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.
“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
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