Why Northeast India has high prevalence of cancer cases -- East Mojo

 published in EastMojo on Feb 4, 2022

Here is why Northeast has high prevalence of cancer cases 

Northeast is becoming the cancer capital of India and there is an urgent need to take a deep dive into the grave issue if we want to stem the rise

The increasing number of cancer cases in the Northeast is a matter of concern and detailed studies are needed to find out the reasons behind the high prevalence in the region, say experts, who also stressed on the need to eradicate the use of tobacco, one of the key reasons behind the killer disease.

Last year, the Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics & Research (NCDIR), Bengaluru, had projected that the number of new cancer cases in the Northeast region is likely to increase to 57,131 by 2025, in comparison to the estimated 50,317 in 2020.

These estimates are based on cancer data compiled by eleven Population Based Cancer Registries (PBCRs) in all the eight states.

The report titled “Profile of cancer and related health indicators in the Northeast Region of India” also includes data from seven hospital-based cancer registries (HBCRs) in Assam, Manipur, Mizoram and Tripura from 2012 to 2016.

“Yes, the scenario is very alarming. A number of well-designed epidemiological studies combined with molecular biomarkers are needed to understand high prevalence of cancer in the region,” said Dr Tapan Saikia, a medical oncologist and blood stem cell transplant physician, said.

A native of Assam, Dr Saikia is the Head of Medical Oncology and Research Director, Prince Ali Khan Hospital, Mumbai. He is also a pro bono visiting professor and consultant at State Cancer Institute, Gauhati Medical College and Hospital, Assam.

Northeastern states have a high burden of cancer, the report says. The highest incidence rate in males (269.4 per 100,000 population) was recorded in Aizawl district in Mizoram, among females (219.8 per 100,000) in Papumpare district in Arunachal Pradesh.

Another important aspect the report points out is the disparity in cancer cases between males and females. It says the proportion of tobacco-related cancers was 49.3% in males and 22.8 % in females. Again, in all the NE states, the incidence of cancer was higher in males than in females, except in Manipur and Sikkim. “The sex disparity is a complex issue. Again, very well-designed population-based studies are needed to find out details. Hospital-based registries are skewed,” Dr Saikia says.

The prevalence of obesity among women aged 15-49 years was highest in Sikkim (34.7%) followed by Manipur (34.1%). While in men, it was highest in Sikkim (36.3%) and lowest in Meghalaya (13.9%). Sikkim had the highest prevalence of hypertension in men (41.6%) and women (34.5%), followed by Manipur (men 33.2% and women 23.0%). In all the eight states, men had a higher blood sugar level when compared to women.

But how are obesity and hypertension linked to cancer? Dr Saikia said that non communicable diseases (NCD) are interrelated, especially diabetes and obesity, with cancer. “Additionally, diabetes and hypertension are interrelated.”

According to the report, the commonly occurring cancers among males were cancer of the oesophagus (13.6%) and lung (10.9%). In females, cancer of the breast was the leading cause (14.5%), followed by that of cervix uteri (12.2%).

Dr Saikia says, “Tobacco and alcohol are etiological factors for most of the NCDs, directly or indirectly. However, there are many cancers that develop due to genetic predispositions. In recent years, a number of models have been discussed and published in high-impact value journals such as Nature and Science. In coming years, further understanding of molecular genetics in the development of cancers will clarify these issues.”

Less than 50% of households in Arunachal Pradesh, Assam, Meghalaya, Nagaland and Tripura were using clean fuel for cooking, mentions the report. So is poverty or poor economic condition another factor?

Dr Saikia says, “There are multiple factors for diagnosis of cancer at advanced stages — socio-economic, poor education about health among lay people, lack of required health care system for early diagnosis.”

The report mentions that the proportion of cancer patients seeking treatment outside the north east was highest for Sikkim (95.3%) and Nagaland (58.1%). For years, people have been generally traveling outside the region for treatment, so hasn’t the situation improved? Dr Saikia said that many states in a country don’t have cancer-focused health care programs. “Of late, some states are waking up.”

At the time of diagnosis of breast, cervix, head and neck, stomach and lung cancers, less than one-third were localised, while the remaining were spread either nearby or distantly in the body.

The use of tobacco, both smokeless and chewing, is widely linked to cancer. In Assam, for example, offering tamul-paan (betel nut and leaf) with raw tobacco to guests is a common practice. People consume paan and are addicted to zarda across all ages so much so that in the Northeast, tobacco is kind of engrained in the culture.

Oncosurgeon Dr Shekhar Salkar says, “All over India, the percentage of smoking cigarettes or bidis is less than 20%. The maximum use is of smokeless tobacco such as gutka, paan masala, zarda, khaini, paan, etc. There is a liquid tobacco found in states like Mizoram, where the cancer rates are high. In the Northeast, the use of tobacco rate is around 45-55 %. Even in weddings if you don’t serve tobacco, they consider it a taboo.”

