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 Table of Contents  
ORIGINAL ARTICLES
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 86-88

Changing pattern of cancer incidence in India: 25-year report of the cancer registry of a large urban cancer center


1 Department of Radiation Oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, West Bengal, India
2 Surgical Oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, West Bengal, India
3 Gynaecologic Oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata, West Bengal, India

Date of Submission27-Jun-2022
Date of Acceptance05-Jul-2022
Date of Web Publication24-Aug-2022

Correspondence Address:
Jyotirup Goswami
Department of Radiation Oncology, Saroj Gupta Cancer Centre and Research Institute, Thakurpukur, Kolkata 700063, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjoc.bjoc_6_22

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  Abstract 

Introduction: Cancer registries are vital for understanding incidence and prevalence of cancer, as well as appropriate funding and control measures. Materials and Methods: The data of patients registered between 1996 and 2020 at a large urban cancer centre in Eastern India was used for analysis of cancer trends over time. Results: There were a total of 1,89,315 patients. The top 5 cancer sites over the most recent 5-year block (2016–2020) were lung, oral cavity, throat, stomach, and colorectum in males and breast, cervix, liver-gallbladder, oral cavity and ovary in females. There was a consistent rise in oral cavity cancers and lung cancer in males and a consistent rise in breast cancer and ovarian cancers in females. There was a consistent fall cervical cancers, which was overtaken by breast cancer in the mid-2000s as the leading cancer in women. Digestive cancers have doubled over the last 25 years, the commonest being stomach cancer and colorectal cancers. Conclusion: The data reflects India’s changing profile of cancer, with the increase of breast and ovarian cancers, as seen worldwide. Despite lack of a robust screening/vaccination programme, cervical cancer has declined. The rise in tobacco-associated cancers (lung and mouth) is a matter of concern.

Keywords: Breast cancer, cancer incidence, cervical cancer, digestive cancer, lung cancer


How to cite this article:
Goswami J, Bhattacharya S, Gupta A, Chowdhury RR, Bhattacharjee G, Ghosh S. Changing pattern of cancer incidence in India: 25-year report of the cancer registry of a large urban cancer center. Bengal J Cancer 2021;1:86-8

How to cite this URL:
Goswami J, Bhattacharya S, Gupta A, Chowdhury RR, Bhattacharjee G, Ghosh S. Changing pattern of cancer incidence in India: 25-year report of the cancer registry of a large urban cancer center. Bengal J Cancer [serial online] 2021 [cited 2022 Sep 27];1:86-8. Available from: http://www.bengaljcancer.org/text.asp?2021/1/2/86/354415




  Introduction Top


Cancer registries are vital for understanding incidence and prevalence of cancer, as well as appropriate funding and control measures. We present the 25 years’ data from a large urban Cancer Centre in Eastern India.


  Materials and Methods Top


The data includes patients registered between 1996 and 2020. Site-wise diagnosis was tabulated for men and women in absolute numbers and percentages. The data was used for analysis of cancer trends over time, both using individual year’s data as well as 5-year blocks (1996–2000, 2001–2005, 2006–2010, 2011–2015, and 2016–2020).


  Results Top


There were a total of 1,89,315 patients. Average footfall per year was 7572. The top 5 cancer sites over the most recent 5-year block (2016–2020) were lung, oral cavity, throat, stomach and colorectum in males and breast, cervix, liver-gallbladder, oral cavity and ovary in females. There was a consistent rise in oral cavity cancers and lung cancer in males and a consistent rise in breast cancer and ovarian cancers in females. There was a consistent fall in other head-neck cancers and cervical cancers, while the number of hematological malignancy cases also consistently rose. Breast cancer overtook cervical cancer in the mid-2000s as the leading cancer in women. There was a slight decrease in the relative incidence of cervical cancer cases presenting in advanced stage (III) versus early stage (I/II). Digestive cancers have doubled over the last 25 years. The commonest digestive cancers are stomach cancer and colorectal cancers. Oesophago-gastric and hepatobiliary cancers have been more common in women, while colorectal and pancreatic cancers have been more common in men. The effect of Covid was seen with a 50% drop in patient footfall in 2020 (4031), which would impact future disease outcome, due to delayed diagnosis and/or treatment.


  Discussion Top


The change in cancer incidence rates worldwide reflects a variety of lifestyle, environmental factors, including infective agents. However the interplay between the factors has been varied, causing significant regional differences worldwide and even within a country. India being a very large and diverse country, is a typical example.

The Indian Hospital-based Cancer Registry data have been recently published,[1] comprising 610,084 cases from 96 cancer hospitals (including our center) during the period 2012–2019. Cancer was slightly more prevalent in males than in females (52.4% vs. 47.6%), whereas tobacco-associated cancers comprised 48.7% of cancers in males and only 16.5% in females. Of the tobacco-associated cancers, 24.4% were mouth cancers, 22.4% were lung cancers, and 16.6% were tongue cancers. There was a wide geographical variation in the incidence of tobacco-associated cancers, with the highest rates being seen in the North-East region. Head–neck cancers overall constitute nearly a third of male cancers (31.2%). Gynecological and breast cancers together constitute over half (51%) of female cancers, of which breast cancers comprised 25.4% and cervical cancers 15.2%. Cancers were commonest in the age group 45–64 years except for prostate cancers, which were seen over the age of 65 years. Lung cancer was the cause of 10% of all male cancers but only 4% of female cancers and was most commonly metastatic at presentation (males 49.2% and females 55.5%), followed by gallbladder (males 40.5% and females 45.7%) and prostate (42.9% of males). Aside from breast and gynecological cancers, the other cancers more common in females were thyroid (2.5% vs. 1%) and gallbladder (3.7% vs. 2.2%). Digestive cancers comprised 18% of all cancers, slightly more common overall in males than in females (20.7% vs. 15%). Of these, the commonest primaries were esophagogastric, followed by colorectal and hepatobiliary.

