Women won’t report lump, men weight loss Urban Cancer Paradox: High Death Rate Despite Best Treatment

 Urban Indians pay heavily for their unwillingness to see doctors to detect and treat cancer early. While more urban than rural Indians suffer from cancer, the death rate in both the segments is almost the same, says India's Million Death Study (MDS). The study was done by Tata Memorial Hospital along with the Centre for Global Health Research. 

    "Age-standardized cancer mortality rates per 1,00,000 were similar in rural (men 95.6 and women 96.6) and urban areas (men 102.4 and women 91.2)," says MDS. 

    An Indian pecularity crops up here. As MDS says that cancer deaths were two times higher in the least educated than in the most educated adults, it would follow that educated Indians living in cities and enjoying better access to cancer care should be able to beat the disease. But this is clearly not the case. "Women won't come to hospitals to show a lump in their breast because it's not painful. Men won't get themselves checked despite losing weight drastically. This is true in both urban and rural India," says a senior doctor. 

The problem, analyzes Dr Shastri, is that greater awareness in urban areas hasn't really translated into attitudinal changes. "People in urban areas, too, visit doctors only when their cancer is advanced. Therefore, the death rate is high in cities despite the availability of world-class treatment." 

    Doctors point out that the incidence of cancer is three times higher in some western countries, but the death rate wasn't as high as in India. "People there are not only aware about cancers, but also actively seek detection and treatment," adds a doctor. 

    Rising incidence of cancer among Indians is another area of concern. Says medical oncologist Dr Sudeep Gupta from Tata Memorial Hospital, "The main reason for this is the aging of our population. Earlier, our population was younger but it is not so now." He also blames lifestyle factors such as late marriages, late motherhood and lack of exercise for growing incidence of breast cancer. "We are adopting a Western lifestyle," Dr Gupta adds. 

    Cancer surgeon Dr P Jagannath, who consults at Lilavati Hospital, says that better access to tobacco in the city also worsens the statistics. "People in urban areas use lifts, don't exercise and are obese, which is emerging as one of risk factors for cancers." 

    However, he says there is a need to take a closer look at the causes of high mortality in urban hubs as reported in MDS. "Urban centres have better detection and treatment facilities. Hence, we need to ensure that all these reported deaths were indeed due to cancer and not a case of a cancer patient suffering a heart attack." 

BIG C IN THE CITY REASONS CONTRIBUTING TO RISING INCIDENCE OF CANCER IN CITIES 

CHANGING COMPOSITION OF DIET 

Intake of animal source food—meat, fish and milk—is rising rapidly Diets' energy density is rising rapidly Oil consumption has risen rapidly Food supply has become sweeter Food preparation time has shortened Consumption of food away from home has increased Portions or serving sizes are bigger 

REDUCTION IN PHYSICAL ACTIVITY 

Major shift away from manual labour or energy-intense work (like agriculture) to sedentary roles (like the service sector) General reduction in physical activity linked to most occupations Changes in transport from physical (walking, cycling, public transport) to motorized (car/motorcycle) Greater mechanization of tasks at home 

Limited facilities for physical activity and recreation in overcrowded cities and towns 

WHAT FAMILIES CAN DO… 

Children and young adults should eat regular meals, including breakfast, in a pleasant, sociable environment — without distractions such as television Parents should eat with children — with all family members eating the same food Parents should encourage active play — for example, dancing and skipping Try to be more active as a family. For example, walking and cycling to school and shops, going to the park or swimming Gradually reduce sedentary activities — such as watching television or playing video games — and consider active alternatives such as dance, football or walking Encourage children to participate in sport or other active recreation, and make the most of opportunities for exercise at school 

(Union for International Cancer Control, 2009)