|Year : 2016 | Volume
| Issue : 4 | Page : 600-606
Cancer statistics in Kamrup urban district: Incidence and mortality in 2007–2011
Jagannath Dev Sharma1, Amal Chandra Kataki2, Debanjana Barman3, Arpita Sharma4, Manoj Kalita5
1 Prof. and Head, Department of Pathology, Dr. B Borooah Cancer Institute, Guwahati and Principal Investigator of Population Based Cancer Registry in Guwahati and Hospital Based Cancer Registry (ICMR-.NCRP-.NCDIR), Guwahati, Assam, India
2 Director, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
3 Medical Research Officer, Population Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
4 Computer Programmer, Population Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
5 Statistician, Population Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam, India
|Date of Web Publication||21-Apr-2017|
Statistician, Population Based Cancer Registry, Dr. B Borooah Cancer Institute, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
Purpose: The aim of this study was to report cancer statistics in Kamrup Urban District, including incidence and, mortality. Introduction: In the last five year PBCR-Guwahati witnessed a remarkable growth in cancer incidence cases. The number of new cases of all cancer was increased from 155.3 to 188.5 and 102.7 to 165.3 per 100,000 men and women respectively from the year 2007 to 2011 in KUD. The data from KUD also have shown that for some of the specific types of cancer are highest or some of the highest incidence in rates in the world; particularly cancers of upper aero-digestive tract consist of anatomical sites such as oral cavity, hypopharynx, larynx gallbladder, stomach, lung, prostate and oesophageal cancer. Materials and Methods: Age-standardized rates (ASR) (per 100,000 person-years) for incidence, mortality were calculated using the World Standard Population as proposed by Segi and modified by Doll et al. Descriptive statistics were presented by tables and figures. Results: A total of 6623 number of cases (male = 3809, female = 2814) were diagnosed with cancer in the last five years (2007-2011) period of time. The overall age standardized cancer incidence rate is almost 21% higher in men than in women. The pooled ASR for the five year period is 175.2 and 144.7 per 100,000 men and women. Conclusion: Overall cancer incidence and mortality rates have increased since 2007.
Keywords: Age-standardized rate, cancer, crude rate, incidence, mortality
|How to cite this article:|
Sharma JD, Kataki AC, Barman D, Sharma A, Kalita M. Cancer statistics in Kamrup urban district: Incidence and mortality in 2007–2011. Indian J Cancer 2016;53:600-6
|How to cite this URL:|
Sharma JD, Kataki AC, Barman D, Sharma A, Kalita M. Cancer statistics in Kamrup urban district: Incidence and mortality in 2007–2011. Indian J Cancer [serial online] 2016 [cited 2021 Jul 28];53:600-6. Available from: https://www.indianjcancer.com/text.asp?2016/53/4/600/204764
| » Introduction|| |
Cancer is one of the leading causes of morbidity and mortality worldwide, with an estimated 14.1 million new cases and 8.2 million deaths annually (GLOBOCAN, 2012) and more than 20 million new cases of cancer are predicted worldwide in 2025, with four-fifths of the burden falling on low- and middle-income countries. The burden of cancer cases for India in the year 2020 is calculated to be 1,148,757 (male = 534,353; female = 614,404) compared to 979,786 in 2010.
On the basis of the report of “Development of Atlas of Cancer in India” 2001 project, a Population Based Cancer Registry (PBCR) was set up in the Department of Pathology at Dr. B. Borooah Cancer Institute (BBCI), Guwahati, in 2003 to generate authentic and reliable data on cancer incidence and mortality pattern of Kamrup urban district (KUD) of Kamrup district. PBCR-Guwahati covers an area of 267.1 km 2 and a total population of 1,179,405, of which 608,844 were male and 570,561 were female (Census 2011, C-14 data). The combined 5-year 2007–2011 estimated total population  calculated as 5,971,776, with 3,169,166 males and 2,802,610 females, with an average annual population of 1,154,355 which is shown in population pyramid [Figure 1]. The inhabitants of KUD have the highest incidence, death rate, and shortest survival for most of the cancers in India.
|Figure 1: Population pyramid showing 5-year age distribution for 2007–2011|
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In the last 5-year PBCR, Guwahati witnessed a remarkable growth in cancer incidence cases. The number of new cases of all cancers was increased from 155.3 to 188.5 and 102.7 to 165.3 per 100,000 men and women, respectively, from 2007 to 2011 in KUD. The data from KUD also have shown that for some of the specific types of cancer has highest incidence rates in the world; particularly cancers of upper aerodigestive tract consist of anatomical sites such as oral cavity, hypopharynx, larynx gallbladder, stomach, lung, prostate, and esophageal cancer.
| » Materials and Methods|| |
Data regarding incidence, probabilities for developing cancer, and mortality were obtained from the National Cancer Registry Program of the Indian Council of Medical Research for 2007–2011 calendar year.
