supporting departments like Medical Oncology, Nuclear Medicine, Anaesthesia,
Pathology, Cytopathology, Haematology, Biochemistry and Radio diagnosis. #If the institute
does not have all these facilities at the time of seeking the grant-in-aid, it should give an
undertaking that all the required facilities would be made available within a period of five years
of the sanction of grant.
e. The State Government should certify and recommend the institution as fit for being
recognized as the RCC.
f. The recognition by the Ministry of Health and Family Welfare will be given after a team of
experts inspects the institute for eligibility to be recognized as an RCC.

2. District Cancer Control Programme:

The DCCP will be implemented by a nodal agency, which may be a Regional Cancer Centre or
Government Medical College or Government Hospital with radiotherapy facility. A cluster of 2-
3 districts are taken up for prevention, early detection, minimal treatment and provision of
supportive cancer care at district levels. A grant-in-aid of Rs. 90.00 lakhs spread over a period of
5 years is provided per DCCP proposal
The District Cancer Control Programme (DCCP) has been designed with a focus on:
a. Prevention of cancers,
b. Early detection,
c. Minimal treatment of common cancers and
d. Provision of supportive care in the district. This may be achieved through increased awareness
about cancers among the health professionals and the community and capacity building at district
level
Provisions under the scheme
1. The state government will identify a Nodal Agency for implementation of DCCP
2. The Nodal Agency will implement the DCCP in two or three congruent districts identified by
the state government
3. Regional Cancer Centre (RCC) or the Government Medical College or Government hospital
with Radiotherapy facility may be designated as the Nodal Agency.
4. DCCP will be implemented through the existing health service by the Nodal Agency.
5. Financial provisions:
a. Rs.17 lakhs as recurring expenditure per year with provision for manpower
deployment, IEC, training, etc.

9
 b. Rs. Five lakhs as non-recurring expenditure for the first year only for
augmentation of diagnostic facilities. (An indicative list of the proposed
expenditure under the DCCP has been enclosed with the document.)
6. The appointments in DCCP will be on contractual basis. No permanent post will be created for
the purpose.
3. ONCOLOGYWING DEVELOPMENT SCHEME :
This scheme had been initiated to fill up geographic gaps in the availability of cancer treatment
facilities in the country. central assistance is provided by for purchase of equipment but the
manpower is to be provided by the concerned state government /institution. the quantum of
central assistance is Rs. 3 crores per institution. under the scheme
Provisions under the scheme:
1. Priority for sanction of grant-in-aid would be given to institutions located in areas where there
are no treatment facilities. First-time grantees will be given priority over institutions that have
already received grants earlier.
2. Institutions, which had earlier availed of the grant at the rates prevailing then, would be
eligible to get the differential amount between the grant received earlier and the grant admissible
under the revised scheme.
3. Financial Provisions:
a. The selected government institute will be provided one-time financial assistance of Rs.3 crore
for procurement of any equipment from the list appended with the document.
b. A part of the grant, not exceeding 30% of the total grant may be used if required, for
construction of building to house the radiotherapy equipments, patient care units, etc.

Eligibility Criteria
a. The selected hospital will be a Government hospital either under the State government or
Central Government.
b. The hospital should have a minimum bed-strength of 100 with major specialities like Surgery,
Gynaecology, Medicine and ENT.
c. The hospital should have the requisite manpower, necessary equipments for surgical care and
the support staff necessary for providing comprehensive cancer care.
d. For the procurement of radiotherapy equipment, the applicant institution should have a
Radiotherapist and Medical physicist in place. (Proof of the same to be enclosed). If there is no
existing post of Radiotherapist or Medical physicist, the required formalities for recruitment, like
sanctioning of post by the government or provision for recruitment on contract basis should have
been initiated. (Proof of the same to be enclosed)

10
e. The State Government should recommend the institute for financial assistance under the
scheme.
f. If the institute does not have all the facilities required for providing comprehensive cancer
care at the time of seeking the grant-in aid, it should give an undertaking that all the required
facilities would be made available within five years of the sanction of grant.

