Non-Communicable Diseases and NP-NCD for NEET PG PSM: Screening at 30+, CBAC Score, Diagnostic Cut-offs, Levels of Care

Start Here

🎯 Exam priority: High-yield (Tier 1). NCD questions ask the screening age, which five diseases are screened, the diagnostic cut-offs, where each cancer test is done and how the CBAC risk score works. Everything here is from the MoHFW NP-NCD Operational Guidelines (2023–2030).

CBME mapping: CM 8 (epidemiology and control of non-communicable diseases).

The Burden and the Risk Factors

• The WHO NCD country profile (2018) estimates NCDs cause 63% of all deaths in India: cardiovascular disease 27%, chronic respiratory disease 11%, cancer 9%, diabetes 3%.

• Five shared risk factors: tobacco (smoked and smokeless), alcohol, unhealthy diet, insufficient physical activity and air pollution (indoor and outdoor).

• Among Indian women, breast cancer is the commonest, followed by cervical cancer; almost three-quarters of cancer spending is out of pocket.

From NPCDCS to NP-NCD

• 2010: NPCDCS (cancer, diabetes, cardiovascular disease and stroke) launched in 100 districts of 21 states.

• 2016: population-based screening (PBS) begins as part of comprehensive primary health care.

• The programme was then widened to COPD and asthma, CKD, stroke, NAFLD and STEMI and renamed the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD); its operational guidelines cover 2023–2030.

• The India Hypertension Control Initiative (IHCI) is a partnership of MoHFW, ICMR, State Governments, WHO-India and Resolve to Save Lives.

• Data are recorded on the National NCD portal, which also generates ABHA IDs.

Population-Based Screening and the CBAC

Everyone aged 30 years and above is screened for five common NCDs: hypertension, diabetes, and cancers of the oral cavity, breast and cervix. The ASHA enumerates every family, and each person is first risk-assessed with the Community Based Assessment Checklist (CBAC):

• The maximum score is 11. Everyone is screened whatever their score; a high score only means they are prioritised for the weekly screening day. (The form says "a score above 4" marks higher risk; the guideline text says "4 or more".)

• Part B of the CBAC asks about symptoms — e.g. cough over 2 weeks, blood in sputum, a mouth ulcer or white/red patch not healed in two weeks — so it also picks up TB, COPD and cancer suspects.

• Opportunistic screening: anyone 30+ attending a PHC OPD is screened by the medical officer.

Worked example: a 52-year-old man who chews gutka daily, does not drink, has a waist of 96 cm, walks 200 minutes a week and whose mother has diabetes scores 2 + 2 + 0 + 1 + 0 + 2 = 7.

Diagnostic Cut-offs

Hypertension: systolic ≥ 140 mmHg and/or diastolic ≥ 90 mmHg on two different occasions. Cutting salt is one of the key interventions.

Cancer Screening — Which Test, Where

Levels of Care

• Community: ASHA enumerates families; CBAC risk assessment of every adult.

• SHC-HWC: screening for hypertension, diabetes and common cancers by the CHO with ANMs/MPWs; referral.

• PHC-HWC: the medical officer confirms and manages referred cases; VIA; opportunistic screening of OPD attenders.

• CHC NCD clinic: run by a medicine specialist and/or MO, with an NCD counsellor.

• District hospital: NCD clinic plus a Cardiac Care Unit / Cardiac Stroke Care Unit (emergency cardiac and stroke care) and a Day Care Centre (cancer chemotherapy).

• Tertiary: State Cancer Institutes and Tertiary Care Cancer Centres (Strengthening of Tertiary Cancer Care Facilities scheme).

Targets: SDG 3.4 — cut premature NCD mortality by one-third by 2030; the 2023 Chief Secretaries' conference set a goal of 75 million people with hypertension and diabetes on standard care.

Traps the Examiner Sets

• Screening age is 30, not 40.

• Five screened NCDs: HTN, DM, oral, breast, cervical cancer — not lung or prostate.

• Cervical screening at primary level = VIA, not Pap smear (Pap is at CHC/DH).

• Hypertension needs two separate readings ≥ 140/90.

• Fasting glucose 110–125 is IFG; post-prandial 140–199 is IGT; HbA1c ≥ 6.5% is diabetes.

• CBAC family history scores 2, alcohol only 1; age ≥ 60 scores 3.

• Day Care Centre = chemotherapy; CCU = cardiac emergencies.

Rapid-Revision Cards

• NP-NCD screening age

  30 years and above.

• Five NCDs screened

  Hypertension, diabetes, oral, breast and cervical cancer.

• Hypertension (NP-NCD)

  ≥ 140 and/or ≥ 90 mmHg on two different occasions.

• Diabetes cut-offs

  FPG ≥ 126; PP ≥ 200; HbA1c ≥ 6.5%; RPG ≥ 200 + symptoms (mg/dl).

• Pre-diabetes

  IFG 110–125; IGT 140–199; HbA1c 5.7–6.4%.

• Cervical screening at PHC

  VIA by trained staff nurse / MO; Pap, colposcopy at CHC/DH.

• Breast cancer tests

  Breast exam at HWC; mammography, FNAC, biopsy at CHC/DH.

