Greater awareness and wider availability of diagnostic facilities are keeping cancer wards of Delhi hospitals teeming, but doctors say there has been only a marginal rise in the disease's incidence and some cancers have in fact shown a downward trend.

Government-run hospitals in the capital are getting a flood of patients referred from other states with awareness of the disease growing in rural areas.

According to doctors, while the rise in cancer cases countrywide has been about one to two percent over the years, largely due to population growth, the survival rate has also gone up considerably.

At Safdarjung Hospital, which gets "the poorest of the poor" patients, the survival rate of cancer patients has gone up though most patients come at a late stage of the disease. The 120-bed cancer ward of the hospital is always full.

The survival rate of patients -- who survive two to three years after the disease is first detected -- has gone up to 35 percent due to better treatment and diagnostic facilities, say doctors.

However, for those patients whose disease is detected at an early stage, the chances of complete recovery are better.

The hospital, which gets about 5,000 new cases a year, has seen a marginal rise in the number of lung cancer and breast cancer patients. However, there has been a decrease in the number of cervical cancer cases.

Harsh Dua, medical oncology consultant at the private Indraprastha Apollo Hospital, says because of increased awareness people are now coming to hospitals in earlier stages of the disease.

The hospital, which gets around 1,500 new cases each year, manages to cure about 20 percent cancer cases, says Dua.

According to Dua, the success rate was better in patients being given targeted chemotherapy -- a relatively new and expensive treatment.

The medicine, which costs around Rs.100,000 per session, plus Rs.25,000 for combination drugs and hospital expenses every time, has shown good results on many. The treatment is mainly used for lymphomas, leukaemia, lung, colon and breast cancers.

Dua says there are more cases of breast cancer among urban women while rural women record more cases of cervical cancer due to poor sanitary habits.

Contributing reasons for breast cancer among urban women are late marriage and subsequently delayed motherhood, while for cervical cancer among rural women it is early marriage and having more children.

Vinod Raina, professor of medical oncology at the government-run premier All India Institute of Medical Sciences (AIIMS), says cervical cancer has shown a downward trend since 1990.

The hospital, which gets about 6,000 new cases of cancer a year, says many patients are referred from other states and hospitals to its Institute of Rotary Cancer Hospital (IRCH).

In Delhi, cervical cancer has shown a downward trend over a 10-year period with the disease's incidence coming down from 28 percent in 1990 (per 100,000 patients a year) to 21 percent, says Raina.

"This is due to reasons like better hygiene, women having fewer children and the Pap smear test (microscopic examination of cells taken from the cervix), which helps detect cervical cancer at an early stage," Raina, who is also head of the Delhi Cancer Registry, told.

Cancer of the larynx has also shown a decrease in the same period from 10 percent to eight percent, he said.

Breast cancer has shown a rise in the same period in Delhi from 27 percent to 31.6 percent. Cancer of the gall bladder among women has shown a disturbing rise -- from 6.9 percent to almost nine percent in the same period.

"The cases are generally from Punjab and other areas in northern India. It is mostly due to reasons like obesity and dietary habits," says Raina.

Prostate cancer has shown a rise from 5.8 percent to 7.7 percent, and lung cancer has also shown a marginal rise.

Government hospitals cannot afford to use the expensive targeted chemotherapy on patients, except on those covered by the Central Government Health Scheme (CGHS).

Some doctors at government hospitals maintain that the situation there is "pathetic" with patients crowding out-patients departments (OPD) and diagnostic equipment malfunctioning.

"The government badly needs to create more such facilities for cancer patients, most of whom are very sick. Sometimes patients collapse while waiting for the doctor," says Raina.

Doctors say with "organised screening", the situation could improve in government hospitals. For head and neck, breast and cervical cancer, there are cheap methods for early detection, which could go a long way in helping people get treatment in time.