Being treated at AIIMS, Delhi. Stays at a facility run by CanKids, an NGO.
Catching Them Young
Nitish loves a red toy car and thinks eating Maggi noodles is a treat. He smiles through heavy sedation to get his photograph taken. The 12-year-old has been battling bone cancer for over six years now. Last month, his father, a farmer from Bihar, was told by doctors at the All India Institute of Medical Sciences (AIIMS) that he should take his son home as the cancer had reached an incurable stage. Now, Nitish’s skeletal body must fight the last and most painful stage of the disease with four rounds of morphine injections every day. All his parents want is for him to die without pain. In his child’s mind, Nitish believes he will be fine, there will be a tomorrow.
During the Christmas season last year, Risa Garg, 7, was diagnosed with leukaemia. No one in her family had had cancer, so her parents were shocked when the body aches and fever she had for a few days turned out to be cancer. Risa wasn’t sick for months: she wanted to skip school only on one day. Her mother thought, at worst, it was rheumatoid fever, which was in the air around that time. A blood test showed Risa had acute lymphoblastic leukaemia, the commonest juvenile cancer—fatal if not treated quickly, but with very high chances of a cure if diagnosed within three weeks. Risa spent the next few months in and out of hospital for radiation, chemotherapy and injections. Big changes had to be made: no school, limited visitors, the family dog was given away to avoid secondary infections. “The biggest challenge for us was at an emotional level,” says Rabani, her mother. “She’d cry and tell us to take her home.”
Photograph by Apoorva Salkade
Adarsh Patil 7 Kolhapur
A few years ago, the boy was detected with a tumour on his cheek and is being treated at the Cancer Research Centre, Mumbai
Like Risa and Nitish, there are 55,000 children being diagnosed with cancers of various kinds in India every year. An unknown number die every year, too. True, India loses more children to malnutrition and other diseases, but the rate at which the number of cancer cases in kids is going up is causing some alarm. (The caveat is that, despite the numbers, childhood cancer still accounts for only 4 per cent of the cancer cases detected in India.) Dr Vinod K. Paul, head of paediatrics at AIIMS, puts it in perspective: “There’s definitely an increased recognition of childhood cancer, a willingness of people to come forward for diagnosis—this could well have translated into more cases. But there’s an overall trend of an increase in cancer with urbanisation. Given that we have a large population, we may well have the largest pool of cancer patients.”
It might be said, without empirical backing, that a global pattern seems to be manifesting in India: no one knows exactly why, but worldwide there seems a direct link between urbanisation and cancer in general and in children too. Cancer is the number one cause of death in children in the US and Canada. Twenty-three per cent of the afflicted children are less than a year old, 20 per cent 1-4 years. In the UK, doctors tell 10 children every day that they have cancer; 7 per cent of children’s deaths there are caused by cancer. In Japan, it’s 6.6 per cent.
Even so, the US has only 12,500 new cases of childhood cancer every year, much lower than India’s 55,000 yearly, with several more going undetected. Dr Amita Mahajan of Apollo Hospital, a leading paediatric oncologist, says, “There’s an increase in childhood cancer with the rise in industrialisation and development. But improved diagnostics has also played a role in more cases being detected early.” Leukaemia is the commonest, followed by lymphoma, brain tumours and tumours of the bone, soft tissues and kidneys. Since only five per cent of childhood cancer is known to have hereditary causes, external factors—food, water, pollution, radiation—are being suspected.
The trouble is, we are hardly equipped to deal with this heart-rending problem. In 2009, India only had 55 paediatric oncologists, and 15 of them were in Mumbai. “It’s a shame some of our top hospitals don’t have paediatric oncologists: regular oncologists attend on children,” says a doctor. The India Paediatric Oncology Initiative of the Jiv Daya Foundation, Dallas, US, found India had just 26 regional cancer centres and 172 oncology departments. In 265 Indian medical colleges, paediatric oncology isn’t recognised as a speciality.
This makes diagnosis of childhood cancer difficult, for the disease can take a curious journey. It was a limp that Shaila Raj’s (name changed) pre-nursery teacher in Mumbai noticed in 2009 (she was three then) that led her to being diagnosed with a brain tumour. Again, no family history, no symptoms. “We questioned everything. The food, the water, the lead in the house paint, the pollution,” says her mother Shruti Raj. “We haven’t been able to come to terms with it.” Now six, Shaila has had four surgeries as the tumour keeps growing back.
