Epidemiology of Cancers in Vidarbha Over 4-year Period, Tobacco-related Cancer and Control

INTRODUCTION

Despite the advances in diagnosis, the cancer burden increasing due to lifestyle factors. The major preventable risk factors of cancer are tobacco, alcohol consumption and dietary habits.

Tobacco is a huge public health enemy worldwide and more than 8 million deaths can be seen each year.^[1] India is considered as the Global epicentre for Oral cancer patients and there is an increase in the problem day by day.^[2] The death proportion in India due to tobacco use has increased from 10% in 1990 to 13% in 2019.^[3] In tobacco use, India ranks second after China, though there is decrease of 4.5% in smokeless and 3.3% decrease in smoked tobacco use.^[4]

Central India, Vidarbha region is addicted to tobacco in some or the other form. Among the risk factors for oral cancer, the most preventable risk factor is tobacco use and this control can decrease the cancer risk.^[5] The awareness about tobacco should be made and prevention is must in battle against hazardous effects of tobacco.

Tobacco consumption in central India is 54.4% in males and 40% in females.^[6] Maharashtra’s average percentage of tobacco consumption is 44.7%.^[7] In Rajasthan, it is 39% in urban men and 19% in urban females and in Delhi and Mumbai, it is found to be more among men.^[8] Vidarbha is considered as the ‘Kharra Capital’ of the country. In Vidarbha, 48.3% of men and 13.3% of women consume tobacco in any form that is, kharra, cigarette, beedi.

The present study describes epidemiology of cancer according to findings of National Cancer Registry Programme (NCRP) report (2017–2020).

MATERIAL AND METHODS

RESULTS

Leading sites of cancers in 2017–2020

A total of 19,291 cancer cases were registered during the period of 2017–2020 out of which 11,868 malignant cases were registered. Of those, 6042 (50.91%) were males and 5823 (49.07%) were females. The leading sites of cancer cases for the period 2017–2020 are shown in Table 1 and Figure 1. The cumulative top 5 cancers in males during period of 4 years were oral (51.92%), lung (5.41%), oesophagus (4.73%), brain (3.20%), larynx (3.08%) and the cumulative top 5 cancers in female were breast (26.97%), cervix uteri (21.76%), oral (14.97%), ovary (5.18%) and oesophagus (4.32%).

Table 1: Proportion of top 10 leading sites of cancer in Rashtra Sant Tukdoji-Regional Cancer Hospital (RST-RCH) for period 2017–2020 in males and females.

Males					Females
ICD10	Site	Number	%	CR	ICD10	Site	Number	%	CR
C00–C10	Oral	3144	51.92	0.5	C50	Breast	1576	26.97	0.2
C33–C34	Lung	328	5.41	0.05	C53	Cervix uteri	1272	21.76	0.2
C15	Esophagus	287	4.73	0.09	C00–C10	Oral	875	14.97	0.15
C70–C72	Brain, nervous system	194	3.20	0.03	C56	Ovary	303	5.18	0.05
C32	Larynx	187	3.08	0.03	C15	Esophagus	253	4.32	0.04
C11–C14	Nasopharynx, hypopharynx, pharynx unspecified	174	2.87	0.02	C54	Corpus uteri	190	3.25	0.03
C19–C20	Rectum	164	2.70	0.02	C33–34	Lung	168	2.87	0.02
C40–C41	Bone marrow	130	2.14	0.02	C70–72	Brain, nervous system	106	1.81	0.01
C61	Prostate	122	2.01	0.02	C19–C20	Rectum	92	1.57	0.01
C16	Stomach	106	1.75	0.01	C23–24	Gall bladder	76	1.30	0.01

ICD10: International classification of diseases, CR: Crude rate

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Figure 1:

Estimated proportion of Top 10 leading sites of cancer in Rashtra Sant Tukdoji-Regional Cancer Hospital (RST-RCH) for period 2017–2020 in males and females.

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The top cancer in males and females in Vidarbha region was in common with the top cancers of India, namely oral cancer in males and Breast cancer in females. The top 5 cancers in India among males were oral, lung, stomach, colorectal, and oesophagus and the top 5 cancers among females in India were breast, oral, cervix, lung and stomach.

In males, lung cancer causes more than 25% of cancer deaths and in females breast and oral cancer cause more than 25% of cancer deaths in India.

Distribution of registered cancer cases according to gender and age

The frequency distribution of cumulative cancer cases registered in RST-RCH in Vidarbha in the period 2017–2020 according to age is demonstrated in Table 2. The age-wise comparison of incidence of cancer in 2017–2020 is shown in Figure 2.

Table 2: The distribution of cumulative cancer cases registered by cancer registry in Rashtra Sant Tukdoji-Regional Cancer Hospital (RSTRCH) in Vidarbha in the period 2017–2020.