4. DECENTRALIZED NGO SCHEME :

This scheme is meant for IEC activities and early detection of cancer .the scheme is operated by
the nodal agencies and the NGOs .financial assistance is given for undertaking health education
and early detection activities of cancer

Provisions under the scheme

a. The NGO scheme will be implemented through the Nodal Agency
b. The Nodal Agency will be a Regional Cancer Centre (RCC) or a Government Medical College
with Radiotherapy facilities or Government Hospital with Radiotherapy facility.
c. State Government will recommend the names of the Nodal Agency (s).
d. The Ministry of Health and Family Welfare (MOHFW), GOI will issue an advertisement
detailing the scheme and intimating the NGOs to approach the respective Agencies in the regions
with proposals for the implementation of the scheme.
e. The identified Nodal Agency will select NGOs as per the prescribed criteria.
f. The Nodal Agency will then submit proposal for request of grants based on the proposals from
the selected NGOs.
g. Periodic monitoring will be carried out by the MOHFW and Nodal Agency in order to ensure
proper functioning of the scheme and suggest modifications if necessary

Role of the Nodal Agency

1. The Nodal Agency will select the NGOs for implementation of the NGO scheme on the basis
of following criteria:
a. The NGOs should have worked in the field of health for 2 years or more. (Proof to be
enclosed)
b. The NGO should be willing to undertake all the activities as envisaged in the role of
the NGO under the scheme, at least for a period of 2 years.
c. The NGO should submit an Action Plan outlining the activities including the proposed
number of camps and the geographical area to be covered.

11
 d. The NGO should clearly indicate the health personnel to be involved in each camp
and the details of the area in which the camps will be held.
2. The Nodal Agency will:
a. Submit the list of NGOs selected for the implementation of the scheme
b. Submit the list of the proposed number of camps
c. Provide the necessary support if required for organization of camps
d. Provide referral services to the cases of cancer detected in camps
e. Monitor the activities of the NGO.
3. While selecting an NGO, priority may be given to NGOs working in the districts covered by
DCCP
4. The Nodal Agency will submit a proposal with the estimated cost for the release of grants
from the centre as per the action plan after ensuring that the NGO is capable of effective
implementation of the scheme.
5. The Nodal Agency will release funds to the organization/s in installments as per the action
plan. 6. The Nodal Agency will give an undertaking to continue the implementation of the NGO
scheme even after the discontinuation of financial assistance.
Role of the NGO :
The NGO will implement the activities by means of organizing of camps at periodic intervals in
a well-defined geographical area. Geographical area will be decided on the basis of the area of
activity of the NGO. The interval at which the camps will be held will be decided on the basis of
capability of the NGO. 1. The camps will be held in rural areas or at work places like factories,
etc.
2. The Nodal Agency will be informed about the camp in advance.
3. Community volunteers from the region where the camp will be held will be trained with
technical assistance from the Nodal Agency. These volunteers will sensitize the community a
few weeks prior to the camp regarding the warning signs of cancer. People with such warning
signs will be encouraged to attend these camps. With this approach the camps will be able to
achieve the objective of detection of cancers at an early stage.
4. Each camp should cater to a minimum of 100 patients
5. For every 50 patients expected, one medical officer should be available in the camp.
6. A card for each patient should be prepared indicating the details regarding the patient,
diagnosis, investigations and suggested management/ follow-up.
7. Appropriate and prompt referral should be ensured for suspected cases.

