|Ahead of print publication
Magnitude and pattern of various cancers from tertiary health care center registry: A study in three southern states of India
H Magesh Rajan, S Mageswari, K Gayathri, S Satish, M Baluswamy, T Vijayapushpam, R Vijayaprabha
ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
|Date of Submission||21-Aug-2019|
|Date of Decision||28-Dec-2019|
|Date of Acceptance||09-Mar-2020|
|Date of Web Publication||22-Jul-2020|
ICMR-National Institute of Epidemiology, Ayapakkam, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Many research studies have looked into the epidemiological aspects including various potential risk factors associated with cancers, namely environmental, dietary, genetic, and hormonal. The present article studies the magnitude and pattern of various cancers registered at tertiary health-care centers in three South Indian states. Data from hospital-based cancer registries compiled by the ICMR-National Centre for Disease Informatics and Research for the time periods 2007–2011 and 2012–2014 for three South Indian states, namely Tamil Nadu, Kerala, and Karnataka, were analyzed using R software. Summarizing the type and proportions of cancers seen at the three registries during the periods 2007–2011 and 2012–2014, it was found that, among men, hypopharyngeal cancer, esophageal cancer, lung cancer, stomach cancer, and oral cancer were the major cancer types prevalent and, among females, cervical cancer, mouth cancer, breast cancer, ovary cancer, and thyroid cancer were the common cancer types. With multidisciplinary approach, cancers can be prevented to a certain extent by insisting behavioural changes through recommendation of increase in physical activities and intake of micro nutrient-rich food items with fiber component.
Keywords: Cancer, epidemiological, health care, hospital based, risk factors
|How to cite this URL:|
Rajan H M, Mageswari S, Gayathri K, Satish S, Baluswamy M, Vijayapushpam T, Vijayaprabha R. Magnitude and pattern of various cancers from tertiary health care center registry: A study in three southern states of India. J Can Res Ther [Epub ahead of print] [cited 2021 Jan 18]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=290470
| > Introduction|| |
Despite the several advancements made in diagnosis and treatment, cancer continues to be a significant threat to our society. All across the world, people are facing a multitude of new and challenging environmental problems every day. The current state of pollution of air, water, and soil may require millions of years for its remediation. With changing lifestyle and improved life expectancy, there is a rising incidence of noncommunicable diseases, namely cancer, diabetes mellitus, and cardiovascular diseases. India is passing through an epidemiological transition. The global burden of cancer continues to increase largely because of aging and growth of world population and increase in cancer-predisposing behaviors, particularly smoking. The world's population is expected to be 7.5 billion by 2020, and approximations predict that about 15.0 million new cancer cases will be diagnosed with deaths of about 12.0 million cancer patients. The GBD study, which reported on 28 types of cancer, used data from 42 population-based cancer registries in India, whereas GLOBOCAN 2018, which reported on 36 types of cancer, was based on cancer incidence in five continents volume XI and used data from 16 Indian cancer registries. Studies used the data available in their selected population-based cancer registries from 2008 to 2012 to calculate estimates of cancer incidence between 2016 and 2018. The data from different population-based cancer registries vary in accuracy and therefore the GLOBOCAN 2018 study used data from 16 cancer registries of better quality to estimate incidence. Similarly, the age-standardized incidence of breast cancer in India, in 2018, was reported to be 41/100,000 people in the GBD study compared with 25/100,000 people according to GLOBOCAN 2018 estimates. The high rates of cervical and breast cancers have resulted in higher cancer burden among women. Breast, lung, and colorectal cancers are occurring in higher frequencies in many economically developing countries, in addition to the disproportionately high burden of cancers related to infections. Cancer is a major cause of morbidity and mortality in developing and developed countries alike. On the Indian scene, 1.1 million new cancer cases were estimated, indicating India as a single country (of the 184 countries) contributing to 7.8% of the global cancer burden; mortality figures were 682,830, contributing to 8.33% of global cancer deaths, and the 5-year prevalence was 1.8 million individuals with cancer corresponding to 5.52% of global prevalence. Cancer is equally distressing for family as well. It could affect both family's daily functioning and economic situation. The economic shock often includes both loss of income and increase of expenses because of treatment and health care. There is also a shortage of skilled workforce and technology in India with cancer specialists, trained staff, and specialized cancer centers available in very few cities across India. For most patients in India, there is no insurance cover and treatment cost out of reach. Thus, delivery of equitable, quality, and affordable cancer care in India is a big challenge. In view of these facts, the present article describes the magnitude and pattern of various types of cancers registered at tertiary health-care centers in three South Indian states and its comparison at national and global levels. Besides, attempts have been made to describe the main causes of cancer along with their preventive measures.
| > Materials and Methods|| |
Data from hospital-based cancer registries compiled by the ICMR-National Centre for Disease Informatics and Research for the time periods 2007–2011 and 2012–2014 for three South Indian states, namely Tamil Nadu (Cancer Institute (WIA), Chennai), Kerala (Regional Cancer Centre, Trivandrum), and Karnataka (Kidwai Memorial Institute of Technology, Bangalore) were analyzed. Data were entered into Microsoft Excel, and descriptive statistics (frequency and percentage) were calculated.
