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Should cancer be a notifiable disease?

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Should cancer be a notifiable disease?


Department of Medical Oncology at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad organised an awareness walk to promote cancer prevention making ‘World Cancer Day’ on Tuesday, February 4, 2025.
| Photo Credit: RAMAKRISHNA G

Time and again, there have been calls to designate cancer as a notifiable disease in India. While some argue that this would enhance surveillance and treatment, the Union government has resisted the move, saying the practice is to notify only infectious diseases and that cancer is non-communicable and not infectious.

Recent shifts in disease notification policies raise questions about whether this reasoning still holds. In 2024, the government asked all the States to make snakebites a notifiable disease. This trend is not unique to India. In 1995, the U.S. became the first country to list lead poisoning as a notifiable disease, establishing a precedent for the surveillance of non-communicable diseases. This evolution in public health policy forces a critical examination of whether cancers warrant notification for surveillance in India.

Also Read | Why does cancer get diagnosed late in India?

The primary purpose of disease notification is to ensure that contagious diseases are kept under check. Notification of infectious diseases is a legal mandate and compels physicians to report designated diseases to public health authorities, failing which they could face legal consequences. Unlike infectious diseases, cancer does not pose an immediate threat to public health through direct transmission and sudden deaths. It is a diverse group of diseases rather than a single condition, and its detection often requires complex diagnostic procedures. Proponents of making cancer notifiable argue that mandatory reporting could enhance early detection and resource allocation.

However, there are fundamental issues with this approach. First, cancer is not a single-point diagnosis. Arguably, cancers as a disease are more diverse ranging from benign to malignant. Notifiability triggers rapid containment measures, whereas cancer requires long-term management rather than emergency interventions. Legal obligations on physicians could impose a burden that does not translate into improved patient care.

Also Read | Cancer-related mortalities increased faster among females in past decade: ICMR

India’s National Cancer Registry Programme (since 1982) functions as a data collection mechanism, compiling crucial information on the demographics of cancer patients, cancer identification including type, stage, and morphology, the timing of diagnosis and staging at the time of detection, treatment details such as chemotherapy, radiation, and surgery, and follow-up and survival outcomes. The NCRP includes hospital-based registries, which collect data from cancer-treating hospitals, and population-based registries, which capture cancer incidence in a defined geographic area.

There are 269 hospital-based and 38 population-based registries as of 2022, which is insufficient. Hospital-based registries should be expanded to every cancer-treating hospital, including all district headquarters hospitals. Similarly, population-based registries should be established in every district, ensuring at least one unit per district for comprehensive nationwide cancer surveillance. Rather than legally mandating notification, strengthening existing cancer registries is a more thorough and effective alternative.

Second, making cancer a notifiable disease also raises privacy concerns. Notifiability generally does not account for privacy because disease notification is meant to preserve public health over individual confidentiality. There is still stigma attached to cancer.

Also Read | Mapping India’s cancer burden: Explained

Many State public health acts still contain provisions that give sweeping powers to local authorities during a health emergency. While much of this has been rendered toothless over time, the legal precedent remains. Introducing cancer into such a framework could further deepen the reluctance among patients to come forward for diagnosis and treatment, making it counterproductive and potentially deterring patients from seeking timely treatment due to stigma and discrimination. The World Health Organization advocates mainly cancer registries, which mention notification as an option at the individual level alone.

An effective approach would be to expand the NCRP to ensure comprehensive data collection at all tertiary and district hospitals. Improving cancer screening initiatives would ensure early detection. Strengthening reporting mechanisms without legal mandates would allow oncologists and healthcare providers to contribute accurate data voluntarily rather than reporting under duress. Mandatory notification remains an apt approach suited for single-point, outbreak-prone diseases. For cancer, a well-structured registry system, bolstered by wider hospital participation, including private hospitals and robust follow-up mechanisms, offers a far superior solution to improving cancer surveillance in India.

Dr. C. Aravinda is an academic and public health physician. Views are personal



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Experts warn against overuse of last line antibiotics

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Experts warn against overuse of last line antibiotics


Image for representation only.
| Photo Credit: Getty Images/iStockphoto

Infectious diseases experts have flagged the overuse of a potent antibiotic leading to it losing its efficacy, and drug resistance. The Drugs Controller General of India has been urged to lay down strict pathways for these newer antibiotics, so that they are not misused by practitioners.

Abdul Ghafur, infectious diseases specialist, and founder of the AMR Declaration Trust, has written to Rajeev Singh Raghuvanshi, DCGI, about ceftazidime-avibactam. “One of the most potent antibiotics currently available in our armamentarium is rapidly losing its efficacy due to extensive, irrational, and uncontrolled use.”

