Lifestyle-related cancers top the chart in the northeast region which has an overall high incidence of cancer in India. Oesophageal cancer is the highest in men followed by cancers of the lung and stomach, says a recent report compiled by the National Centre for Disease Informatics and Research under the Indian Council of Medical Research (ICMR). Together, they form 33.5% of all cancers in the northeast among men. In women, breast cancer is the highest followed by cervix and oesophageal cancer (33.8%). All these cancers are linked to extremely high lifestyle-related risk factors, say experts.
The report analyses a total of 37,448 cancer cases reported from 11 population-based cancer registries in the States of the northeast from 2012 to 2014.
High tobacco consumption
A feature that stands out in Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura is excessive tobacco consumption. The report says that as many as 57% of all cancers in males and 28% of all cancers in females are because of tobacco consumption. While these are linked to tobacco consumption, oesophageal cancer is also linked to consuming extremely hot beverages. A study by the Tata Memorial Hospital in Mumbai in 2009 showed that people who gulped down very hot tea (simmering temperature) were four times more prone to oesophageal cancer.
“There are certain dietary habits that definitely play a role in the increased incidence of cancer in the region.
“While tobacco consumption in some parts is more than 60%, people in the region are also very addicted to raw betel nut and its fermented variety. Both tobacco and betel nuts are known carcinogenic substances,” says Dr. A.C. Kataki, director of the Dr. B. Borooah Cancer Institute in Guwahati, Assam. Dr. Kataki, who is one of the principal investigators in the National Cancer Registry Programme (NCRP) network in the northeast that compiled the report, adds that the genetic variations as a result of there being a large number of ethnic groups are also a contributing factor.
Among the other prevalent cancers in the area, stomach cancer is linked to H. pylori bacteria infection that happens due to contaminated food and water, obesity, and a diet consisting of salty or smoked foods, etc. Breast cancer too is linked with obesity and late pregnancies among other risk factors. In cervical cancer, the most important risk factor is a Human Papilloma Virus (HPV) infection that is mainly transmitted through sexual intercourse. Multiple sex partners, a lack of hygiene and smoking are some factors linked to the spread of cervical cancers.
The possibility of developing cancer can be as high as 20%, says the report. Despite this, most cancer patients have to travel outside the northeast for treatment and care due to an inadequate number of cancer facilities.
For example, nearly 4% of the cancer cases detected in Mumbai’s Tata Memorial Hospital (TMH) — Asia’s largest — are in patients from the northeast. “A good proportion of people from the north east visit TMH every year for diagnosis and treatment,” says Dr. B. Ganesh, Professor and Head, Department of Biostatistics, Epidemiology and Cancer Registry, TMH. “In 2016, 1,254 out of the total 32,913 cancer cases detected in the hospital were of northeast patients. In 2015, 1,147 out of the 30,107 cancer cases were from this region.” he added.
There are only about eight centres that offer various types of cancer care such as surgery, chemotherapy and radiation therapy in Guwahati, Dibrugarh, Silchar [all in Assam], Imphal [Manipur], Agartala [Tripura] and Shillong [Meghalaya].
“The number of facilities is very small due to which a patient is forced to travel far for treatment,” says Dr. R. Ravi Kannan, Director of the Cachar Cancer Hospital and Research Centre. “Cancer cannot be treated from afar as therapy is a prolonged one. For chemotherapy and radiation therapy, a patient may need to get to a hospital every week,” he says, adding that travelling in the region is not easy due to the difficult terrain. “This results in a low compliance of treatment. Starting treatment late, skipping follow-ups and investigations are very common.”