| > Results|| |
[Table 1] summarizes the type and proportions of cancers seen at the three registries during the periods 2007–2011 and 2012–2014. The cancer types in the Bangalore registry [Figure 1], Chennai registry [Figure 2] and Trivandrum registry [Figure 3] is graphical represented. If we look at the 2012–2014 registry data, it is observed that lung cancer is the most prevalent cancer among men in the registries of Chennai and Thiruvananthapuram with the prevalence rate of 13.2% and 19.1%, respectively, and esophageal cancer leading in Bangalore registry with the prevalence rate of 10%. In the Bangalore registry, hypopharyngeal cancer (11.6%) was the most prevalent cancer reported among men during the year 2007–2011 which decreased to 9.7% during 2012–2014. The second most prevalent cancer seen was esophageal cancer accounting for 10.9% during 2007–2011 and 10% during 2012–2014. This was followed by lung cancer, which accounted for 9.7% of all cancer cases among males during 2007–2011 and 9.9% during 2012–2014. It was observed that the prevalence of stomach cancer increased from 7.6 to 9.1 during the years 2007–2011 and 2012–2014. In Chennai, stomach cancer accounted for 12.9% and 12.4% of all cancers among men during 2007–2011 and 2012–2014, respectively. Oral cancer was the third highest reported cancer in this registry. In Trivandrum, lung cancer (20.1% and 19.1%) was the leading cancer type followed by mouth cancer (11.2% and 9.4%) and tongue cancer (8.6% and 7.7%) in the years 2007–2011 and 2012–2014, respectively. In Thiruvananthapuram, data indicate that there was an overall decrease in the prevalence rate of all the leading cancers among men except for stomach cancer which increased from 6.4% to 6.8%.
|Table 1: Type of cancer prevalence among male in Bangalore, Chennai and Thiruvananthapuram|
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[Table 2] summarizes the cancer types and their prevalence among females in Bangalore, Chennai, and Trivandrum registries during 2007–2011 and 2012–2014. It is observed that the prevalence of cervical cancer increased in Bangalore and Chennai registries, whereas it decreased in Thiruvananthapuram registry. In Bangalore, the top three cancer types among females during the study periods (2007–2011 and 2012–2014) were cervical cancer (27.9% and 34%), mouth cancer (24.6% and 11.4%), and breast cancer (16% and 16.3%). The data show that there has been a significant decrease in the prevalence of mouth cancer in Bangalore from 24.6% in 2007–2011 to 11.4% in 2012–2014. In Cancer Institute, Chennai, cervical cancer (30.5% and 25.9%), breast cancer (26.8% and 28%), and ovary cancer (6.3% and 6.5%) were the major three cancers. In Trivandrum, Breast cancer (34.5 % and 33%), Thyroid cancer (13.3% and 16%) and Cervical cancer (11.2% and 8.6%) were the three most common cancer type in 2007-2011 and 2012-2014 respectively.
|Table 2: Type of cancer prevalence among female in Bangalore, Chennai and Thiruvananthapuram|
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Among females, cervical cancer and breast cancer are the most commonly diagnosed cancers and the leading cause of cancer death, followed by mouth cancer for incidence, and vice versa for mortality; cervical cancer ranks fourth for both incidence and mortality.
| > Discussion|| |
Epidemiological information on magnitude and pattern of cancer is an important basis for determining the priorities of population group or region to control cancer. There are marked regional differences in the distribution of cancer around the world. The factors such as active and passive smoking, use of nonsmoking tobacco, alcohol intake, dietary factors, and pollutants of air, water, and land contribute to the event of various forms of cancers. In this study, among men, lung cancer was a leading cancer followed by esophagus and mouth cancer. Among women, breast cancer was a leading cancer followed by cervix and mouth cancer. The consolidated report of Hospital Based Cancer Registry (HBCE) 2004–2006 shows that oral and lung cancers were the leading cancers among men, whereas among women, cervix and breast cancers are leading in India.,,,, However, worldwide breast cancer is the most frequent cancer in women and represents the second leading cause of cancer death among women after lung cancer., These results support the findings of the present study. In contrast to this study finding, prostate cancer for men in developed countries and liver cancer for men in Asian countries are the most common. For women, cervical and liver cancers are more common in Asia compared to the developed countries. The incidence rate for oral cancer is high in South Asian countries such as Sri Lanka, Pakistan, Bangladesh, and India, contributing to most of the cases in Asia., Lung, colorectal, and stomach cancers are among the five most common cancers for both men and women in both developed and less developed countries. In this study, it is also found that in cancer types common to both the sexes, the proportion in the female exceeds that in men in mouth cancer, and in other all types of cancer, men exceed than women. This is supported by the Iqbal et al.'s  study where it is reported that the proportion of cancer in the men exceeds that in women in almost all types of cancer. The regional and gender variation in cancer incidence may be due to the adoption of different lifestyles such as smoking, alcohol consumption, physical inactivity, obesity and high-fat, low-fiber diet, environment and occupation risk factors. Thus, lifestyle, environmental, and occupational differences contribute to the variation in cancer incidence.
| > Conclusion|| |
The present study mainly summarizes the magnitude and patterns of different types of cancer incidence in the tertiary care center of three states of South India. Among men, the most common cancer is lung cancer, while in women, the most common cancers are cervix and breast cancers. To conclude, cancer incidence is increasing progressively among the population, and there is a rise of cancer incidence in women compared to their counterparts. Therefore, there is need for strengthening and augmenting the prevailing diagnostic and treatment facilities under National programs. There is also need for strengthen of referral channels, complete follow-ups and campaigns to increase awareness among the population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]