Photograph by Sandipan Chatterjee
Deep Maity 4, Nayan Das 4, Moinuddin Ashif 5, Farhan Aparba 3, Sakeeb 8 (at back), Calcutta
These children, from varied backgrounds, are united in having to fight cancer. The disease is painful, the treatment debilitating. They stick together, in all innocence, at the Saroj Gupta Cancer Centre.
Doctors loosely explain that viruses (contracted through food, water or air) and a low immunity can cause gene mutations leading to cancer. But there’s no detailed study yet. Dr Navin Dang, who runs one of the oldest pathology labs in Delhi and has had to test an increasing number of children, has his own way of putting it: a conglomeration of factors. “Food, water, what kids are inhaling, or exposed to—these can all contribute to cancer. Three years ago, one saw the occasional child come for cancer screening; now, we have many being tested daily.”
Dr R.N. Ghosh, head of the paediatric oncology department at the Saroj Gupta Cancer Centre & Research Institute, Calcutta, says that at any time he has 40-50 child patients. West Bengal’s unique problem, he says, is the presence of arsenic, a carcinogen, in water in some parts of the state, which people are forced to consume. “Of the 85 cancer patients in my hospital, 40 are children—an indication of the sheer numbers of children afflicted with the disease,” he says.
That external factors have a strong correlation with cancer—even across generations—is borne out in Bhopal. According to a study, says Dr Shyam Agarwal, an oncologist based there, people exposed to the MIC gas leak in 1984, and children born to parents who were exposed, had a higher incidence of cancer. Scientifically, it takes more than just correlation to establish a causative relationship, so Dr Agarwal steers clear of doing that.
Photograph by Apoorva Salkade
Haripriya 15, Kandhamal
The girl has two tumours, one on her foot, the other on her cheek. During treatment, she stays at an NGO’s facility in Mumbai.
Part of the trouble in diagnosis is in the vagueness of symptoms—prolonged fever, black spots, marks on the body, bleeding gums or blood in the urine, paleness or yellowness of skin, swollen lymph nodes, shortness of breath—any number of diseases could be the cause. “Some of these could also be associated with other, much more common, childhood infections,” says Dr Agarwal. “So doctors often suspect other diseases.”
One factor being blamed for cancers now is radiation from mobile towers, though research on this is still inadequate. Neha Kumar of NESA, a company which has made a handheld device to measure radiation levels, claims she has found areas that can be called as a “cluster of cancer”—say a particular floor in a building. But is such panic-mongering aimed at selling a product? Parents may go without it, but would definitely want to save their children from exposure (see photo and box). In fact, after the diagnosis, Risa’s parents worried about the three mobile towers within 20 ft of their Jor Bagh house in Delhi.
Despite the poor facilities for diagnosis and collation of cases, some initiatives seem encouraging. Chennai will be the first to get a paediatric cancer registry, in about two years. Work began last year, says Dr Rejiv Rajendranath of the Cancer Institute. The city has only eight paediatric oncologists—so most children get treated by the 600 general oncologists in the city. At the Cancer Institute, where treatment is free, there are 60-70 child patients, many from rural areas. The big task, though, is quantifying the burden of the disease, as Prof B. Arora of the Tata Memorial Hospital, Mumbai, pointed out in a 2009 paper, ‘Childhood Cancers in India: Burden, Barriers and Breakthrough’. Much of India’s childhood cases are invisible, he says, for there is no registry for the poor: only when the burden is quantified can we focus on better cure rates. Worldwide, as Prof Tim Eden, former president of the International Society of Paediatric Oncology, pointed out in a 2011 report, “childhood cancer is becoming an increasingly important cause of morbidity and mortality as parasitic and infectious diseases are conquered”. All the more reason for India to wake up.
Photograph by Sanjay Rawat
Nitish 12, Jehanabad, Bihar
Has a bone cancer that doctors have declared is incurable. All his parents wish is that he remains pain-free. Morphine helps.
