'It is a myth that cancer is prevalent only in urban areas'
More than 5,56,000 cancer deaths occurred in India in 2010 and 71.1 per cent of those who died were aged between 30 and 69 years, says a report on cancer mortality in India, published in the March 28 issue of The Lancet.
While men in the age group of 30-69 years are more likely to die of oral cancers followed by stomach and lung cancers, the most fatal cancers in women are cervical, stomach, breast and oral.
The study—Cancer mortality in India: a nationally representative survey—draws comparisons between cancer deaths reported from urban and rural areas. Author Prabhat Jha from Centre for Global Health Research, a non-profit, says in the study that about three-quarters of Indians live in rural areas. Yet, mortality for specific cancers is estimated mostly with data from India’s 24 urban population-based cancer registries. There are only two registries representing rural areas; most deaths in India occur at home and without medical attention, says Jha.
“The study breaks the myths many people have about cancer that it is only prevalent in urban areas. This study clearly shows that the rural population is equally at risk of getting cancer,” says P C Gupta, director, Healis-Sekhsaria Institute for Public Health, a Mumbai-based non-profit.
In men, oral cancers are common in both urban and rural areas. But lung cancer incidence is higher in urban areas and incidence of stomach cancer is higher in rural areas. In women, cervical and stomach cancers are slightly higher in the rural areas while breast cancer is prevalent in both rural and urban areas.
The study focuses on the geographical and social variations of specific cancers as well. It says that tobacco-related cancer deaths in men in Assam and other northeastern states is higher than the national death rate from all cancers. Rate of cervical cancer in women in Jammu and Kashmir and Assam, was found to be less than the national cervical cancer rate. "Cervical cancer was around 40 per cent less common in Muslim than in Hindu women, probably circumcision among Muslim men protects against human papillomavirus (HPV) infection, a causative agent in cervical cancer," note the authors.
The study, which traces the causes of high number of deaths in the country, says tobacco consumption is one of the major reasons. In India, 42 per cent men (84,000) and 18.3 per cent women (35,700) died of tobacco-related cancer in 2010, finds the study.
“This study redefines the fact that tobacco use causes not only most number of cancers in India, but it is also the reason behind high cancer mortality,” says Gupta, who is one of the authors of the paper. He adds that one-third of all cancer deaths in India can be prevented by eliminating the use of tobacco.
Rural Indians are more given to bidi smoking and tobacco chewing. Their cancers are diagnosed at a later stage and they have fewer cancer treatment facilities available to them, notes the study.
Another important finding in the study is the mortality caused by stomach cancer. It killed 25,200 men and 27,500 women in India in 2010. “This fact was not so well realised earlier,” says Gupta. “There have been several studies globally that strongly connect stomach cancer to smoking. In India, studies have shown such a link to chewing tobacco also.”
The study recommends that tobacco control is a priority for cancer prevention and the taxes on tobacco products must be increased.
“India has the highest number of oral cancers in the world with 75,000 to 80,000 new cases every year. Gutka and other forms of chewing tobacco sold in small pouches across the country are a serious health hazard as they are targeted at the youth and children. The government should ban gutka under the Food Safety and Standard Authority of India rules that came in effect on August 2011,” says Bhavna Mukhopadhyay, executive director, Voluntary Health Association of India, a non-profit.
The study also states that the cancer death rate in India is 40 per cent lower for men and 30 per cent lower for women as compared to the cancer death rates in the US and the UK. However cancer deaths are expected to increase, particularly with age-specific exposure to tobacco smoking. Many cancer deaths before the age of 70 are avoidable, most notably through prevention of cervical, liver and tobacco-related cancers, and with early diagnosis of oral, cervical and breast cancers that enable effective treatment," conclude the authors.
The funding for the study came from the Bill & Melinda Gates Foundation and US National Institutes of Health
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