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  Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 54  |  Issue : 1  |  Page : 388-391
 

Epidemiology of gynecological cancers in Kamrup Urban District cancer registry


1 Population Based Cancer Registry, Guwahati, Assam, India
2 Population Based Cancer Registry, Guwahati, Assam; Department of Pathology, Population Based Cancer Registry, Guwahati, Assam, India
3 Depatment of Gynecology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
4 Director of Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
5 Population Based Cancer Registry, Guwahati, Assam; Director of Dr. B. Borooah Cancer Institute, Guwahati, Assam, India

Date of Web Publication1-Dec-2017

Correspondence Address:
Mr. M Kalita
Population Based Cancer Registry; Director of Dr. B. Borooah Cancer Institute, Guwahati, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.219590

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 » Abstract 

BACKGROUND: Cancers of the female reproductive system - namely cancer of the cervix, corpus uteri, ovarian, vulvar, vaginal, fallopian tube cancers and choriocarcinoma are an important cause of cancer morbidity and mortality among women worldwide. It is estimated to be the third most common group of malignancies in women. The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynaecological cancers accounted for 20% of the 14.1 million estimated new cancer cases and 8.2 million cancer deaths among women in the world in 2012. The estimation of cancer burden is necessary to set up priorities for disease control. Gynaecological cancers have increased in India and are estimated to be around 182,602 by the year 2020 constituting about 30% of the total cancers among women in India. Among these, cancer of the uterine cervix followed by ovary and corpus uteri are the major contributors. METHODS AND MATERIALS: Cancer is not notifiable in India, so method of collecting information on cancer was active with voluntary participation of different sources including major hospitals, diagnostic centers, state referral board and birth and death registration centers within registry area. RESULTS: A total of 3767 (44%) cases were registered in women out of the total number of 8561 cancer cases during the period from 2010-2014. In case of gynaecological cancers a total of 661 cases of cervical, ovarian and corpus uterine cancers were registered out of the total 3767 female cancer cases (17.5%) for the year 2010-2014.The annual average crude rate in women for all sites of cancer was 117.4 per 100000 population. The corresponding AARs was 166.6. CONCLUSIONS: Women's health issues have attained high concern in recent decades. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms.


Keywords: Age-adjusted rate, crude rate, incidence, Kamrup Urban District, mortality


How to cite this article:
Barman D, Sharma J D, Barmon D, Kataki A C, Sharma A, Kalita M. Epidemiology of gynecological cancers in Kamrup Urban District cancer registry. Indian J Cancer 2017;54:388-91

How to cite this URL:
Barman D, Sharma J D, Barmon D, Kataki A C, Sharma A, Kalita M. Epidemiology of gynecological cancers in Kamrup Urban District cancer registry. Indian J Cancer [serial online] 2017 [cited 2020 Apr 5];54:388-91. Available from: http://www.indianjcancer.com/text.asp?2017/54/1/388/219590



 » Introduction Top


Health issues in women are of great importance in a society and have attained high concern as they form the sheet anchor for the upkeep and integrity of the family and society. With limited access to education or employment, high illiteracy rates and increasing poverty levels health improvements for women are quite difficult in developing countries including India.

The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynecological cancers accounted for 20% of the 14.1 million estimated new cancer cases and 8.2 million cancer deaths among women in the world in 2012. The estimation of cancer burden is necessary to set up priorities for disease control.[1]

Cancers of the female reproductive system-namely cancer of the cervix, corpus uteri, ovarian, vulvar, vaginal,  Fallopian tube More Details cancers, and choriocarcinoma are an important cause of cancer morbidity and mortality among women worldwide.[2]

Gynecological cancers have increased in India and are estimated to be around 182,602 by the year 2020 constituting about 30% of the total cancers among women in India.[3] Among these, cancer of the uterine cervix followed by ovary and corpus uteri are the major contributors.

The first step in controlling the cancer burden in each population is to know their status in the population and collect information about the incidence. Several cancer incidence data sources have been used to measure cancer burden across the world. The statistics presented are from Population-Based Cancer Registry (PBCR), Guwahati under the network of National Cancer Registry Programme (NCRP), Indian Council of Medical Research (ICMR).

The ICMR launched the NCRP in 1982 to record the burden of cancer in India. In 2001, WHO-sponsored ICMR project called “Development of an  Atlas More Details of Cancer in India” was initiated.[4] The relatively high frequency of microscopically diagnosed cancer cases observed in this project prompted the ICMR to start a PBCR in the Kamrup Urban District (KUD) of the Northeastern region of India from 2003. It was established in the Department of Pathology of Dr. B. Borooah Cancer Institute (BBCI), Guwahati, in 2003 to estimate the incidence of cancer and pattern in KUD of Assam.