The drug which was initially registered with the U.S. FDA in 2015 and after three years it was approved in India, is a last-line antibiotic. It is to be used as targeted therapy for certain carbapenem-resistant gram-negative infections and not prescribed as a general antibiotic.

Dr. Ghafur however claims it is already being misused in the community. “To overcome this resistance, aztreonam is often added to ceftazidime-avibactam, unfortunately, resistance has now emerged even to this combination, due to irrational use.”

The problem, he explains, is that while the DCGI has licenced the drug, it has only provided indications for use. There are no clear-cut pathways laid out, and nothing to deter mis-prescriptions.

This trend could erode the huge gains secured in India primarily with the ban on use of colistin as a growth promotion drug amongst poultry, in recent times. This ‘bold and meaningful action’ from the government resulted in a significant drop in prevalence of colistin-resistant bacteria in hospitals in India, he adds.

Rational use

There are two new very powerful antibiotics that are about to enter the Indian market, Cefierocol and Cefepime-zidebactam. Dr. Ghafur urges the DCGI to kick in with antibiotics stewardship: “We need these drugs in India. However, their use must be restricted strictly to infections where no other effective alternatives exist. Education alone is not enough; we need a clear regulatory pathway to ensure the rational use of these molecules from the moment they are licensed.”

“If we do not act now, we risk losing the few therapeutic options left. Antimicrobial resistance (AMR)is already a serious crisis in our country. Without urgent and strong action, it may escalate to an unmanageable level. We cannot change the past — but we still have time to act for the immediate future,” he says.



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When it comes to edible oil, finding the right balance is key

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When it comes to edible oil, finding the right balance is key


The debate on how much edible oil, and what kind of oil, is good or bad for health seems never-ending. But the trick here is finding the right balance as moderation is key, say experts.

Importance of fats in a balanced diet

Meenakshi Bajaj, dietician, Tamil Nadu Government Multi Super Speciality Hospital, said it is essential to understand that all three macronutrients (carbohydrates, fats, and proteins) play a crucial role in an individual’s health. “Fat is an indispensable component of a balanced diet, necessary for the absorption of fat-soluble vitamins, synthesis of hormones, as well as several vital physiological and metabolic functions in the body. Dietary fat comprises both visible and invisible sources. Visible sources include fats and oils, ghee, vanaspati and butter used for cooking. Invisible sources encompass whole eggs, milk and milk products, nuts and oilseeds, meat, poultry, and fish,” she said.

Edible fats and oils have benefits and drawbacks, she said, adding: “There are three types of fatty acids present in our diet: saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and polyunsaturated fatty acids (PUFA). A healthy diet should incorporate varied sources of fats and oils, maintaining an ideal ratio of healthy fats (mono and polyunsaturated fats) to unhealthy fats (saturated fat).”

Choosing and using oils wisely

Daphnee Lovesley, chief clinical dietitian, Apollo Hospitals, Chennai, points out, “Oils are essential in our diet as they provide essential fatty acids that the body cannot produce. Like everything else, moderation is key. Oils are calorie-dense, providing about 9 calories per milliliter, and in Indian cooking, there is often a tendency to use them generously, particularly in fried foods. Reducing oil intake by four to five teaspoons per person per day can make a big difference. Nuts like almonds, walnuts, or peanuts can be enjoyed in moderation—a handful a day is sufficient.”

The National Institute of Nutrition (NIN) suggests incorporating a diverse variety of oil seeds, nuts, and whole grains, Ms. Bajaj pointed out. “Studies indicate that consuming nuts like almonds and cashews can improve lipid profiles and reduce blood pressure in individuals with type 2 diabetes. However, moderation is key,” she said.

Blending oils to achieve a balance of fatty acids and antioxidants is beneficial, she said, noting: “NIN advises combining oils such as groundnut, sesame, rice bran, and mustard oils, which have been shown to reduce the risk of type 2 diabetes and metabolic syndrome.”

Health risks associated with reheated oils and trans fat

Ms. Lovesley further adds. “Oils rich in monounsaturated fats—such as sesame oil, groundnut oil, and rice bran oil—are good options and are readily available locally. Using a blend of oils is often considered a safer and more balanced approach.”

However, reusing oil is harmful, she adds. “Repeated heating at high temperatures causes chemical changes that lead to the formation of polycyclic aromatic hydrocarbons, which are carcinogenic. Reheated oils have been linked to an increased risk of cancer, cardiovascular diseases, and elevated cholesterol and blood pressure levels. When consuming food outside, it is difficult to know how many times the oil has been reheated—this could contribute to inflammation and, subsequently, obesity.”

