In the throes of a cancer crisis

In his book on cancer, author and doctor, Siddhartha Mukherjee describes cancer as organised chromosomal chaos, adding “Cell division allows us as organisms to grow, to adapt, to recover, to repair — to live. And distorted and unleashed, it allows cancer cells to grow, to flourish, to adapt, to recover, and to repair — to live at the cost of our living.”

Cancer is one of the leading causes of death. However, it’s possible to avert many of these deaths. About 30-50 per cent of cancer can be prevented by adopting healthy lifestyle choices such as avoiding tobacco and public health measures. Further, cancer can be detected early, treated and cured. To guide all of these, we need to understand the scale of the problem, and the data from cancer registries serve as a valuable tool towards this end. Cancer registries are of tremendous epidemiological and public health importance, and generate the evidence to formulate effective management, prevention and control strategies.

About cancer registries

The assessment of the burden of cancer as a national effort started in 1982 when six cancer registries were set up by the Indian Council of Medical Research (ICMR) as the National Cancer Registry Programme (NCRP) in Bengaluru. This now runs under the National Centre for Disease Informatics and Research (NCDIR), which manages disease databases and informatics for cancer, cardiovascular diseases, diabetes, stroke and other major non-communicable diseases.

Cancer registries collect data, from diagnosis through survivorship, to build an understanding of the disease and its management. India has 31 population-based cancer registries (PBCR) and 29 hospital-based cancer registries (HBCR), which serve as the primary source of credible data on cancer. Hospital-based cancer registries record information on patients being treated at a specific hospital, while population-based cancer registries collate data on the occurrence of cancer in a defined population.

Facts at a glance

The NCRP reports 14.5 lakh new cases (incidence) and 7.3 lakh deaths in 2016, and has projected 17.3 lakh new cases and 8.8 lakh deaths in 2020, based on 2012-14 cancer registry data.

A higher occurrence of cancer is being witnessed across urban registries compared to rural areas. The highest rates of cancers of all sites were observed in men in Aizawl (Mizoram) and women in Papumpare district (Arunachal Pradesh) compared to the rest of India. The 35-64 year age group is the most affected by cancer among all registries. The lifetime probability of a person developing cancer, for an average life span of 74 years, ranged from one in four (high) in the North East as opposed to one in eight in the rest of the country.

The leading sites of cancer among males across most registries include the lung, mouth, oesophagus and stomach. Over the years, there is a significant increase in the incidence of cancers of the colon, rectum and prostate among men. In women, cancer of the breast is the leading site of cancer in most registries and an increase in the incidence of cancers of the breast, uterus, ovary and lung has been reported over the years. Cancers associated with tobacco use account for about 30 per cent of all cancer in males and females. The East Khasi Hills of Meghalaya had the highest relative proportion for tobacco-related sites of cancers, with almost 69.5 per cent for males and 45 per cent for females. Cancer of nasopharynx is the leading site in Nagaland among both men and women, whereas very few incidents have been reported from the rest of India.

A relatively high frequency of cancer of the gall bladder is reported across the Gangetic belt and in northern parts of India, showing a distinct divide between northern and southern regions of the country, mainly attributing to diet and other lifestyle factors.

Leveraging data from cancer registries

The NCRP data translates into ‘health intelligence’ for the government’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Analytics gleaned from the registries help predict trends; guide and assess impact of cancer prevention and control activities; highlight environmental risk factors and high risk behaviours, so that appropriate measures can be taken to reduce cancer cases and resulting deaths; sharpen the focus of public health education campaigns, as well as help, identify specific opportunities such as urging women to attend health facilities for any health issue on self-examination for breast cancer and about preventive measures for cervix cancers.

Currently, the ICMR’s Cancer Registries cover less than 10 per cent of the Indian population. Cancer registration by hospitals in India is voluntary and national coverage will require stronger legislative backing. The absence of registries in several large states restricts better estimates of the disease. Expanding cancer registries across the country will provide region-wise specific data to strategically plan and prioritise interventions to triumph over cancer – the emperor of all maladies.

The author is Secretary , Dept of Health Research, Ministry of Health & Family Welfare and Director-General, Indian Council of Medical Research