This article is part of the UPSC Daily Editorial Analysis, covering The Hindu editorial – “Should cancer be a notifiable disease?" published on 17th March, by the best UPSC coaching in Kolkata.
Syllabus: General Studies Paper II (Governance, Health and Policy); General Studies Paper III (Science & Technology and Public Health)
Cancer is a major public health challenge in India. And there is a rising incidence and mortality rates due to it. There have been recent debates on whether cancer should be designated as a notifiable disease or not.
A notifiable disease is any disease that must be reported to government authorities by law. This facilitates monitoring, early outbreak detection and intervention to prevent its spread. The World Health Organization’s (WHO) International Health Regulations (1969) mandate disease reporting for global surveillance and advisory functions.
In India registered medical practitioners must report notifiable diseases in a prescribed format within three days or verbally within 24 hours in urgent cases. This reporting obligation is applicable for government hospitals, private hospitals, laboratories as well as clinics.
Traditionally infectious diseases such as tuberculosis, HIV/AIDS and COVID-19 have been included in this category due to their potential for rapid spread and public health risks. However, there has been a shift in policy worldwide. Nowadays some non-communicable diseases (NCDs) like lead poisoning in the U.S. and snakebites in India being made notifiable.
Mandatory reporting could lead to a more comprehensive database on cancer incidence its types and treatment outcomes. This could facilitate better epidemiological studies and in turn help policymakers to design targeted cancer control programs.
Notification could prompt healthcare systems to identify cancer cases early. Thus, it reduces delays in diagnosis and treatment. This is crucial in a country like India where many cases are detected in advanced stages.
When the government has accurate data in hand it can allocate resources more efficiently. It can ensure that cancer treatment facilities, medicines and specialists are available in regions which have high disease burden.
A mandatory notification system could help integrate cancer surveillance with existing public health initiatives like the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). And then there would be a more coordinated response.
The primary rationale for disease notification is containment and outbreak control. And these do not apply to cancer. Unlike infectious diseases, cancer is a chronic, non-communicable condition and requires long-term management rather than emergency interventions.
Cancer is not a single disease but a broad category which has diverse forms. Now each form requires distinct diagnostic and treatment approaches. Notification frameworks designed for single-point diagnosis diseases might not be suitable for cancer’s complexity.
Legal obligations to report every cancer case could impose an additional administrative burden on oncologists, hospitals and diagnostic centers. And all this could divert focus from patient care.
Making cancer notifiable raises privacy concerns. This is because mandatory reporting does not always account for individual confidentiality. There remains significant stigma associated with cancer especially in rural India where fear of discrimination may deter people from seeking timely medical attention.
Many State Public Health Acts grant authorities sweeping powers in notifiable disease cases. And these powers allow for enforced quarantines and restrictions. Such measures are justified for infectious diseases. But applying them to cancer could discourage voluntary reporting and treatment-seeking behavior.
India already has a robust data collection system through the National Cancer Registry Programme (NCRP) that was established in 1982. The NCRP compiles data on:
The NCRP operates through hospital-based and population-based registries. However, coverage remains inadequate, with only 269 hospital-based and 38 population-based registries as of 2022. Instead of legal mandates, an expansion of the NCRP could serve as a more effective solution.
In India, cancer cases are rising alarmingly, with an estimated 14 lakh cases in 2023, according to the Indian Council of Medical Research (ICMR). The National Cancer Registry Programme (NCRP) has been tracking cancer trends since 1982, supporting policy decisions. To tackle this growing burden, India has implemented robust policies, research initiatives and financial aid programs to enhance cancer care and accessibility.
The Ministry of Health and Family Welfare has been allocated Rs. 99,858.56 crore, with Rs. 95,957.87 crore designated for healthcare services and Rs. 3,900.69 crore for research. Key initiatives include:
The NPCDCS, under the National Health Mission (NHM), focuses on cancer prevention and treatment, covering oral, breast and cervical cancer screening.
This scheme enhances specialized cancer care and decentralizes treatment for better accessibility.
Launched in 2018, PM-JAY provides financial protection for cancer treatment, covering chemotherapy, radiotherapy and surgical oncology.
Under Rashtriya Arogya Nidhi (RAN), this fund provides financial assistance up to ₹5 lakh, with a maximum limit of ₹15 lakh.
Established in 2012, NCG ensures standardized cancer treatment and now includes 287 member institutions.
In April 2024, India introduced NexCAR19, its first CAR-T cell therapy, developed by IIT Bombay, Tata Memorial Centre and ImmunoACT. This breakthrough offers an affordable treatment for blood cancers, reducing dependence on costly foreign therapies.
Launched in September 2024, India, along with the US, Australia and Japan, aims to eliminate cervical cancer in the Indo-Pacific region through:
In January 2025, the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) launched an expansion initiative to:
Making cancer a notifiable disease is a step toward improved surveillance. But it is not the most effective approach given the nature of cancer as a non-communicable disease. Instead, expanding cancer registries, improving voluntary reporting, enhancing screening programs and involving private healthcare providers offer more pragmatic solutions. A strengthened National Cancer Registry Programme can ensure comprehensive cancer data collection without the drawbacks of mandatory notification, ultimately leading to better cancer control and treatment outcomes in India.
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PRACTICE QUESTION Q.Should cancer be a notifiable disease in India? Analyze its impact on surveillance, healthcare burden and patient rights. (250 words) |
A notifiable disease is one that must be legally reported to health authorities for surveillance and public health intervention.
While better data collection and early detection are benefits, concerns include administrative burden, privacy issues and the non-infectious nature of cancer.
It could improve cancer data collection, aid policy decisions, enhance screening programs and allocate healthcare resources effectively.
Cancer is non-communicable, diverse in types, requires long-term care and mandatory reporting could lead to privacy concerns and increased administrative workload.
Strengthening cancer registries, voluntary reporting, improved screening, private sector collaboration and public awareness campaigns.
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