Cancer in India

The report on the incidence of cancer during 2008-2011, in India, prepared by the National Cancer Registry Programme (NCRP), reveals some significant facts about the types of cancers found in the country and the areas that show a high prevalence of the disease. On the basis of this report, the World Health Organisation has estimated that there were 682,830 cancer deaths—356,730 males and 326,100 females—in India in 2012, that is 64.49 deaths for 100,000 adults.

The data were collected via a network of 25 Population Based Cancer Registries (PBCRs) spread across the country.

The latest says that among males, the lung, the mouth, the oesophagus and the stomach are the leading sites of cancer across all the registries. Lung cancer is the leading type in Bangalore, Chennai, Delhi, Kolkata, Tripura, Kollam and Thiruvananthapuram. All PBCRs in Gujarat, Maharashtra and Bhopal reported mouth cancer as the leading type.

North-eastern States

For the first time, data from the north-eastern States appears in the report. They reveal that the North East States have reported high incidence rates of cancers of the upper aerodigestive tracts, which include anatomical sites such as the oral cavity, the pharynx, the hypopharynx, the larynx, the oesophagus and even the stomach.

In Assam and Meghalaya cancer of the oesophagus is the most common and stomach cancer is the leading type in Sikkim and Mizoram. Among females, cancer of the breast and the cervix are the leading types in 18 of the 25 PBCRs. The lung was the leading site in Manipur and Mizoram. Cancer of the oesophagus led the list of cancers in Megalaya. Cancer of the thyroid followed cancer of the breast in Kollam and Thiruvananthapuram in Kerala.

Incidence

The cancer incidence rate is generally expressed as age adjusted or age standardised rate (AAR, according to the world standard population) per 100,000 persons. The international comparisons of the incidence rates of these sites of cancer reveal that the PBCRs at Meghalaya (East Khasi Hills district) and Mizoram (Aizawl district) and Kamrup in Assam have the highest AARs of cancers of these sites, particularly oesophagus, hypophrynx and larynx.

Childhood cancer

In another first, the NCRP collated information on cancers in childhood. The report says cancers in childhood constitute one of the most important groups of tumours. In boys, the proportion was the lowest in the East Khasi Hills (0.8 per cent) and the highest in Delhi (5.8 per cent). In girls, it varied from 0.5 per cent in East Khasi Hills to 3.4 per cent in Ahmedabad Rural. Incidence rates for childhood cancers are generally expressed as per million children and not as per hundred thousand, unlike in the case of adults, says the report.

Detection

The report says cancers of the upper aerodigestive tract as a group have emerged as important type for undertaking risk factor research and implementing early detection programmes. The PBCRs in the north-east have shown some of the highest incidence rates in the world. Suggestions in the report include deep investigation into the type of tobacco consumption and dietary factors. Early detection and screening exercise, particularly in areas such as the north-east and Bangalore is an immediate requirement.

Researchers suggest that programmes using endoscopy and laryngoscopy should be tried out initially as pilot studies. Simultaneously, education of the public about these sites of cancer and the need for early detection, including the benefits of undergoing endoscopy, should be publicised widely.

The NCRP does not explore the reasons for the incidence of cancers, But data collection helps in designing, planning, monitoring and evaluating cancer control activities under the National Cancer Control Programme (NCCP).