Objective and aim

Our aim is to highlight the incidence and pattern of gynecological cancers with respect to all other sites of cancer in this part of the country. We report the pattern and incidence of cancers of the reproductive system in resident population of KUD for the year (2010–2014).


 » Materials and Methods Top


PBCR Guwahati covers KUD with a population (annual average) of 1,179,405 of which 608,844 are males and 570,561 are females for the year 2011. KUD covers an area of 267.1 km 2.[5]

Cancer is not notifiable in India, so method of collecting information on cancer is active with voluntary participation of various sources of registration within registry area. Direct interview with patients/relatives is possible for all the patients at BBCI, a regional cancer center which is the main source of registration. In other centers, direct interview for 40%–45% of cases is possible. For rest of the cases, information are retrieved from case files. Coding is done as per the International classification of diseases for oncology, third edition [6] and all neoplasms with a morphological behavior of “/3” are included in the registry. Quality checks on the data are done through the specialized software PBCR Data Management 2.1 provided by the coordinating unit of NCRP, Bengaluru, India. The age-standardized or age-adjusted rate (AAR) (per 100,000 population) using the world standard population as proposed by Segi and modified by Doll et al.[7],[8]


 » Results Top


Total population at risk in females for 2010–2014 was estimated as 3,682,175, and average annual population was 736,435. The annual average crude rate in women for all sites of cancer was 117.4/100,000 populations, and the corresponding AAR was 166.6.

Epidemiology of female cancer in KUD for the year 2010–2014 shows that out of the total number of 8561 cancer cases, 3767 were females (44%). In case of gynecological cancers, a total of 661 cases of cervical, ovarian, and corpus uterine cancers were registered which accounts 17.5% of all female cancer cases.

[Figure 1] shows the age-specific rates of cervical, ovarian, and uterine cancers (2010–2014). It is seen that with age the rates has increased in cervical cancers. It reaches peak at the age group 60–64 years. For ovarian and corpus uterine tumors also, there is a rise in rate with age.
Figure 1: Age-specific rates of cervical, ovarian, and uterine cancer in Kamrup Urban District

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[Figure 2] and [Table 1] represents the AAR of cancers of the cervix, ovary, and corpus uteri in the Northeastern registries in India. 2010–2014 data of KUD has been compared with 2012–2014 data of all other Northeastern registries. In case of cervical cancer, Papumpare district of Arunachal Pradesh has the highest AAR followed by Aizwal district. KUD is in the fourth position after Mizoram. In case of ovarian cancers, KUD records the second highest AAR after Papumpare district. KUD has highest AAR in cancer of the corpus uteri among the other Northeastern PBCRs.
Figure 2: Age-adjusted rate of cancer of the cervix, ovary, and corpus uteri in Northeastern India

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Table 1: The relative proportion (%) and age-standardized incidence rates of three reproductive sites in women in the Kamrup Urban District in the year 2010-2014

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 » Discussion Top


[Figure 3] shows that in cancer of the cervix, Papumpare district (AAR 30.2/100,000 women) has the highest incidence rate followed by Aizawl district and Mizoram state. KUD records an AAR of 15.0. [Figure 4] shows that in cancers of the ovary, Papumpare district (AAR 15.2) has the highest AAR followed by New Delhi (AAR 10.0) and KUD records the third highest incidence rate (9.2). In [Figure 5], Chennai (6.0), New Delhi (5.5), and Thiruvananthapuram district (5.1) occupies the top three places among all the PBCRs in cancer of the corpus uteri, whereas KUD (3.9) has highest AAR among the other Northeastern PBCRs.
Figure 3: Comparison of age-adjusted incidence rates - cervix uteri (ICD-10:C53)

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Figure 4: Comparison of age-adjusted incidence rates - ovary (ICD-10:C56)

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Figure 5: Comparison of age-adjusted incidence rates - corpus uteri (ICD-10:C54)

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Several lifestyle factors affect a woman's risk of gynecological cancer and – potentially – can be modified to reduce risk.[9] Age is an important factor for these group of cancers, for example, ovarian cancer is not common in younger women (<40 years) however, risk increases with age.[10] Socioeconomic factors such as low literacy amongst females, cultural beliefs, and traditions in different ethnic groups, are some of the factors resulting in a delay in diagnosis and treatment of cancers in female patients.[11]