• CBAC age scores

  30–39: 0 · 40–49: 1 · 50–59: 2 · ≥ 60: 3.

• CBAC heaviest single items

  Age ≥ 60 (3); tobacco daily (2); waist > 90/100 (2); family history (2).

• CBAC rule

  Everyone 30+ screened; high score only sets priority. Max score 11.

• NPCDCS launch

  2010, 100 districts in 21 states; PBS from 2016.

• NP-NCD additions

  COPD/asthma, CKD, stroke, NAFLD, STEMI.

• District hospital NCD units

  NCD clinic, CCU/CSCU (cardiac/stroke), Day Care Centre (chemo).

• NCD share of deaths (India)

  63%; CVD 27%, CRD 11%, cancer 9%, diabetes 3%.

• NCD risk factors

  Tobacco, alcohol, unhealthy diet, physical inactivity, air pollution.

• NCD targets

  SDG 3.4: premature mortality −1/3 by 2030; 75 million HTN+DM on standard care.

Sources

Sources

Facts in this article were checked against these documents.

• National Programme for Prevention and Control of Non-Communicable Diseases (2023-2030): Operational Guidelines — MoHFW, 2023 (link)

Test Yourself: Practice Questions

Seventeen questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. Population-based screening under NP-NCD covers people aged

• (a) 30 years and above

• (b) 45–70 years

• (c) 18 years and above

• (d) 40 years and above

Q2. Which of the following is NOT one of the five NCDs in population-based screening?

• (a) Lung cancer

• (b) Oral cancer

• (c) Diabetes

• (d) Cervical cancer

Q3. Cervical cancer screening at the PHC-Health and Wellness Centre is done by

• (a) visual inspection with acetic acid (VIA)

• (b) colposcopy

• (c) Pap smear

• (d) HPV DNA test

Q4. Under NP-NCD, hypertension is diagnosed when BP is

• (a) ≥ 140/90 mmHg on a single reading

• (b) ≥ 140 and/or ≥ 90 mmHg on two different occasions

• (c) ≥ 160/100 mmHg once

• (d) ≥ 130/80 mmHg once

Q5. A fasting plasma glucose of 118 mg/dl indicates

• (a) impaired glucose tolerance

• (b) impaired fasting glucose

• (c) diabetes

• (d) normal glucose

Q6. The HbA1c value diagnostic of diabetes in the NP-NCD guidelines is

• (a) ≥ 6.5%

• (b) ≥ 5.7%

• (c) ≥ 6.0%

• (d) ≥ 7.0%

Q7. In the Community Based Assessment Checklist, a positive family history of high BP, diabetes or heart disease scores

• (a) 1

• (b) 2

• (c) 3

• (d) 0

Q8. A 63-year-old woman with a waist of 85 cm, who never used tobacco, does not drink and exercises 180 minutes a week, with no family history, has a CBAC score of

• (a) 3

• (b) 2

• (c) 4

• (d) 5

Q9. Which statement about the CBAC score is correct?

• (a) Everyone aged 30+ is screened whatever the score; high scorers are prioritised

• (b) A score of 0 excludes the person from screening

• (c) Only those scoring above 4 are screened

• (d) The score diagnoses hypertension

Q10. NPCDCS was launched in 2010 in

• (a) 50 districts of 10 states

• (b) all districts of India

• (c) 640 districts

• (d) 100 districts of 21 states

Q11. Which conditions were added when NPCDCS became NP-NCD?

• (a) Mental illness only

• (b) Tuberculosis and leprosy

• (c) Thalassaemia and sickle cell disease

• (d) COPD/asthma, CKD, NAFLD and STEMI (with stroke)

Q12. Day Care Centres under the NCD programme at district hospitals provide

• (a) emergency cardiac care

• (b) dialysis

• (c) palliative home visits

• (d) cancer chemotherapy

Q13. Mammography for breast cancer under NP-NCD is available at

• (a) ASHA home visit

• (b) CHC / district hospital

• (c) PHC only

• (d) sub health centre

Q14. According to the WHO NCD India profile 2018 cited by NP-NCD, NCDs cause about what share of all deaths in India?

• (a) 45%

• (b) 80%

• (c) 63%

• (d) 27%

Q15. Which is listed among the five major NCD risk factors in the NP-NCD guidelines, alongside tobacco, alcohol, diet and inactivity?

• (a) Low birth weight

• (b) Hepatitis B infection

• (c) Air pollution

• (d) Iodine deficiency

Q16. SDG target 3.4 aims to reduce premature NCD mortality by 2030 by

• (a) one-third

• (b) 10%

• (c) 25%

• (d) one-half

Q17. The India Hypertension Control Initiative is a partnership that includes MoHFW, ICMR, State Governments, WHO-India and

• (a) UNICEF

• (b) the World Bank

• (c) Resolve to Save Lives

• (d) the Gates Foundation

Active Recall

From memory: state who is screened under NP-NCD and for which five diseases; score the CBAC questions; give the hypertension and diabetes cut-offs; say which cancer test is done at the HWC and which at the CHC or district hospital; and outline the programme's history, levels of care and targets.