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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 790-792

Patterns of cancer incidence in India – What next?


1 Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
2 Department of Medical Oncology, Ernakulam Medical Centre and MOSC Medical College, Kochi, Kerala, India

Date of Submission25-Nov-2020
Date of Decision07-Dec-2020
Date of Acceptance07-Dec-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Bhawna Sirohi
Apollo Proton Cancer Centre, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_358_20

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How to cite this article:
Sirohi B, Mathew A. Patterns of cancer incidence in India – What next?. Cancer Res Stat Treat 2020;3:790-2

How to cite this URL:
Sirohi B, Mathew A. Patterns of cancer incidence in India – What next?. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 18];3:790-2. Available from: https://www.crstonline.com/text.asp?2020/3/4/790/305017



Cancer registries provide the basic benchmark for the national cancer control programs. In India, the registry data are being collected since 1982 under the umbrella of the National Cancer Registry Program (NCRP). The Indian Council of Medical Research and the National Centre for Disease Informatics and Research published the NCRP report 2020 that included 28 population-based cancer registries (PBCRs) and 58 hospital-based cancer registries.[1],[2] The report gives an overview of the cancer incidence patterns across India between 2012 and 2016.[2] Within India, the cancer incidence differs dramatically based on the geographical location (north/south/northeast, rural/urban, and Ganges belt/Deccan plains). The highest cancer incidence was observed in Northeast India, with the most common cancers being nasopharyngeal, hypopharyngeal, esophageal, stomach, liver, gallbladder, laryngeal, lung, breast, and cervical cancers.[3] Overall, there is a trend suggesting a transition to lifestyle-related cancers such as breast and colorectal cancers, while the incidence of infection-related cancers such as cervical and stomach cancers is declining.

Shetty et al. in their study have looked into the geographical distribution of cancers and reported the common (oral, breast, cervical, and lung) and emerging (prostate, ovarian, and endometrial) cancers across India to assess if national efforts can be directed accordingly.[2] They selected six PBCRs with the highest number of patients from each zone in the country (north, south, east, west, central, and northeast), which included a total of 187891 patients in their analysis. The relative proportions of the selected cancers from the six PBCRs were considered based on the assumption their mean values would represent the relative proportion of these cancers across the country. The report highlights that oral, cervical, and breast cancers constitute the major cancer burden (more than 50%) and that there are incommensurately high incidence rates of cancer in Northeast India. They also reported that the incidence of lung, breast, prostate, and colorectal cancers is increasing.

One of the major limitations of their study and the NCRP report 2020 is the fact that only 10% of the population is covered by the PBCR. Although the coverage across most states of India has improved over the years, rural India is still underrepresented. Shetty et al. did not discuss the trends in cancer incidence. Therefore, their study overlooked an optimistic piece of information for cancer caregivers. Although cervical cancer is still among the leading cancers among women in India, it is important to note that its incidence is declining.[4],[5]

The registry study rightly highlights that the proportion of preventable cancers is high – for instance, oral cancer from tobacco abuse. Tobacco and alcohol continue to remain the greatest threats to public health. Moreover, obesity and lifestyle diseases are contributing to the rising cancer burden (breast, endometrial, and colorectal cancers). What steps can be taken to reduce the cancer incidence in India via reducing the exposure to these risk factors?

Greater awareness of cancer risk factors and early signs of cancer and premalignant conditions is crucial. For that, dissemination of information and education in regional languages and through social media platforms must be adopted. Meanwhile, we must also conduct implementation research for some of the current strategies being used in cancer awareness programs. For instance, does pictorial representation of the dangers of oral tobacco use result in tobacco cessation? Has an increase in sales tax for tobacco products reduced tobacco use?[6]

India has experienced rapid economic growth in the last two decades, and given the younger population matrix, the number of cancers in the younger population living in the cities is rising. Our efforts should be focused on the cancers contributing to the highest disability-adjusted life years in India, such as cancers of the breast, head-and-neck, cervix, esophagus, stomach, lung, and colorectal cancer.[7] Our efforts should also be regionally focused and locally driven. For instance, Kerala must consider ways to reduce the incidence of thyroid cancer in women, which is very common in the state.[1] Although several states have made cancer a notifiable disease, the implementation leaves much to be desired.

