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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 771-772

Increasing incidence of colorectal cancer among Indians: Concerns and the way forward

Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, Kolkata, West Bengal, India

Date of Submission02-Nov-2021
Date of Decision11-Nov-2021
Date of Acceptance12-Nov-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Nabendu Murmu
Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37, Shyama Prasad Mukherjee Road, Bakul Bagan, Bhowanipore, Kolkata - 700 026, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_258_21

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How to cite this article:
Murmu N, Mitra D, Das G. Increasing incidence of colorectal cancer among Indians: Concerns and the way forward. Cancer Res Stat Treat 2021;4:771-2

How to cite this URL:
Murmu N, Mitra D, Das G. Increasing incidence of colorectal cancer among Indians: Concerns and the way forward. Cancer Res Stat Treat [serial online] 2021 [cited 2022 May 16];4:771-2. Available from: https://www.crstonline.com/text.asp?2021/4/4/771/334203

We read the article by Tahiliani et al. titled, “Retrospective analysis of histopathological spectrum of premalignant and malignant colorectal lesions,” with great interest.[1] The article highlights the increasing incidence of colorectal cancers (CRCs) in developing countries such as India and Africa, which could be attributed to lifestyle changes.[2] The study conducted in patients (N = 150) from the Gujarat Cancer Society Medical College reported ulcerative colitis to be the most common premalignant lesion and adenocarcinoma to be the most common malignant colorectal lesion. They also reported that these lesions advance with age and have a higher incidence among male patients. The rectum was reportedly the most common site of the lesions. Most of the findings of this study corroborated the findings of previous studies with some variations; for instance, the most common premalignant lesion was reported to be tubular adenoma in CRCs by two previous independent studies.[3],[4]

While Tahiliani et al.'s study showed that most patients affected with CRC are in the sixth decade of life, akin to the findings of previous studies, an interesting observation in this study was that around 22.8% of the patients were aged less than 40 years.[1] First, CRC is not as frequent in developing countries such as ours, and second, the increasing incidence of CRC among the youth is a definite cause for alarm. A number of factors could be responsible for this drastic rise of CRC among Indian youth, ranging from lifestyle changes to dietary habits.[5] Recently, over-usage of antibiotics has been linked to a higher incidence of colon cancer, and India, as we know, is one of the largest consumers of antibiotics.[6] This higher risk may be due to the disruption of the gut microbiota in the colorectal region.[7] Post coronavirus disease-2019 (COVID-19), with the indiscriminate and unwarranted usage of antibiotics among patients,[8],[9] this concern is even larger and needs to be addressed and understood only through future studies keeping the negative impact of the pandemic in mind. To truly understand the effect of lifestyle changes and dietary habits on the increasing incidence of CRC among Indian youth, we must stratify the youth with CRC from rural and urban areas. This stratification will help in the delineation of how the sedentary lifestyle and fast-food consumption by the urban youth put them at a relatively higher risk of developing CRC compared to their rural counterparts, leading a more active life and consuming traditional Indian diet.

Although this study sheds some light on the prevalence of CRC in the Indian population, it suffers from several drawbacks, some of which have been mentioned by the authors themselves. First, a cohort comprising only 150 patients is too small to draw any significant conclusion.[1] A more extensive statistical analysis is required with higher number of patients. Second, the study was conducted among majorly tertiary patients with stage IIIB cancer,[1] and hence, more patients with less advanced disease such as stage IIA, I, and IIC need to be included to expand the evidence. Third, along with age, the anatomical site, and sex of the patients, more patient information should has been recorded such as antibiotic usage, whether the patient lived in an urban or rural area, the level of daily physical activity (active versus sedentary), and dietary habits. All these parameters along with the parameters already mentioned in this study would lead to a more comprehensive study on CRC in Indian patients, which will pose a plethora of important questions and hopefully lead to greater awareness among people.

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  References Top

Tahiliani HT, Purohit AP, Desai SC, Jarwani PB. Retrospective analysis of histopathological spectrum of premalignant and malignant colorectal lesions. Cancer Res Stat Treat 2021;4:472-8.  Back to cited text no. 1
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Aster JC. The gastrointestinal tract. In: Vinay K, Abdul KA, Jon CA, editors. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Philadelphia: Elsevier; 2021. p. 814.  Back to cited text no. 2
Umana IO, Obasek DE, Ekanem VJ. The clinicopathological features of lower gastrointestinal tract endoscopic biopsies in Benin City, Nigeria. Saudi Surg J 2017;5:9-20.  Back to cited text no. 3
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Sheikh B, Ambreen B, Summaiya F, Ruby R, Farzaana M, Sheikh J. Spectrum of colorectal lesions on colonoscopic biopsies; a histopathological study in a tertiary care hospital. Int J Med Sci Clin Invent 2017;4:2750-8.  Back to cited text no. 4
Zargar T, Kumar D, Sahni B, Shoket N, Bala K, Angurana S. Dietary risk factors for colorectal cancer: A hospital-based case-control study. Cancer Res Stat Treat 2021;4:479-85.  Back to cited text no. 5
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Zhang J, Haines C, Watson AJ, Hart AR, Platt MJ, Pardoll DM, et al. Oral antibiotic use and risk of colorectal cancer in the United Kingdom, 1989-2012: A matched case-control study. Gut 2019;68:1971-8.  Back to cited text no. 6
Ramirez J, Guarner F, Bustos Fernandez L, Maruy A, Sdepanian VL, Cohen H. Antibiotics as major disruptors of gut microbiota. Front Cell Infect Microbiol 2020;10:572912.  Back to cited text no. 7
Ghafur A. COVID-19 pandemic, superbugs, and the oncologists! Cancer Res Stat Treat 2021;4:8-9.  Back to cited text no. 8
Calderón-Parra J, Muiño-Miguez A, Bendala-Estrada AD, Ramos-Martínez A, Muñez-Rubio E, Fernández Carracedo E, et al. Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID. PLoS One 2021;16:e0251340.  Back to cited text no. 9

This article has been cited by
1 Authors' reply to Murmu et al.
HenishaT Tahiliani, AshaP Purohit, ShashankC Desai, PujaBhavesh Jarwani
Cancer Research, Statistics, and Treatment. 2021; 4(4): 772
[Pubmed] | [DOI]


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