12
8. IEC activities should also be incorporated into the camps.
9. The NGO may also use suitable innovative measures to improve the effectiveness of the camp
5. IEC activities at central level:
IEC activities at the central level are to be initiated in order to give wider publicity about Anil
Tobacco legislation for discouraging consumption of cigarettes and other tobacco related
products, and for creating awareness among masses about ill effects of consumption of tobacco
and tobacco related products . November 7th is observed as National Cancer Awareness Day in
the country
Research and training :
Training programes, monitoring and research activities will be organized at the central level
under this scheme
Manual for health professional These manuals are developed
under NCCP for capacity
Manual for cytology building under cancer control
Manual for palliative care at district level

Manual for tobacco cessation

For every 10 blocks, 5 medical officers and 1 consultant doctor have been recruited. Their
responsibilities were to guide and supervise the NCD workers and to examine the women
referred by the workers. This has given the pilot project an entirely new dimension by linking
community – based awareness with early cancer detection facilities. This program is now comes
under NRHM.
The charitable and private sector has been mobilized to participate in cancer control activities
through recognition of NGO s or private health care facilities in cancer care .
There is regular monitoring of NCCP implementation through review meetings, visits etc.
However, National Integrated Disease Surveillance Programme has included the risk of cancer
for surveillance.

New initiatives :
There are various activities , which are carried out under the National Cancer control program:
India has become the member of International agency for Research on cancer ( IARC)
Onco net – India: telemedicine project to connect 27 RCCs and each RCC with 4 to 5 peripheral
centers is being operationalized and C-DAC Trivandrum is also involved .
Training of cyto pathologists and cyto technicians in the quality assurance in Pap smear
technology.
Participation in Health melas and distribution of health education material.

13
Past age stamp depicting “Breast self examination “ was brought out by Department of posts on
National Cancer awareness Day . national cancer awareness day is celebrated on the birth
anniversary of Nobel Laureate Madam Curie 7th nov
Telecast of a health magazine “ kalyani “ in the current year with cancer and anti tobacco items
under the agreement with Prasar Bharati and MOHFW.
Broadcast of health education audio material developed by CNCI, Kolkatta, through FM radio .
Community based cancer control program carried ot with the help of WHO

 Training of health care personnel at district level in early detection and awareness of
cancer.
 Telemedicine in cancer .
 IEC activities including “National Cancer awareness day celebrated on 7th November ,
the birth anniversary of madam curie.

National Cancer Registry Programme (NCRP):

Estimating the cancer burden not only helps us to formulate policies but also gear up for future
management strategies
National Cancer Registry Programme (NCRP): For data base of cancer cases, National Cancer
Registry Programme (NCRP) was initiated in 1982 by ICMR, which gives a picture of the
magnitude and patterns of cancer. There are two types of registries; Population Based Cancer
Registry and Hospital Based Cancer Registries, which was started in January 1982. The
Population-based registries take the sample population in a geographically defined area while the
Hospital-based registries take the data from patients coming to a particular health institution. At
present we have 28 Population-based registries and 9 Hospital-based registries all over the
country. In 2001, data from all cancer registries and all medical colleges were collated for the
“Development of an Atlas of Cancer in India” to have an idea of patterns of cancers in several
other parts of the country, including those not covered under the NCRP.

Objectives ( NCRP) :
1. To generate authonetic data on the magnitude of cancer problem in India.
2. To undertake epidemiological investigation and advise control measures : and
3. Promote human resource development in cancer epidemiology
These registries generate annual reports which indicate the annual incidence of particular cancer
in the population which help in the planning and evaluation of cancer control. from these
registries , trends are indicating to put more emphasis on cancer prevention . Operational wing at
ICMR, Headquarter in Delhi and Technical wings at Delhi and Mumbai have to coordinate the
functions and review and monitor them regularly.