Northeast India remains an enigma with high cancer incidence and poor outcomes. Various factors implicated are the use of smokeless tobacco, dietary patterns, and topographical barriers including access to services. An effort has been made by the Tata Trusts to drive a hub-and-spoke model for cancer centers in this region.[8] The B. Borooah Cancer Institute in Assam has become a unit of the Tata Memorial Center in Mumbai to deliver affordable cancer care.[9] We need to support research into the etiology of cancers in Northeast India. Well-conducted case–control studies will help provide quick answers. We must incentivize such research by encouraging collaborations between local organizations and specialized institutions across India and globally.

Cancer care in India is still centered in major metropolitan cities even though 70% of the population lives in rural India. We must find ways to increase access to quality institutions across the government and private sectors and also provide optimal regulatory scrutiny in such centers.[8] In India, patients travel long distances to gain access to cancer care. Cancer outcomes are compromised as patients are not able to adhere to the continuum of care necessary to improve the chance for cure.[8] Optimally conducted cancer surgeries should be within the reach of our citizens at an affordable rate. For instance, it is common to see patients with suboptimal nodal yield following gastrointestinal cancer surgery or poor cosmesis following breast cancer surgery.

Encouragingly, India has launched the national clinical screening program though this has not been implemented nationwide.[10] This will include organized screening for all men and women above the age of 30 years for oral, breast, and cervix cancers. The challenges remain the infrastructure, trained personnel, capacity building, robust referrals, and the diagnostic pathway.[11] The key stakeholders must focus on screening and early diagnosis with investment in early multidisciplinary diagnostic centers as part of the rapid diagnostic and referral pathways as piloted by the NHS.[12],[13]

While we can now reliably get cancer incidence data from these registries, we still do not have high-quality information on the survival outcomes. Our national registry program should next focus its attention on generating such data as well. The NCRP 2020 is an excellent start to presenting systemic information on the patterns of care, and hopefully, we can build on these data.



 
  References Top

1.
National Centre for Disease Informatics and Research: Time Trends in Cancer Incidence Rates, 1982-2010, Bangalore: National Cancer Registry Programme (NCRP-ICMR); 2013. Available from: https://www.ncdirindia.org/All_Reports/TREND_REPORT_1982_2010/. [Last accessed on 2020 Nov 22].  Back to cited text no. 1
    
2.
Shetty R, Mathew RT, Vijayakumar M. Incidence and patterns of distribution of cancer in India: A secondary data analysis from six population-based cancer registries. Cancer Res Stat Treat 2020;3:678-82.   Back to cited text no. 2
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3.
Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al., Cancer Statistics, 2020: Report from national cancer registry programme, India. JCO Glob Oncol 2020;6:1063-75.  Back to cited text no. 3
    
4.
Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health 2020;8:e191-203.  Back to cited text no. 4
    
5.
Badwe RA, Dikshit R, Laversanne M, Bray F. Cancer incidence trends in India. Jpn J Clin Oncol 2014;44:401-7.  Back to cited text no. 5
    
6.
Chaturvedi P, Sarin A, Seth S, Gupta PC. India: Steep decline in tobacco consumption in India reported in second global adult tobacco survey (GATS 2017). BMJ Blogs 2017. Available from: http://blogs.bmj.com/tc/2017/06/23/. [Last accessed on ?2020 Nov 22].  Back to cited text no. 6
    
7.
India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: The Global Burden of Disease Study 1990-2016. Lancet Oncol 2018;19:1289-306.  Back to cited text no. 7
    
8.
Sirohi B, Chalkidou K, Pramesh CS, Anderson BO, Loeher P, El Dewachi O, et al. Developing institutions for cancer care in low-income and middle-income countries: From cancer units to comprehensive cancer centres. Lancet Oncol 2018;19:e395-406.  Back to cited text no. 8
    
9.
Available from: https://tmc.gov.in/index.php/en/bbci. [Last accessed on 2020 Nov 22].  Back to cited text no. 9
    
10.
Kedar A, Kannan R, Mehrotra R, Hariprasad R. Implementation of population-based cancer screening program in a pilot study from India: Views from health personnel. Indian J Community Med 2019;44:68-70.  Back to cited text no. 10
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11.
Philip CC, Mathew A, John MJ. Cancer care: Challenges in the developing world. Cancer Res Stat Treat 2018;1:58-62.  Back to cited text no. 11
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12.
Chapman D, Poirier V, Vulkan D, Fitzgerald K, Rubin G, Hamilton W, et al. First results from five multidisciplinary diagnostic centre (MDC) projects for non-specific but concerning symptoms, possibly indicative of cancer. Br J Cancer 2020;123;722-29.  Back to cited text no. 12
    
13.
Crawford M. Cancer diagnostic centres must have high throughput. BMJ 2017;357:j2070.  Back to cited text no. 13
    




 

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