Dr Salkar, who is Chief of Department of Oncology at Manipal Hospital, Panaji, Goa, and president for the National Organisation for Tobacco Eradication, said it will take a long time for such habits to go as it is ingrained in the culture.

The Global Adult Tobacco Survey (GATS) India, 2016-17, had highlighted the high use of tobacco in the Northeast. The highest prevalence of tobacco use has been reported in Tripura (64.5%).

All the seven states from the Northeast with high tobacco prevalence together account for less than 7% of tobacco users in the country.

Tripura is followed by Mizoram at 58.7 %, Manipur 55.1 %, Assam 48.2 %, Meghalaya 47.0 %, Arunachal Pradesh 45.5 % and Nagaland 43.3 %. The all-India prevalence is 29%.

So how do we check this? “We will have to continue our awareness programme. The people themselves must know that these are the side effects of tobacco. If we continue, we will have problems and suffer and we have to stop all these habits,” Dr Salkar said.

The word cancer itself is scary for the common man. Do those with a family history of cancer have more chances of getting cancer? Dr Saikia concluded, “Cancer is a complex and multifactorial group of disease. A simplified example — if a person has some genetic predilection for development of a particular cancer: if s/he is a heavy tobacco user, the cancer will develop early. Otherwise, it might’ve manifested a few years later or never experienced clinical cancer.”

The writer is an independent journalist and video content creator based in Delhi-NCR and runs a YouTube channel Think Positive Live Healthy.

 Why Northeast India has high prevalence of cancer cases

 

Interview with Dr Tapan Saikia in Mumbai, one of India's leading oncologists. Published in North East Sun. Along with video interview on Think Positive Live Healthy

Interview with  Dr Tapan Saikia in Mumbai, one of India's leading oncologists. Published in North East Sun. Along with video interview on Think Positive Live Healthy

I would love to give something back to the people of Assam: Dr Tapan Saikia

Don’t miss the video interview at the end

  

 

Dr Tapan Saikia is among those people who work tirelessly to bring hope to others and live life differently. He is also one of the leading oncologists in India, dealing with terminal cases of cancer. He is the best man in India for bone marrow transplants. Right now he is associated with Prince Ali Khan Hospital in Mumbai.

 

Dr Tapan Saikia wanted to take up a job in Assam as a doctor and settle in his home state. But things didn't work out. He says, may be the people who interviewed him thought he was not good enough. Now he feels his heart is in Assam and body in Mumbai.

Dr Saikia's dream project is to make a very good cancer hospital in the NE. He thinks such a hospital is a necessity in that region so that the people don't have to travel for treatment.

Old man and the sea is one of Dr Saikia's favourite books. The story is about an old fisherman but what fascinates Dr Saikia is the everyday struggle in the character that can be seen also in a common man's life. He draws a lot of strength from that character. He believes whatever one does should be meaningful. His principle is, end will come one day in whatever way may be, but the fight should be well fought.

Dr Saikia thinks everybody influences him in some way or the other. He believes he lives for today because tomorrow is uncertain. He loves to hear Bhupen Hazarika's famous number Bristinna Parore Ashonkya Jonore …which has inspired him a lot since childhood. This doctor also has a regret – that he couldn't sing or play any instrument.

After the lighter side, let's peep into the deeper side of this medical man.

 

 

North East Sun: What is your subject of specialisation and major achievements?

Dr Tapan Saikia: Medical Oncology, my area of specialisation, is study of cancer medicine, a relatively new branch. It started during the Second World War, when it was realised that mustard gas used in the war as a poison, could reduce some of the tumours. Many classified (later unclassified) work took place in the US defense and led to development of a number of anticancer drugs. Most of these drugs are very, very strong and cause side effects. Medical Oncology is not only about using these drugs; the specialist needs to take care of the patient as a whole. He/she is more of an internist rather than only being a chemotherapist.

Currently, many childhood cancers can be cured with chemotherapy. First evidence came with some long survivors of acute leukaemia in children. A number of adult tumours also could be treated very effectively with medicines alone. Bone marrow transplantation (now known as blood stem cell transplantation) has added the number of survivors among patients with blood cancer, lymphoma, myeloma and some non-cancerous conditions. More recently, molecules are being developed to target the basic pathology of a disease (chemotherapy drugs are usually non-specific in choosing targets) and has shown great potential in controlling various cancers. One drug known as glivec (imatinib mesylate) has been very effective in controlling a blood cancer called CML and a solid tumour called GIST.

NES: Your greatest medical achievement.

DTS: I consider becoming a physician (by providence, rather than by design) itself is an achievement for me. Also, I have not achieved anything significant yet. If I could continue to help the community at large till my last day of working, my job will be done.