The rich can pay for the treatment of their child’s cancer. What happens to a poor child? Nitish was aided by CanKids, an NGO near AIIMS. But this premier government hospital has only six beds for palliative and pain care—children with painful cancers have little chance of getting there. The pain is terrible: Gitanjali Bhalla of Pall Can Care, an NGO, knows of a child who attempted suicide. Thankfully, the government recently eased the law for use of morphine for pain relief.
Perhaps the only good news about childhood cancer is that, unlike adult cancers, the cure rate is high: 75 per cent of childhood cancers are completely curable. But the severe pain will have to be borne—by those who should have to deal with no more than knees and elbows scraped at play.
The debate over the harm that radiation causes is far from over. However, the fact remains that there are currently 7 lakh towers across the country, emitting radiation beyond permissible limits. On September 1, the government ordered that the minimum distance of a tower from a residential building should be 35 metres. “Public health comes first. Technology must be embraced, but ultimately it must be subject to public health,” says Union telecom minister Kapil Sibal. The department of telecom (DoT) will ensure the exposure limits (for radio frequency fields for 1,800 Mhz) are brought down to 0.92 watt per square metre from 9.2 watts per square metre currently, he adds. Many feel this is a complete eyewash, given the strong lobbying the telecom sector is capable of. The bottomline is that in India monitoring of radiation of towers will be unreliable unless civil society gets active.
By Amba Batra Bakshi with Pushpa Iyengar in Chennai, Dola Mitra in Calcutta, K.S. Shaini in Bhopal
Apropos your cover story The Shadow of the Crab (Sep 24), it is an acknowledged fact that parents, many of whom lead busy lives and have little time for their children, have little or no control over their children’s diet. Habituated to fast food, children increase their risk of lifestyle diseases, worst of which is cancer.
Narendra M. Apte, Pune
If the law binds corporates to spending 2 per cent of their net annual profit on CSR projects, some of that money, one hopes, finds its way to anti-cancer research.
Ashok Lal, Mumbai
India is an ecological disaster. Industrialisation, consumerism, pollution, the plunder of forests and reckless disposal of industrial waste and city garbage, the rape of pristine hills for minerals—all these factors contribute to the rising cancer figures. It’s no surprise we have such a high rate of cancer cases.
Ganesh Natrajan, on e-mail
Such a long article on cancer without a mention of the biggest contributor to cancer—consuming tobacco and tobacco products.
I may offer you the the riddle of Greek philosopher Epicurus:
Is God willing to prevent evil, but not able? Then he is not omnipotent. Is he able, but not willing? Then he is malevolent. Is he both able and willing? Then whence cometh evil? Is he neither able nor willing? Then why call him God?
“I want to ask ALMIGHTY just one question – If He Loved These Little Souls So Much, Why Did He Separate Them From Himself And Sent On Earth In The First Place? Only To Send Their Biological Parents Shattered?”
Regarding Mobile Towers as a causative factor for Cancer - OUTLOOK should first provide us concrete Scientific Evidence before making exaggerated claims.
There is Concrete Scientific Evidence that Consumption of Tobacco in all forms - including passive smoking, causes CANCER.
There is Concrete Scientific Evidence that Excessive Consumption of Alcohol causes Cirrhosis and that is fatal in itself..
And OUTLOOK's article does not have even a single word about how India is Home to second largest number of Tobacco consumers and also the second biggest home to alcohol consumers in the world.
Yet there is a big mention about mobile tower radiation, even though there is no current evidence on same causing cancer.
Agree that more research is needed on mobile tower radiation and its ill effects on health but we have decades of evidence on tobacco consumption and alcohol overconsumption ruining human health but not a word uttered on same..
OUTLOOK again proves itself that it is not interested in OBJECTIVE Reporting, even in such subjects that do not involve the ruling establishment, the ruling party (CONgress) or the ruling dynasty (SAINT SONIA )
And unfortunately in India, there is no way an YELLOW CARD can be shown to such shoddy and poor journalism !!!!!!!!!!!!!!!