Ms. Bajaj emphaised that trans fats from reheated oil, bakery items (such as cakes, pizza, puffs, pastries, biscuits, cookies, doughnuts), and partially hydrogenated edible fats in packaged and processed snacks increase triglycerides and LDL cholesterol (bad cholesterol), lower HDL cholesterol (good cholesterol), and heighten the risk of cancers and cardiovascular diseases. Check food labels on ready-to-eat foods for partially hydrogenated fats (unhealthy fats), she added .

The impact of cooking methods on the nutritional quality of oils should be considered. “Oils exposed to high temperatures for extended periods can lose antioxidants and generate toxic compounds and trans fats. Repeated heating of cooking oils produces harmful compounds and should be avoided. On a household level, vegetable oil once used for frying should be filtered and reused for sautéing purposes within the next 24 hours. Remove food particles from oil during frying before they turn black. Oils repeatedly heated should not be mixed with fresh oil but can be used for seasoning,” she said.

Healthy eating as preventive care

With obesity being a major public health concern, it’s important to recognise the key contributing factors: poor dietary habits, a sedentary lifestyle, and inadequate sleep. Stress can also play a role in some individuals. “However, we should focus on what we can control—eating balanced meals, staying physically active, and maintaining good sleep hygiene—to prevent obesity. Childhood obesity is growing too, making it crucial to encourage healthy habits early in life,” Ms. Lovesley said.

Ms. Bajaj reiterates that intake of oils and fats should be moderated. “It’s not about restriction; it’s about smart and healthy choices for improved metabolic health. By making informed choices regarding the types and quantities of fats in our diets, we can promote better health and well-being for ourselves and our families,” she said.



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Autism Spectrum Disorder and the importance of early diagnosis and support

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Autism Spectrum Disorder and the importance of early diagnosis and support


By acquiring a comprehensive understanding of ASD and utilising appropriate resources, families can effectively navigate this journey. | Image used for representational purpose only
| Photo Credit: Getty Images/iStockphoto

Autism Spectrum Disorder (ASD) is a developmental condition that impacts communication, behaviour, and social interactions. For many families, receiving an autism diagnosis can be a moment of confusion and concern. However, with the right guidance and support, there is also hope for growth and progress. By understanding ASD and accessing appropriate resources, families can navigate this journey with strength and resilience, fostering a supportive environment that allows individuals with autism to thrive.

Early signs to watch for

Most children show signs of autism before the age of three. Some children may experience delayed speech or language development, along with limited eye contact or fewer facial expressions. They might find it difficult to understand social cues or recognise emotions in others. Repetitive behaviors or a strong attachment to routines are also common. In some cases, certain sounds, textures, or lights can trigger strong sensory reactions. Adapting to school environments may present additional challenges. It’s important to remember that autism is a spectrum, meaning the signs and their intensity can vary greatly from one child to another.

Why early diagnosis matters

With early intervention, many children with autism can make great strides in their development. Therapies started at a young age are often more effective because the brain is still growing and learning quickly.

If you notice signs, do not delay in seeking an evaluation. Paediatricians, child psychologists, and developmental specialists can guide you through the process.

Understanding the impact on families

Having a child with autism can bring emotional and practical challenges. Families may feel overwhelmed, unsure of what to do next, or even isolated. It’s important to know: you are not alone, and support is available.

Understanding your child’s needs is the first step. Ask questions, read reliable sources, and talk to specialists. The more you know, the better you can support your child.

Every child has unique talents- some are musically gifted, others are great at puzzles or drawings. Celebrate their strengths while helping them improve areas they find difficult. Children with autism thrive on structure. A predictable daily schedule can reduce anxiety and improve behaviour.

Speech therapy, occupational therapy, and behavioural therapy are often recommended. These therapies focus on improving communication, motor skills, and daily living skills. It also aims at helping  helping them become more independent in their day-to-day activities.

Even if your child is non-verbal, they can still communicate. Tools like picture cards, sign language, or assistive devices can help.

Progress may be slow, but small victories matter. Celebrate every new word, every new skill, and every smile.

Support systems for families

Many parents ask, “Is there anyone who can help us through this?” The answer is yes. Talking to other families going through similar experiences can be reassuring and informative. Schools now offer inclusive education and support for children with autism. Several organisations provide therapy, counselling, and vocational training for children and young adults with autism.

Hope for the future

While autism cannot be “cured,” it can be understood and managed. With early help, many children grow up to lead independent and meaningful lives. Some may need more support than others, but every child deserves the chance to reach their full potential.

There are incredible growth that’s possible with the right mix of therapy, family support, and community awareness. What matters most is not changing the child—but changing the way we understand and support them.

With love, patience, and the right care, children with autism can thrive. The journey may be different, but it can be beautiful in its own way.

(Dr. Pushpakala is consultant paediatrician at Kauvery Hospital, Alwarpet. She can be reached at lakshmisundararajan@gmail.com)



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