Age group	2017		2018		2019		2020
	Number	%	Number	%	Number	%	Number	%
0–10	22	0.7035497	21	0.6218537	9	0.3140265	4	0.1603206
11–20	41	1.3111609	85	2.5170269	34	1.1863224	29	1.1623246
21–30	136	4.3492165	170	5.0340539	122	4.2568039	105	4.2084168
31–40	525	16.789255	568	16.819662	446	15.561759	404	16.192385
41–50	766	24.496322	849	25.140657	748	26.099093	687	27.53507
51–60	811	25.935401	843	24.962985	743	25.924634	640	25.651303
61–70	600	19.187719	614	18.181818	574	20.027913	465	18.637275
71–80	189	6.0441317	201	5.9520284	166	5.7920447	136	5.4509018
81–90	35	1.1192836	25	0.740302	24	0.837404	25	1.002004
91–100	2	0.063959	1	0.0296121	0	0	0	0
Total	3127	100	3377	100	2866	100	2495	100

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Figure 2:

Estimated age-wise comparison of incidence of cancer in 2017–2020.

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About 2/3^rd of cases registered in 2017 are in age group of >50 years and in 2020 are in the age group of >40 years.

The least number of cases are found to be in age group of 0–10 years.

DISCUSSION

This descriptive epidemiological study includes all cancer cases registered in cancer registry data from 2017 to 2020. A total of cases registered were 19,291 and of which malignant were 11,866.

The most frequent cancer cases during our study according to Cancer Registry data in males are oral (51.92%), lung (5.41%), oesophagus (4.73%), brain (3.20%), larynx (3.08%) and among females breast (26.97%), cervix uteri (21.76%), oral (14.97%), ovary (5.18%) and oesophagus (4.32%).

On cumulative basis, cancer is higher in males compared to females in Central India; this is because of highest number of oral cancer cases among males because of tobacco usage excessively due to ignorance of risk factors and lack of proper education. Tobacco control is must in Vidharbha as it is consumed since very young age though government is implementing many acts but despite following very strict rules on legalisation of tobacco sales and banning tobacco advertisements and banning smoking in public still, many more preventive measures should be taken very strictly.

This study shows that the major cancer among females is of breast cancer 1576 cases that is, 26% of total malignant cases in females. Hence, its prevention is must. This can only be done by getting screened early. Family members of the breast cancer patient should also be screened compulsorily. Risk factors also should be made aware to women and healthy lifestyles, physical activities, preventing smoking, and avoiding contraceptive pills after age 35, should be followed.

According to our study, in females, increasing incidence of cervix cancer is more this is because of lack of awareness about risk factors such as use of contraceptive pills, human papillomavirus (HPV), and multiple sexual partners. Cervix cancer can be prevented by launching various awareness cancer campaigns and early detection. Women should be given knowledge about HPV vaccination and awareness about PAP smear screening every 3 years after the age of 30.

This study shows increase in incidence of cases with age, mostly at the age of 40 years and the highest number of cases that is, almost 2/3^rd of cases occurred between 4^th and 6^th decades and after that cases declined at age group of 80 this is because survival rates and life expectancy has been decreased in our country due to unhealthy lifestyle.

The data of 2017 show cancer cases found to be mostly between 5^th and 6^th decades but in 2020 study highest cases are found to be between 40 and 50 years that is, 4^th and 5^th decades. These clearly show cancer incidence started increasing more in young people that is, 40–50 years age group. This difference in cancer incidence might be related to magnitude of risk factors such as unhealthy diet, unhealthy lifestyle, tobacco smoking, lack of physical activity, environmental pollution, and lack of education about risk factors and their effects.

The discussion stress is mostly on burden of certain cancers such as oral, mostly tobacco-related, breast cancer and cervix cancer in Vidarbha and which is a burden globally in India as well.

It is needed to conduct cost-effective studies and screening programmes for early detection to reduce morbidity and mortality. It is necessary to work on already known risk factors prevailing and primary preventive measures such as smoking cessation, physical activity, nutrition, healthy diet, vaccination and secondary prevention including screening and early detection.

This study concludes cancer is increasing steadily year by year. According to report of NCRP annual report 2020, it has shown that Mouth cancer significant increase by 9.4% and 6.5% annually in males and females, respectively, and tongue cancer showed significant increase of 6% annually for period 2005 and 2016 in Nagpur Vidarbha region according to cancer registry data. By this, it can be concluded that the incidence of cancer burden can be estimated to be increased to 12.5% by 2025 compared to earlier data.

CONCLUSION

In summary, the study shows epidemiology of distribution of cancer in Vidarbha according to age and gender and leading cancers and preventive measures. Cancer increased incidence found among younger people compared to the previous years. Hence, efforts to be increased to overcome cancer incidence in early stages which can be only made by bringing awareness to the people regarding the risk factors and several screening programmes and awareness campaigns and a lot of research studies to be made.