There are many other factors besides mobile towers which may be responsible for high rates of cancer in India. Over 70% of our population lacks clean drinking water. Our sources of water are contaminated by lead, arsenic, cadmium, pesticides etc, all capable of triggering cancer. The quality of the air in most Indian cities in way below globally accepted standards, and may be responsible for the high rates of lung cancer. There is neither any effective pollution control anywhere, nor are there strict fines or penalities for industries which pollute in India. Our idea of waste disposal is to either burn it, thereby increasing pollution, or simply dump it in unregulated landfills where rain water carries all the harmful stuff into the land and water table. In short, India is an ecological disaster that is not just waiting to happen, but has already reached the point of no return. Is it surprising then, that we have such high rates of cancer and other diseases?
INDIA - The so called Land of Gandhian Values and Traditional Heritage, is the World's Second Biggest Consumer of Tobacco in the world. India has 20% of World's smokers and more male smokers than any nation except China.
We have such a long article on Cancer in Outlook which is all right, but not a word or mention of the way government is itself encouraging the single biggest contributor to Cancer - namely consumption of Tobacco and its products.
Tobacco Farmers make billions but pay no tax since they are farmers. Tobacco farmers get cheap loans as farmers. The high taxes on Cigarettes makes little impact since the taxation system completely lets out bidis, which are the biggest form of tobacco consumption in India.
And biggest irony, is the so called LIFE INSURANCE COMPANIES , that too a state owned LIFE INSURANCE COMPANY - LIC is the biggest investor/shareholder in India's biggest cigarette making company, that is ITC.
All these are known fact, but will OUTLOOK and its so called SOCIALLY AWARE JOURNALISTS expose these facts?
UPA Govt has in last 8 years struggled to ban smoking in movies but why all this unproductive ideas? Why dont we emulate Bhutan, stop tobacco cultivation and restrict cigarette production and eventually ban all forms of tobacco consumption?
Maybe OUTLOOK wont talk about this, because some of the writers are themselves tobacco addicts ?
We at Outlookindia.com welcome feedback and your comments, including scathing criticism
1. Scathing, passionate, even angry critiques are welcome, but please do not indulge in abuse and invective. Our Primary concern is to keep the debate civil. We urge our users to try and express their disagreements without being disagreeable. Personal attacks are not welcome. No ad hominem please.
2. Please do not post the same message again and again in the same or different threads
3. Please keep your responses confined to the subject matter of the article you are responding to. Please note that our comments section is not a general free-for-all but for feedback to articles/blogs posted on the site
4. Our endeavour is to keep these forums unmoderated and unexpurgated. But if any of the above three conditions are violated, we reserve the right to delete any comment that we deem objectionable and also to withdraw posting privileges from the abuser. Please also note that hate-speech is punishable by law and in extreme circumstances, we may be forced to take legal action by tracing the IP addresses of the poster.
5. If someone is being abusive or personal, or generally being a troll or a flame-baiter, please do not descend to their level. The best response to such posters is to ignore them and send us a message at Mail AT outlookindia DOT com with the subject header COMPLAINT
6. Please do not copy and paste copyrighted material. If you do think that an article elsewhere has relevance to the point you wish to make, please only quote what is considered fair-use and provide a link to the article under question.
7. There is no particular outlookindia.com line on any subject. The views expressed in our opinion section are those of the author concerned and not that of all of outlookindia.com or all its authors.
8. Please also note that you are solely responsible for the comments posted by you on the site. The comments could be deleted or edited entirely at our discretion if we find them objectionable. However, the mere fact of their existence on our site does not mean that we necessarily approve of their contents. In short, the onus of responsibility for the comments remains solely with the authors thereof. Outlookindia.com or any of its group publications, may, however, retains the right to publish any of these comments, with or without editing, in any medium whatsoever. It is therefore in your own interest to be careful before posting.
9.Outlookindia.com is not responsible in any manner whatsoever for how any search engine -- such as Google, Bing etc -- caches or displays these comments. Please note that you are solely responsible for posting these comments and it is a privilege being granted to our registered users which can be withdrawn in case of abuse. To reiterate:
a. Comments once posted can only be deleted at the discretion of outlookindia.com
b. The comments reflect the views of the authors and not of outlookindia.com
c. outlookindia.com is not responsible in any manner whatsoever for the way search engines cache or display these comments
d. Please therefore take due caution before you post any comments as your words could potentially be used against you
10. We have an online thread for our comments policy:
You are welcome to post your suggestions here or in case you have a specific issue, to directly email us at Mail AT outlookindia DOT com with the subject header COMPLAINT