More than 70% of the cervical cancer cases occurred in developing countries.[12] Risk factors include multiple sexual partners, poor sexual hygiene, repeated childbirth, etc. Infection with human papilloma virus is now considered a prerequisite for the development of cervical cancer.[13] Improvement in the living standard of women results in a reduction in the incidence of cervical cancer.[14] Regular cervical cytology examination ( Pap smear More Details) by all women can prevent the occurrence of this cancer.[15] Improvement of female education can contribute to increase the proportion of early stage diagnosis.[16] In case of ovarian cancers several factors, including genetic, reproductive, hormonal and behavioral factors have been suggested to increase the risk. Genetic factors perhaps have the strongest and most consistent association with increased risk for ovarian cancer.[17] Estrogen intake increases the risk of endometrial cancer. Women with early onset of menarche, late onset of menopause and childless women are at a higher risk.[18] Breast cancer also increases the risk of developing cancer of the uterine corpus. Physical activity, taking oral contraceptives, a soy-rich diet reduce the risk. The prognosis for cervical cancer and cancer of the corpus uteri is good as increasing numbers of tumors are diagnosed at an early stage, while ovarian cancer has a poor prognosis. The rising trend is due to the increase in the elderly women population and improved life expectancy. Efforts should be made to detect at an early stage by creating awareness on risk factors and symptoms.

Based on these facts, several activities were organized in KUD for improving access to early diagnosis of cancer through screening. Several health workers are sensitized for mobilizing population at risk for the screening program.


 » Conclusion Top


Health is an important factor contributing to human well-being. Women's health issues have attained high concern and commitment in recent decades. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms. Study on the trends of gynecological cancers is essential to plan and evaluate cancer control programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr. [Last accessed on 2016 Sep 24].  Back to cited text no. 1
    
2.
Weiderpass E, Labrèche F. Malignant tumors of the female reproductive system. Saf Health Work 2012;3:166-80.  Back to cited text no. 2
    
3.
Takiar R, Nadayil D, Nandakumar A. Projections of number of cancer cases in India (2010-2020) by cancer groups. Asian Pac J Cancer Prev 2010;11:1045-9.  Back to cited text no. 3
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4.
Shamra JD, Barman D, Sharma MK, Sharma A, Kalita M, Kataki AC, et al. Burden of head and neck cancers in Kamrup urban district cancer registry of Assam, India: A retrospective study. Int J Res Med Sci 2014;2:1382-7.  Back to cited text no. 4
    
5.
Registrar General, India. Population Enumeration data; 2011. Available from: http://www.censusindia.gov.in. [Last accessed on 2016 Oct 11].  Back to cited text no. 5
    
6.
Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, editors. International Classification of Diseases for Oncology. (ICD-O-3). 3rd ed. Geneva: WHO; 2000.  Back to cited text no. 6
    
7.
Segi M. Cancer Mortality for Selected Sites in 24 Countries (1950-1957). Sendai, Japan: Department of Public Health, Tohoku University of Medicine; 1960.  Back to cited text no. 7
    
8.
Doll R, Payne P, Waterhouse JA. Cancer Incidence in Five Continents. Vol. I. Geneva: Union Internationale Contre le Cancer; 1966.  Back to cited text no. 8
    
9.
Rieck G, Fiander A. The effect of lifestyle factors on gynaecological cancer. Best Pract Res Clin Obstet Gynaecol 2006;20:227-51.  Back to cited text no. 9
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10.
Thigpen T, Brady MF, Omura GA, Creasman WT, McGuire WP, Hoskins WJ, et al. Age as a prognostic factor in ovarian carcinoma. The Gynecologic Oncology Group experience. Cancer 1993;71 2 Suppl: 606-14.  Back to cited text no. 10
    
11.
Kurkure AP, Yeole BB. Social inequalities in cancer with special reference to South Asian countries. Asian Pac J Cancer Prev 2006;7:36-40.  Back to cited text no. 11
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12.
Stewart B, Wild CP. World Cancer Report 2014. World; 01 June, 2016.  Back to cited text no. 12
    
13.
Sonnex C. A General Practitioner's Guide to Genitourinary Medicine and Sexual Health. CUP Archive; 1996.  Back to cited text no. 13
    
14.
Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health 2015;7:405-14.  Back to cited text no. 14
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15.
Safaeian M, Solomon D, Castle PE. Cervical cancer prevention – Cervical screening: Science in evolution. Obstet Gynecol Clin North Am 2007;34:739-60, ix.  Back to cited text no. 15
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16.
Krishnatreya M, Kataki AC, Sharma JD, Nandy P, Talukdar A, Gogoi G, et al. Descriptive epidemiology of common female cancers in the North East India – A hospital based study. Asian Pac J Cancer Prev 2014;15:10735-8.  Back to cited text no. 16
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17.
Henderson BE, Ross RK, Pike MC, Casagrande JT. Endogenous hormones as a major factor in human cancer. Cancer Res 1982;42:3232-9.  Back to cited text no. 17
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18.
Persson I, Adami HO, Bergkvist L, Lindgren A, Pettersson B, Hoover R, et al. Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: Results of a prospective study. BMJ 1989;298:147-51.  Back to cited text no. 18
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]

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