The NCRP report on cancer incidence in India was released recently. The report estimates that the number of cancer cases in India would reach 15.7 lakhs by 2025. The report also mentions that more than 25% of these cases are due to tobacco usage which is preventable. The global cancer incidence is estimated to reach 2.94 crores by 2040 with 2/3rd of these cases in lower & middle-income countries.
The month of October is globally observed as the Breast Cancer Awareness Month during which a dedicated campaign is organized to educate people about breast cancer. However, according to the recently released National Cancer Registry Programme (NCRP) Report 2020, the incidence of many different types of cancer is on a rise along with breast cancer. The report, published by Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics and Research, estimates that there will be over 13.9 lakh cancer cases by the end of 2020 which is likely to increase to 15.7 lakhs by 2025.
Considered the emperor of all maladies, cancer is a generic term for a collection of related diseases which may develop in almost any organ or tissue in the body when there is an uncontrollable growth of abnormal cells formed due to the alterations in DNA spread and damage the surrounding tissues/organs. When these cells spread to other organs, the process is called metastasizing, which is a major cause of death from cancer. Cancer is the second leading cause of death across the world among the ‘Noncommunicable diseases’ (NCDs), after cardiovascular diseases. About one in six deaths in the world is because of cancer, according to the WHO.
Multiple factors cause cancer
The cause of cancer cannot be pin pointed as it is multifactorial in origin. Interaction between a person’s genetic factors and the different types of external carcinogenic agents such as ultraviolet and ionizing radiation, chemicals such as tobacco smoke components, asbestos, and infections from certain pathogens such as human papillomavirus, is what results in the abnormality in cells. Other factors include ageing and physical inactivity. Cancer cells could develop even because of genetic mutations inherited from parents. It can be acute (sudden onset), sub-acute (slow onset), or chronic (long period). The International Classification of Diseases lists more than 600 types of cancer. Cancer of lung, mouth, stomach, and oesophagus were the most common among males and cancer of breast and cervix uteri were the most common among females.
Many Countries implementing National Cancer Control Plans
Many countries are implementing their own National Cancer Control Plans in preventing the disease, treatment, rehabilitation, and other purposes. Under these plans, it is necessary to keep track of the cancer burden in the country and its future evolution. Effectiveness of interventions need to be monitored too. Cancer registries that are maintained by countries which is like a census of cancer cases serves this purpose. The registry collates data on incidence, type, and mortality due to cancer in the country. The National Cancer Registry Programme Report (NCRP) provides the information on estimated incidence and mortality in India.
The latest NCRP report is based on the data from 2012-16. Data from 28 Population Based Cancer Registries (PBCR) and 58 Hospital Based Cancer Registries (HBCR) have been used. PBCRs record new cancer cases in a defined population whereas HBCRs record information on cancer patients attending a particular hospital. The report has estimated that the incidence of cancer cases in India rose from 12.6 lakh cases in 2016 to 13.25 lakhs in 2018. Further, it is projected that the incidence of cases would go up to at least 13.9 lakh cases by the end of 2020 and increase to nearly 15.7 lakh cases by 2025, an increase of almost 13%.
Incidence of Cancer among female is higher than the male counterparts
The incidence of cancer among females is estimated to be higher than males. Incidence of the disease among females was 6.43 lakhs in 2016 and estimated to be 6.95 lakh cases in 2019. The number of females diagnosed with cancer is projected to cross 7 lakh cases in 2020 and 8 lakh cases by 2025. Meanwhile, the incidence of the disease among males was 6.16 lakhs in 2016, which increased to 6.47 lakhs in 2018 and is projected to reach 7.63 lakh cases by 2025. It is projected that the number of males with cancer will increase by 12.4% between 2020 and 2025 while that of females will increase by around 13.1%.
27% of the cancer cases in India are due to tobacco usage
Estimates by site of cancer for 2019 shows that Breast Cancer accounted for nearly 15% of the cancer cases in India in 2019. Among females, 28.8% of the cases (more than 2 lakh cases), were that of breast cancer and cervix cancer was the site in about 10.5% of the cases (around 0.73 lakhs). Among males, lung cancer was the most common, accounting for 10.5% of the cases, nearly 0.7 lakh cases. Mouth cancer accounted for over 8.4% of the cases. Breast cancer was more common in metros.
The 2020 projection indicates that 27.1% of the cases in India, about 3.77 lakh cases, are due to tobacco related causes. This is projected to increase to 4.27 lakh cases by 2025. Cancers in the gastrointestinal tract is estimated to contribute to 19.7% of the cancer cases in 2020. It is also observed that the incidence of cancer was high in the north-eastern region. Aizawl, the capital of Mizoram, has the highest incidence rate for cancer in the male population with more than 269 persons per lakh population diagnosed with cancer. Papum Pare district in Arunachal Pradesh had the highest incidence rate of cancer among females with nearly 220 females diagnosed per lakh population. It is also seen that the cancers related to tobacco was highest in the north-eastern region as compared to other parts of the country.
The incidence rate of stomach cancer among males in Aizawl district was the highest even compared to non-Asian countries. The highest incidence of lung cancer in females in Asia was also recorded in Aizawl. It must also be noted that the nortḥ-eastern region does not have adequate medical facilities. Accessibility is also a problem in this region. Incidence of tobacco related cancers such as oral and lung cancers and cervix cancers are an indication of the poor socio-economic conditions of a country since both these are preventable. Lower- and middle-income countries have more incidence of cervix and tobacco related cancers.
Cancer rates projected to increase by 60% in the next 20 years
According to WHO, nearly every country has seen an increase in cancer cases over the past decade. The cancer rates are projected to rise by at least 60% over the next 20 years. In 2018, a total of 1.81 crore cancer cases were recorded worldwide and around 96 lakh people lost their lives to the deadly disease. Lung, breast, and colorectal cancer were the most prominent and together accounted for 33.4% of the cancer cases globally in 2018. It is projected that by 2040, there will be over 2.94 crore cases of cancer. Nearly 67% of these will be in lower and middle-income countries. Vaccination against HPV virus, limiting tobacco usage, encouraging an active lifestyle, are some of the measures that could be taken to reduce the disease burden.