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Resource centre on India's rural distress
 
 

Cancer risk highest in N-E by GS Mudur

The risk of dying from cancer is highest in the Northeast and the lowest in Bihar, Jharkhand and Orissa, according to a new study described as the first to provide direct nationally-representative estimates of cancer deaths across the country.

The study by researchers at the Centre for Global Health Research at the University of Toronto, Canada, and Indian institutions has shown large variations in cancer risk across the states, but suggests that the risk of dying from cancer declines with education.

Their analysis shows that a 30-year-old man in Northeast India had the highest chance (11 per cent) of dying from cancer before the age of 70 years in contrast to the risk of less than 3 per cent for men in Bihar, Jharkhand and Orissa.

The new findings were published today in the journal, Lancet.

“This is a big puzzle — tobacco may explain part of this pattern, but we really do not understand why the Northeast has a cancer mortality nearly four times higher than the rates in the neighbouring states of Bihar, Jharkhand, or Orissa,” said Prabhat Jha, director of the Centre for Global Health Research. Cancer epidemiologists say the study is significant because it is the first to provide direct estimates of cancer deaths in rural and urban areas. The three most common causes of cancer deaths in men are oral, stomach and lung cancer. In women, the most common forms are cervical, stomach and breast cancer, Jha said.

All previous national data on cancer mortality is based on 24 registries run by the Indian Council of Medical Research, but only two of these are in rural areas.

The findings are based on what has been dubbed the Million-Death-Study, an effort to document the causes of child and adult deaths and their risk factors in India through a process of “verbal autopsies” — individual narratives obtained from household members of the circumstances of deaths. The study has estimated that in the Northeast, 138 people among 100,000 adults between the ages of 30 and 69 would die of cancer, in contrast to 68 in Bihar, 63 in Orissa, and 53 in Jharkhand.

The figure for Bengal was 110 per 100,000 population in that age group.

“These variations in cancer patterns across the states tell us there is something we need to investigate in the Northeast,” said Rajesh Dixit, professor of epidemiology at the Tata Memorial Hospital, Mumbai, a member of the research team.

“We need to understand whether diet of infections may be playing a role in the Northeast,” Dixit told The Telegraph.

“For instance, we observe high rates of stomach cancers in the Northeast, and there is high meat (especially pork) consumption there — these could be contributing factors.”

“But we also observe high rates of nasopharyngeal cancers in the Northeast. This cancer is sometimes associated with the Epstein Barr Virus — we need to investigate this infectious agent too.”

Jha said one of the unexpected findings was that cancer death rate was twice as high among the least educated than in the highest educated. Tobacco may again explain this pattern as the consumption of tobacco, particularly chewing tobacco, decreases with education. But cancer epidemiologists also point out that people with superior education are also likely to have greater access to early diagnosis and treatment which could reduce cancer mortality in this group.