NES: Tell about your experience being part of the team during the first Bone Marrow Transplant (BMT) in India.

DTS: I was fortunate to be a part of it. I was young and even now feel like living a dream. Drs Advani and Gopal, our senior faculty members, were trained at the Fred Hutchinson Cancer Research Center, Seattle, USA, and they taught us on the subject at the Tata Memorial Hospital. We learned everything first-hand. This has helped us learning many aspects of this difficult field. The first transplant was successful. Subsequently, there have been many failures and some successes. We are continuing to learn every day.

NES: Medical profession is more of a business now. What is your say about this?

DTS: I have mixed reactions. Nevertheless, I have consciously managed to keep the faith. It is unfortunate that some of us are looking at the profession from a different perspective. There are good things and bad things and there are good people and bad people. We have to live all through these, is not it?

NES: Cancer treatment is very expensive. What do you do for the poor patients?

DTS: From a very recent personal experience, I have just found out that any illness can cost you a large amount of money; very unfortunate, but appears unavoidable at the present time. Cancer being a chronic disease, often drains the patient/family financially and emotionally.

As many of our patients are poor, we have been trying to find as many means as possible for funding. It is amazing how some hospital authorities (not all of them though), charitable trusts and good Samaritans extend help! I have noted this big heart, especially in Mumbai. However, it is never enough. Until the health care system is revamped in the country, the poor will always be at the receiving end.

NES: How do you deal with the psychology of cancer patients?

DTS: Every one is different. We need to understand the person as a whole and act accordingly. Getting the patient into a positive frame of mind could be easy, tough or impossible. I try to act rather than react (often fail). More often than not, it is the family with whom we end up dealing more. Hence, knowing family members' psyche is equally important. Dealing with a terminal stage cancer patient is extremely difficult. The need for palliative care is increasing.

NES: What is the status of medical care in India right now and what about the North-East?

DTS: Medical care in India is excellent in its own ill-organised way. The word ill-organised means failing to keep a proper document for future reference. We need more human resources to record notes and keep documents.

In the North-East, more efforts are needed. We have brilliant students of medicine. Existing institutes need better treatment from the authorities concerned. I would have loved to give something back to the people of Assam; I owe it to them. However, I do not want to initiate anything in a haphazard way. Also, the people should accept me (a difficult one from certain perspectives).

NES: What is your dream achievement in the medical field?

DTS: I need to be realistic here. In the past, I considered many ifs and buts. It is not feasible to have seminal contributions in the field while working in India. The environment is not truly conducive to do basic research, not because of lack of institutes but due to poor organisational shortcomings. Nevertheless, I have not given up on my dreams yet.

NES: Your memorable moment in life.

DTS: To identify one or several incidents is not easy. Seeing some young people back in their studies, jobs, starting a family gives me immense happiness. Some young people have been very generous in helping needy people. Some would adopt a patient for financial assistance, while the other would send a month's salary every year (earned in dollars abroad) for the poor. Some would form help groups. What else do you need in life to be happy!

NES: Do you get emotionally attached with your patients?

DTS: How could you avoid it? Yes, I usually get close. If someone says we should not, I consider him/her a demon. It is as simple as that.

NES: Do you believe in God?

DTS: I would let the question pass. It is too personal a matter and my interpretation would be misunderstood by others. Only one comment – religion and God are two different issues.

NES: Do you get time from your hectic schedule to spend with your family?

DTS: It is all in day's work. Everything overlaps. We give space to each other. We share responsibilities. I try to do everything – cooking, washing, cleaning, plumbing, ironing clothes, etc., excepting the accounting part. My wife, Beethi, is the expert in that department. She is more efficient in every area.

NES: Your hobbies.

DTS: I have too many hobbies, not necessarily good ones. I like to see the world as a colourful one, no dark glasses (shades) for me. I love to travel, read books (all kinds), occasionally cook, do exercises, clean the house, sit in front of the computer for hours and writing articles. There is no spare time, everything overlaps.

NES: Tell about your hometown.

DTS: I grew in half urban, half rural, Naharkatia. Looking back, I had a fairly happy childhood; can not remember any long-lasting traumatic events. We are nine siblings brought up by maternal grandmother (she is no more to see us surviving this way). Had a great neighbourhood full of events like, Bihu, moina parijat, jungle adventures (it was our backyard, now gone), sports and healthy/unhealthy gossips. It was a normal childhood. The growth depended on one's outlook and dreams. Medicine happened and I became a physician; destiny brought me to Mumbai ( Bombay) 1981. I did not have the opportunity of working in Assam.

Video interview with Think Positive Live Healthy

Link: 

https://www.youtube.com/watch?v=7GevGQ5Ke30&t=294s

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