Cancer trends and burden in India

In October, 2018, Lalit Dandona and colleagues 1 India State-Level Disease Burden Initiative Cancer CollaboratorsThe burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016. Lancet Oncol. 2018; 19: 1289-1306 Summary Full Text Full Text PDF PubMed Scopus (181) Google Scholar published the findings of their Global Burden of Disease (GBD) Study of the burden and incidence of cancers in India, in The Lancet Oncology. The previous month, GLOBOCAN, a trusted source of global cancer statistics, published its report of cancer incidence in India, using 2018 estimates. 2 Bray F Ferlay J Soerjomataram I Siegel RL Torre LA Jemal A Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; (published online Sept 12.)DOI:10.3322/caac.21492 Crossref PubMed Scopus (50356) Google Scholar The number of cancers diagnosed in India in 2012, according to GLOBOCAN estimates, was 1 157 294, versus 1 069 000 in the GDB India study. 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. Both 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. Unfortunately, the data from different population-based cancer registries vary in accuracy, 3 Parkin DM The evolution of the population-based cancer registry. Nat Rev Cancer. 2006; 6: 603-612 Crossref PubMed Scopus (286) Google Scholar which might be the reason why GLOBOCAN 2018 only retrieved data from the 16 cancer registries they deemed were of better quality to estimate incidence. Similarly, the age-standardised incidence of breast cancer in India, in 2018, was reported to be 40·7 per 100 000 people in the GBD study compared with 24·7 per 100 000 people according to GLOBOCAN 2018 estimates. This substantial difference in the age-standardised incidence of breast cancer questions the credibility of the GBD study. Similarly, according to the GBD study, the highest estimate of crude cancer incidence in India was in the state of Kerala (135·3 per 100 000 people). But this estimate seems far from real. The data from Kerala were retrieved from the population-based cancer registry maintained by the Regional Cancer Centre in Trivandrum. This registry has better manpower, infrastructure, and resources to capture accurate cancer data from the region than registries in the rest of India. The average life expectancy in Kerala is 7 years higher than that of the rest of India (mean 67·9 years vs 74·9 years), 4 National Institution for Transforming IndiaLife expectancy. http://niti.gov.in/content/life-expectancyDate accessed: November 1, 2018 Google Scholar which might be due to a better sociodemographic index and health-care delivery system in the region. Therefore, the reported higher crude cancer incidence in Kerala compared with the rest of India might be due to the efficiency of the regional population-based cancer registry to record cancer cases and the longer life expectancy of the population in this region. Cancer trends and burden in IndiaThe Global Burden of Disease study1 published in The Lancet Oncology highlights the need to understand the reasons behind the changing trends in different cancer burdens in India between 1990 and 2016. In India, economic liberalisation started in the early 1990s and was followed by rapid industrialisation; after liberalisation, foreign direct investments grew more in the polluting sectors than in the less polluting sectors. So, environmental pollution that started in the early and late 1990s will show its effect now, as far as cancer is concerned, and this might partly explain the changing trends of cancer. Full-Text PDF Cancer trends and burden in India – Authors' responseRegarding the differences between Global Burden of Disease (GBD) and GLOBOCAN estimates raised by Chandramohan K and Boben Thomas, GBD uses all available relevant sources of data for cancer incidence estimates, including population-based cancer registries and mortality data from India's nationwide Sample Registration System and the Medically Certified Cause of Death data, whereas GLOBOCAN incidence estimates rely only on data from population-based cancer registries, which cover less than 10% of India's population. Full-Text PDF Cancer trends and burden in IndiaThe Global Burden of Disease Study on cancers, published in The Lancet Oncology, provides excellent data about variations in cancer incidence across the states of India.1 However, I wish to express two concerns about statements regarding breast and colorectal cancer screening. Full-Text PDF Cancer trends and burden in IndiaCancers put an enormous burden on society. A Global Burden of Disease (GBD) study published in The Lancet Oncology1 reported that of the northeastern states (with a population of 45 million people), Mizoram, Meghalaya, Arunachal Pradesh, and Assam have the highest burden of cancer in terms of age-standardised mortality and incidence, and low survival rates. The findings of this study also correlate with the findings of the National Cancer Registry Programme of India, which shows that, in men, Aizawl district in Mizoram state has the highest incidence of all cancers (270 per 100 000 people) followed by Papumpare district (230 per 100 000 people) in Arunachal Pradesh; for women, the highest incidence of cancer is in Papumpare district (249 per 100 000 people), followed by Aizawl district (207 per 100 000). Full-Text PDF The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016The substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focus on the ten cancers contributing the highest DALYs in India, including cancers of the stomach, lung, pharynx other than nasopharynx, colon and rectum, leukaemia, oesophageal, and brain and nervous system, in addition to breast, lip and oral cavity, and cervical cancer, which are currently the focus of screening and early detection programmes. Full-Text PDF Open Access