The population-based cancer registry data for our own region, the state of West Bengal, were also published very recently, drawn from the cancer registries of five large cancer centers (including our own), since 2005.[2] These data also reflect a higher incidence of cancer in males than in females (52.7% vs. 47.3%), translating to 1 in 10 males and 1 in 11 females between the age group of 0 and 74 years, with rising risk beyond the age group 45–50 years. The commonest male cancers were lung (20%), prostate (6.9%), mouth (6.7%), tongue (5%), and larynx (4.7%), whereas the corresponding sites for females were breast (24.8%), cervix (9.9%), ovary (7.6%), gallbladder (7.3%), and lung (6.6%). The tobacco-associated cancers comprised 46.7% of male cancers and only 15.4% of female cancers, with lung being the commonest site in both genders (43% for each). Overall, the cancer incidence is expected to rise from 53,758 in 2020 to 60,169 in 2025 in males and 54,636 in 2020 to 61,470 in 2025 in females.

Our data reflect the regional and national trends in the rising incidence of lung and oral cavity cancers, both tobacco-associated. Overall, cancer is significantly more common in males than in females (54.5% vs. 45.5%). The oral cavity (mouth and tongue) cancers, in particular, are correlated with the very common use of chewable tobacco in our region. The rising incidence of breast cancers reflects both national and international trends and is thought to be related to an increasingly Western lifestyle. An interesting trend has been the falling incidence rates of cervical cancers, seen in our data, as well as the national data, which, in the absence of a robust screening program/HPV vaccination strategy, suggests that there are important effects exerted even by sociocultural changes, such as avoidance of early marriage and better menstrual hygiene. There was a slight decrease (52% in the period 1996–2000 vs. 39% in the period 2016–2020) in the relative incidence of cervical cancer cases presenting in the advanced stage (III).

The top 5 cancer sites in our data over the most recent 5-year block (2016–2020) were lung (11.11%), oral cavity (10.72%), throat (7.98%), stomach-esophagus (6.58%), and colorectum (5.57%) in males and breast (19.73%), cervix (9.8%), liver-gallbladder (5.91%), oral cavity (4.37%), and ovary (4%) in females. This broadly reflects the regional and national data, although the overall rate of head–neck cancers, at 20.57%, was lower than the national figures. In contrast, our center did not see a significant number of prostate cancers (2.86% of all male cancers), which could be due to the lack of urology services initially. Contrarily, our registry recorded an increasing trend of hematological malignancies, in synchrony with the expansion of hematology services at our center.

Digestive cancers have doubled over the last 25 years, with the incidence rate being 8.3% in the period 1996–2000 and 16.5% in the period 2016–2020 [Figure 1]. The commonest digestive cancers are esophagus-stomach and colorectal cancers. Esophagogastric and hepatobiliary cancers have been more common in women, whereas colorectal and pancreatic cancers have been more common in men.
Figure 1: Digestive cancers

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Among the less common cancers, thyroid cancer constituted 3.22% of female cancers in the most recent 5-year block (2016–2020) analyzed in our data vs. 1.42% of male cancers, which fits with the national trends.

Our registry also comprises a group of non-malignant conditions and undiagnosed malignancies, the numbers for which have gradually reduced over time, from 37.3% of all male cancers in the 5-year block 1996–2000 to 21.75% in the 5-year block 2016–2020, with the corresponding figures for females being 40.31% and 23.95%, respectively. This would be commensurate with the availability of better diagnostic facilities, such as positron emission tomography-computed tomography scan and immunohistochemistry, although it is interesting that the relative proportion of these patients continues to be higher for females than for males.

Our study suggests that public health spending on breast and oral cancer screening would be worthwhile, along with a total ban on all tobacco use. Innovative solutions are called for, with regard to screening for digestive cancers, as mass endoscopy is unlikely to be a successful strategy [Figure 2].
Figure 2: Female cancers

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The effect of Covid was seen with a 50% drop in patient footfall in 2020 (4031 vs. the average figure of 7572), which was likely to have been caused by lockdown and difficulty of access to treatment. As a result, some of the trends in the 5-year period 2016–2020 are somewhat blunted (though not reversed). This is also expected to impact future disease outcome, due to delayed diagnosis and/or treatment.


  Conclusion Top


The registry data reflect broadly India’s changing profile of cancer, especially with the increase of breast and ovarian cancers, as seen worldwide. Despite lack of a robust screening/vaccination program, cervical cancer rates have declined. The rise in tobacco-associated cancers is reflected by increasing numbers of lung and mouth cancers and is a matter of concern and action.

Acknowledgment

We are grateful to Dr. Manas Nath Bandyopadhyay, Dr. Sunil Gupta Kaviraj, and Dr. Saroj Gupta.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
ICMR-NCDIR. Clinicopathological Profile of Cancers in India: A Report of the Hospital Based Cancer Registries. Bengaluru, India: 2021.  Back to cited text no. 1
    
2.
Profile of Cancer and Related Factors: West Bengal (ICMR-NCDIR). Benaluru, India: 2021.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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