Malkeet Kaur, 55, travels 60 km each day to Kalianwali in the heart of Haryana’s cotton belt to undergo radiation therapy at the Advanced Cancer Diagnostic, Treatment and Research Centre in Bathinda.
A resident of Kaali Mali village in the Sirsa district, the mother of four was diagnosed with breast cancer in her right breast in April this year. She now goes for radiotherapy five days a week to remove the last of the cancer cells in her body.
“Our lives were normal until my wife complained of some issues in April. We were lucky the cancer was diagnosed at a controllable stage,” said Nachattar Singh, a retired bank employee.
The family spent more than Rs 4 lakh on the surgery at a private hospital in Bathinda, following which they chose radiotherapy at a government centre, where it cost them Rs 15,000 for eight weeks course, compared to Rs 80,000 to Rs 1.5 lakh at a private hospital. The travel costs them an additional Rs 400 a day.
Malkeet is one of more than 25,000 people living with cancer in Punjab. A government survey in 2009 put the number at 7,738, but it shot up three times to 23,874, showed a survey in February 2013. Over the past five years, there have been 24,000 cancer cases detected, with more than 33,000 deaths.
The Malwa region topped the cancer list, with 14,682 of the 33,318 deaths. The unusually high incidence, especially in the cotton growing districts of south-western Punjab, has been linked to the use of pesticides by cotton farmers, among other factors. Malwa consumes 75% of the pesticides used in Punjab, shows the State Council for Science and Technology’s State of Environment Report 2007.
In 2005, a study of high cancer among the agricultural community of PGIMER Chandigarh held “multiple factors” responsible for cancer cases in Talwandi Sabo, including pesticide use, alcohol consumption and smoking. “PGI is currently studying the correlation between breast cancer and pesticide use. The results are being analysed,” said Dr JS Thakur, community medicine department, PGIMER, who did the 2005 study.
That same year, Centre for Science and Environment (CSE), found pesticide content in blood from 20 samples drawn from random persons in different villages in Bathinda and Ropar.
CSE’s new State of India’s Health report, released this week, found that 12.5% of the food samples tested contained non-approved pesticides, though the evidence to show that pesticide can increase the risk of acquiring cancer is scarce.
Mandir Singh, 61, developed sourness in his throat two years ago and was diagnosed with throat cancer. The farmer from Burh Sema village in Bathinda district has undergone two surgeries since then and is currently undergoing chemotherapy sessions under the chief minister’s cancer relief fund scheme. “It was difficult to raise money for two back-to-back surgeries and we’ve spent more than Rs 5 lakh on father’s treatment,’ said his son Baljeet Singh, who works on the family’s 8-acres of agricultural land.
“More than 90% of people with cancer have no family history,” said Dr Harith Chaturvedi, director of surgical oncology at Max Hospital, Saket. “In all, 7% to 8% of people have genes that raise the risk of developing cancer or don’t have the genes that control tumour growth if they get cancer after being exposed to environmental and lifestyle factors,” he said.
“Family history is usually found only in breast, ovary, colon and prostate cancer,” said Dr Sapna Nangia, a radiation oncologist consultant at Indraprastha Apollo.
“If the risk of breast or ovary cancer is more than 80%, very close screening is needed for early detection or people can consider surgical removal of the breasts, ovary and fallopian tubes by ages 40–45 years as an option,” said Dr Chaturvedi.
Environment and lifestyle plays a bigger role, with tobacco, air and water pollution, radiation exposure, bad diets etc. Numbers are rising also because of rising awareness. “A decade ago, 90% cases were diagnosed at the late stage when nothing much could be done, now this has reduced to 60-70%,” said Dr NK Shukla, head of department of surgical oncology at All India Institute of Medical Sciences (AIIMS).
(With Anonna Dutt in New Delhi and Kanika Sharma in Mumbai.)