Cancer atlas :
Under the national cancer registry programme ,the India council of Medical research has
developed an ATLAS of cancer in india based on the information collected for the year 2001-02
from 105 collaborating centers to have an idea of the pattern of cancer across the country .
14
In close collaboration with its Member States and other partners, WHO has developed a global
strategy for the prevention and control of non communicable diseases in which cancer control
appears as one of the major priorities. WHO headquarters, regional and country offices can be
called upon to provide technical assistance and advice in support of the promotion of national
cancer control programmes at the country or state level. Cancer experts, other health service
workers, patients’ groups, and representatives from other sectors involved.
A national Task Force for developing a “Strategy for Cancer Control in India during the 11th
Five Year Plan” (2007-2011) has been constituted. The new components include information,
education , communication (IEC) activities; research and monitoring and evaluation.
Dissemination of information through media and NGOs is planned. India is the first member
country from the developing world to become a member of IARC. This will ensure appropriate
direction of the Agency’s research efforts in India to benefit its large population. India has
ratified the framework convention on tobacco control by WHO. A proposal (Onconet) for linking
up of Regional Cancer Centers amongst themselves and each with 5 peripheral centers has been
prepared.
STRATAGIES :
1. Prevention and early detection of cancers through district cancer control activities and
strengthened IEC campaign .
2. To promote “centers of excellence “ in the field of cancer management with support to
existing RCC of 20 years of proven track record by providing financial assistance .
3. To augment comprehensive cancer care facilities across the country through institutional
capacity bulding in new and existing in regional cancer centers and through new and
existing oncology wings.
4. Development of early diagnosis capabilities in district hospitals
5. Encouraging public and partnership.
6. Increase capacity for palliative care in cancer
7. Promote research in cancer that would be relevant to cancer control in India
8. Capacity building and training of all personnel in cancer prevention and early detection to
be done for all categories in phased manner
9. Health education of the general public through use of audio video, and print media
regarding prevention and early detection of cancers.
Promote innovations in cancers care and in deginization of cancer treatment equipments
Organizational structure : It is at two level- central government and state government with
linkage through the central council of health . the full time officer in-charge of cancer control is
an oncologist who head the cancer control cell at the directorate general of health services.

NCCP MANAGEMENT CHART

Chief Project Director(DG)

Vice Project Director (Addl.DG)

15
 Steering committee

Project Director

Administrative division Technical Division

Deputy Secretary Addl. Project Director

Planning coordination
Non –tech Tech MIS Health Dep .of service
GEA
Under secretary Epidemiologist
Consultant Bio-Statistician
Section Officer Computer Program
Assistant Sr. Program Assistant
UDC Health Educator
LDC Statistical Assistant
Computer
UDC
LDC

Health Minister's Cancer Patient Fund Under "RAN"

The "Health Minister's Cancer Patient Fund" (HMCPF) within the Rashtriya Arogya Nidhi
(RAN) Scheme has also been set up in 2009. In order to utilize the HMCPF, it is proposed to
establish the revolving fund like RAN in the Various Regional Cancer Centre(s) (RCCs) which

16
are getting fund for equipments from Cancer Programme of Govt. of India. Such step would
ensure and speed up financial assistance to needy patients and would help to fulfil the objective
of HMCPF under RAN. The Financial Assistance to the Cancer Patients up to Rs.1,00,000/-
(Rs.one lakhs only), would be processed by the concerned Institute/Hospitals on whose disposal,
the revolving fund has been placed. The cases of financial assistance above this limit would be
referred by the Hospitals/Institutes for assistance from Central Funds. Initially, 27 Regional
Cancer Centres have been proposed, for whom revolving funds of (Rs.10 lakhs) have been
released.

COMMUNITY ONCOLOGY :
Cancer control is about much more than providing specialist treatments in hospitals.
The Community Oncology Division of the NCCP was established in 2008. Its main aims are to:
Promote healthy lifestyles for the prevention of cancer especially in relation to smoking
cessation, maintaining a healthy diet, increasing physical activity, reducing alcohol consumption
and protecting the skin against UV rays.

Facilitate smooth patient pathways from Primary Care to the specialist services, and after
discharge from hospital.

Develop cancer survivorship awareness and programmes to support patients after their diagnosis
and treatment.

