Having suffered myself from another form of blood cancer called Lymphoma-three times in just six years, I have some idea of what it takes to deal with cancer. And as an environmentalist, I have a deep interest in the role of pollution, lifestyles and diet in its causation. There was not one substantive political statement or media report on how to deal with this horrifying disease on which there is nothing but a conspiracy of silence from the government.

The ministry of health has been acting like an ostrich, refusing even to acknowledge the seriousness of the problem. But the young minister's death provided an excellent peg for substantive reports on this major public health problem. How could the media have missed such an opportunity? Kumaramangalam did not die because the private sector Apollo Hospital misdiagnosed him and the "prestigious" AIIMS failed to deal with him. He died because cancer treatment is extremely poor in this country.

Ironically, cancer is a great leveller - even important people do not escape it. Except, of course, ordinary people do not get a bevy of doctors flitting around them. For a poor person a diagnosis of cancer is the equivalent of death. According to Vinod Raina, an oncologist at AIIMS, only about 30% of the patients diagnosed with cancer undergo treatment because of the high costs and many drop out halfway having run out of money. The average cost of treatment of cancer can be about Rs 2-3 lakh, and that, when there are no major complications. However, cancer treatment is improving in the US, survival rates for many types of cancers is now higher than 50 per cent.

Unfortunately, the cost of treatment has also risen. For example, an infusion of monoclonal antibodies or a bone marrow transplant, recommended for various cancers, greatly increases the chances of success. Monoclonal antibodies can specifically target cancer cells but one infusion can cost as much as Rs one lakh. A patient may require several. So, what do we do in India? First, we have to take the preventive route, We have far too many poor who cannot afford treatment. Unless, of course, our politicians do not mind poor people dying despite all their pro-poor rhetoric. This means controlling pollution-a gigantic task for the government-educating people towards better diets and improved lifestyles. For instance, awareness of the risks of smoking has cut lung cancer rates dramatically in the US. But, in India, there is little health education; fruits, vegetables and dairy products are contaminated with pesticides; and, pollution of air, water and soil is increasing by leaps and bounds.

The government does not collect cancer data properly or regularly and disseminate it. Considered a secret by the government, we had to ferret it out. The latest data on cancer incidence dates back to 1991, collected only from hospitals in five metros and one rural segment. Even the data available is very worrying.

The best way to understand the impact of cancer is not to look at the annual incidence rate (which is about 150 per 100,000 people) but at the lifetime incidence rate, because cancer is more or less fatal, you normally are not lucky enough to get it more than once. The rural data shows a lifetime incidence of one out of 34-36 for men and one out of 18-20 for women. But the data for the worst city, Delhi, is one out of 13-14 men and one out of 9-10 for women. Next worse is Chennai. In other words, cities are more cancer-prone than rural areas.

In the early l990s, we could have expected one out of 10-15 urban Indians to get cancer in their lifetime. When compared to western countries that have a lifetime incidence of one out of four-six persons, the Indian data looks good. But not to worry, we are catching up. Government's data relies on information only from hospitals, which makes it inadequate and probably is an underestimate. My personal experience says that a city like Delhi is probably already matching the west. In 20 years, 35 members on the board of the Centre for Science and Environment (CSE), an environmental non-governmental organisation, which I head, have come from Delhi. Of these, six have had cancer.

Three have passed away. A lifetime incidence rate, as high as one out of six: the prevailing situation in the West. The situation, with respect to blood cancers like Lymphomas and leukaemias, is worse in Delhi. Though the overall cancer incidence is higher in women, blood cancers are higher among men. The average incidence of blood cancers among men of Delhi is about four times more than in the rural areas for which data is available, twice that in Bhopal, and nearly 50% more than in Chennai, Mumbai and Bangalore. Even in the case of women, Delhi tops the list. Of the six directors of CSE who have suffered cancer, exactly half have had blood cancers of which two were diagnosed while in their forties. Like "young" Kumaramangalam, two of the three suffering CSE directors have passed away. I am the only one alive.

-- (From Down To Earth. The author is director, Centre for Science and Environment. Tomorrow: Blood cancer and Delhi)