Cancer is a significant health concern worldwide, and its incidence and patterns can vary across different regions. In Northeast India, a distinctive cancer landscape emerges, presenting unique challenges and opportunities for healthcare professionals and policymakers. This article delves into the key insights and findings regarding cancer incidence, prevalence, and treatment infrastructure in the Northeast region, highlighting the need for specialized care and improved resources.
High Cancer Prevalence and Gender Disparities:
The highest age-adjusted cancer incidence rate in males (269.4 per 100,000) has been recorded in the Aizawl district in Mizoram, among females (219.8 per 100,000) in Papumpare district, Arunachal Pradesh, which happens to be the highest in the region and the country.
Across the North East Region (NER), the prevalence of cancer shows notable variations between genders. Among males, oesophageal cancer tops the list at 13.6%, followed by lung cancer (10.9%) and stomach cancer (8.7%). Conversely, breast cancer leads among females at 14.5%, trailed by cervix uteri (12.2%) and gall bladder (7.1%) cancers. These statistics underscore the importance of gender-specific awareness campaigns and targeted screening programs to address the prevalent cancer types effectively.
Lifetime Cancer Risk and Regional Disparities: The probability of developing any type of cancer over a lifetime varies significantly across different regions within the NER. Kamrup Urban exhibits the highest lifetime cancer risk, affecting 1 in every 4 males and 1 in every 6 females. Mizoram State follows closely, with a risk of 1 in every 5 males and 1 in every 5 females, while Meghalaya demonstrates a risk of 1 in every 5 males and 1 in every 9 females. These numbers emphasize the urgent need for comprehensive cancer prevention strategies, including lifestyle modifications, regular screenings, and early detection.
Tobacco Usage and Cancer: Alarming statistics indicate that nearly half (49.3%) of male cancers and approximately one-fourth (22.8%) of female cancers in the NER are linked to tobacco use. The correlation between tobacco consumption and cancer underscores the significance of robust anti-tobacco campaigns and stringent tobacco control policies to curb cancer prevalence in the region.
Age at Diagnosis and Regional Comparisons:
The median age at cancer diagnosis in the NER is found to be lower compared to the rest of India. This observation suggests that cancer impacts individuals at a relatively younger age in the region, necessitating enhanced early detection initiatives and age-appropriate screening protocols. Additionally, it emphasizes the need for age-specific cancer research and tailored treatment approaches to address the unique challenges faced by younger patients.
Challenges in Healthcare Infrastructure:
The NER faces significant challenges in terms of healthcare infrastructure and specialized treatment facilities. Human resource availability is limited, leading to low 5-year survival rates for breast, cervix, and head and neck cancers compared to the rest of India. Consequently, a substantial number of cancer patients from the NER are compelled to travel outside the region to access quality treatment and care. Addressing these challenges requires investment in infrastructure development, strengthening healthcare workforce, and ensuring access to affordable and comprehensive cancer care facilities within the NER.
Cancer incidence patterns in the NER differ from the rest of India, with notable similarities to the Southeast Asian region. Lung, mouth, esophagus, stomach, and nasopharynx cancers are the most common among males, with lung and oral/mouth cancers prevailing in the Indian subcontinent. However, the NER stands out with a higher incidence of esophageal, stomach, and nasopharynx cancers. These distinct patterns necessitate targeted research, region-specific prevention strategies, and specialized treatment approaches tailored to the NER population.
Some state specific peculiarities which may be related to difference in cancer statistics –
- Among the 8 NE states, current tobacco use was highest in Tripura at 64.5% and lowest in Sikkim at 17.9%. Men (59%) and Women (26.3%) from Arunachal Pradesh who were over 15 years‟ of age, consumed higher proportions of alcohol than in other NE states.
- 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. Less than 50% of the households in Arunachal Pradesh, Assam, Meghalaya, Nagaland and Tripura were using clean fuel for cooking.
- Meghalaya had the most households covered with a health insurance scheme or financing scheme (63.5%).
Now let us discuss what factors can increase the risk of cancer. It is not an exhaustive list but enough to give you a basic idea. Also remember family history is a very strong and important risk factor.
| Risk Factor | Explanation |
|---|---|
| Age | The risk of developing cancer increases with age. |
| Alcohol | Excessive alcohol consumption can increase the risk of various types of cancer. |
| Cancer-Causing Substances | Exposure to substances like asbestos or certain chemicals can lead to cancer. |
| Chronic Inflammation | Persistent inflammation can contribute to the development of certain cancers. |
| Diet | Poor dietary choices, such as a high intake of processed foods, can raise cancer risk. |
| Hormones | Imbalances or prolonged exposure to certain hormones may increase cancer risk. (eg- Estrogen therapy for menopause) |
| Immunosuppression | Weakened immune system can make individuals more susceptible to cancer. (eg- Kaposi sarcoma) |
| Infectious Agents | Certain infections, like HPV or Hepatitis B and C, are linked to specific cancers. |
| Obesity | Being overweight or obese is associated with an increased risk of various cancers. |
| Radiation | Exposure to ionizing radiation, such as from X-rays or radiation therapy, can raise cancer risk. |
| Sunlight | Overexposure to UV radiation from the sun or tanning beds can increase skin cancer risk. |
| Tobacco | Smoking tobacco or exposure to secondhand smoke is a significant cause of cancer. |
Screening of cancer
Cancer screening involves testing individuals who do not show symptoms to detect cancer at an early stage when treatment is most effective. It plays a vital role in reducing cancer-related deaths. In India, despite the availability of screening programs, awareness and participation remain low due to limited public knowledge and outreach efforts. Increasing awareness about the importance of screening can help save lives through early detection and intervention. Below is a table which covers the age at screening for some cancers for general population.
| Cancer Type | Recommended Age for Screening |
|---|---|
| Breast | 40-74 years (mammogram) |
| Cervical | 21-65 years (Pap smear) |
| Colorectal | 45-75 years (colonoscopy) |
| Lung | 55-80 years (low-dose CT scan) |
| Prostate | 50-70 years (PSA blood test) |
We commend the National Cancer Registry of India (NCRI) by Indian Council Of Medical Research for its pivotal role in collecting and analyzing cancer data and for conducting the research in this domain to further our understanding on the same.
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