Strengthen the
CANCER VACCINES : body’s natural
defense against
Cancer vaccines are intended either cancers that have
 to treat existing cancer ( therapeutic vaccines) already developed
 to prevent the development of cancer (prophylactic vaccines )
Therapeutic vaccine : prevents the further growth of existing cancer, prevent the recurrence
of treated cancers, or eliminate cancer cells not killed by prior treatments.
Prevention or prophylactic vaccines, on the other hand , are administered to healthy
individuals and are designed to target cancer – causing viruses and prevent viral infection .
The vaccine triggers mainly the cellular antitumoral immune responses . when drug is
introduced into an organism , a numerous clones of antitumoral lymphocytes are formed . in
those cases when thus formed antitumor immunity could achieve a complete destruction of
the tumor , replaces do not occur , due to the formation of the immunological memory . The
chances of the complete destruction of a tumor depends on :

 Number of tumor cells ( size of tumor ) and their mitotic activities .

17
  Type of tumor – histological structures, antigen structures, the number of HLA-A
class molecules on the tumor cells
 Initial state of the immune system .
GARADASIL VACCINE : this is associated with nearly all cases of cervical cancer . This is the
promising vaccine that targeted at two cancer causing HPV types that account for approximately
70 % of cervical cancers cases worldwide ( HPV TYPE 16 and HPV 18) . This vaccine has been
shown to be highly protective against persistent infection over a two to four year period . large
scale human trails are currently underway to conform these early findings and to determine the
efficacy of the vaccine.
In boys and young men ages 9 to 26 , Gardasil helps protect against 90% of genital warts cases.
Gardasil is administered intramuscularly in the deltoid region of the upper arm or in the higher
antero lateral area of thigh in 3 separate 0.5 ml doses over 6 months.

JOURNAL REFERANCE

2019 Oct-Dec;8(4):212-214. doi: 10.4103/sajc.sajc_427_18.

Organochlorine pesticide exposure as a risk factor for breast cancer in young Indian women: A
case-control study.
Kaur N1, Swain SK1, Banerjee BD2, Sharma T2, Krishnalata T2.

Author information
1. Department of Surgery, UCMS and GTB Hospital, Delhi, India.
2. Department of Biochemistry, UCMS and GTB Hospital, Delhi, India.

Abstract
BACKGROUND:
Incidence rates of breast cancer are showing an increasing trend in young women (≤40 years) in
India. Risk for breast cancer in this age group can be attributed only partially to various known
risk factors. Environmental exposure to organochlorine (OC) compounds has been identified as a
potential risk factor. However, the possible role of OC compounds in increasing
breast cancer risk in young women has not been explored. This case-control study was planned
with the objectives to assess the serum levels of OC compound in a North Indian population of
young women.

MATERIALS AND METHODS:

Forty-two patients of breast cancer ≤ 40 years age and 42 age-matched controls were evaluated
for exposure to OC compounds by performing assays in blood samples for pesticides such as
dichlorodiphenyltrichloroethane (DDT) and its metabolites DDD and DDE; dieldrin; aldrin;

18
methoxychlor, heptachlor; α-endosulfan; β-endosulfan; and hexachlorocyclohexane and its
isomers (α, β, and γ).

RESULTS:
Young women with breast cancer were found to have significantly higher serum levels of all the
OC compounds except aldrin, p, p' DDT, and methoxychlor.

CONCLUSIONS:
Exposure to OC pesticides could be an important modifiable risk factor for breast cancer,
especially in younger women.

Bibliography :
Park.k text book of preventive and social medicine .23rd edition. Banarsidas bhanot
publication:Jabalpur : 2013 : pg:424-25.
Kishore .J text book of national health programme of India :12th edition . century publication
:new delhi 2017:pgno :571-75
Gulani.kk : text book of community health nursing : kumar publishing house : 2nd edition pg-
712-15.
Web reference :
https://www.who .int.> cancer >nccp
https://mohfw.gov.in>departments>
https://www.iccp-portal.org>files>plans

19