Data collection procedures
Cancer registries collect information from three main sources: hospitals, laboratory services, and death certificates. Computerized hospital information systems or manual indexes of hospital discharges are the primary sources of data on patients and their diagnoses. Private hospitals and clinics in the area covered by the registry should be included among the information sources as should hospices and palliative care services. The second key source of information is pathology laboratories, which provide the definitive histological diagnosis of a tumor. The third source is death certificate. These documents are important because they enable the identification of cancer cases that may have been missed by the other two sources and make it possible to investigate the survival of cancer patients.
In India, collection of data on cancer incidence and mortality is an active one; since here in India, cancer is not a notifiable disease. The primary source of data collection for our registry is BBCI, a regional cancer center in Guwahati; 51.4% of incident cancer cases were collected from this center alone for the period of 2007–2011. Other than BBCI, data were collected from 40 other hospitals and 31 diagnostic centers, along with a pain and palliative care center and a state referral board.
Age-standardized rates (ASRs) (per 100,000 person-years) for incidence and mortality were calculated using the World standard population as proposed by Segi and modified by Doll et al. Survival was measured for some leading cancer sites in months and estimated by means of the Kaplan–Meier method.
Cancer is a disease of older people; incidence rates increase with age for most cancers. The current distribution of new cancer cases by broad age group for the year 2007–2011 is shown in [Figure 2]. In KUD, only 4.52% of diagnosed cancer cases were of the age group of 0–29 years, while 27.83% were of the age group of 30–49 years and 67.65% were of the age group of 50 years and over. Carcinoma of lip and prostate is found to be rare among young individuals accounting a total of 90.0% and 96.5% cases in the fifty and above age group. Carcinoma of lung, small intestine, kidney, bladder, and multiple myeloma accounts for >80% in fifty and above age group. In KUD, a total of 54.6% of female breast cancer occurs in the 30–49 age groups.
Prostate cancer is very uncommon in men younger than 45 but becomes more common with advancing age. About 75.3% of all prostate cancers are diagnosed in men over the age of 65 years, and a total of 96.5% of this cancer occurs in men 50 years of age and older. Testicular cancer is largely a disease of young and middle-aged men; however, about 13.6% of cases occur in children and teens (0–14 age group) and 4.5% of cases occur in men over the age of 65 years, while 72.7% of this cancer occurs in 15–49 age group. About 66.7% of eye cancers diagnosed in KUD were children aged 0–14 years; retinoblastoma is a major contributor. Hodgkin's lymphoma can be diagnosed at any age but is most common in early adulthood (66.7% of patients are diagnosed between ages of 15 and 49 years). About 75.0% of lymphoid leukemia cases were seen in below 50 years of age group whereas 41.7% cases alone were between the age group of 0 and 14.
| » Results|| |
Cancer cases and population at risk, 2007–2011
A total of 6623 cancer cases were diagnosed in KUD during the period of 5 years from January 1, 2007, to December 31, 2011, of which 3809 were male cases and 2814 were female cases [Table 1]. The male: female ratio is 1.35:1.00.
|Table 1: Population at risk and total number of malignant cancer cases, 2007-2011|
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Age-specific incidence rates of all cancers together by sex, 2007–2011/100,000
Age-specific incidence rate per 100,000 populations for all cancer sites by sex for the year 2007–2011 is presented in [Figure 3]. Cancer incidence rate was found to increase with age. The curves for either sex are quite distinct.
Overall and leading sites of cancer
Incidence and mortality rates for all cancers
The number of new cases of all cancers was increased from 155.3 to 188.5 and 102.7 to 165.3 per 100,000 men and women, respectively, from the year 2007 to 2011 in KUD. A total of 6623 cases (male = 3809, female = 2814) were diagnosed with cancer in the last 5 years (2007–2011), and the pooled ASR for the 5-year period is 175.2 and 144.7 per 100,000 men and women, respectively [Figure 4].
A total of 1570 deaths due to cancer (male = 1058, female = 512) have occurred in KUD for 2007–2011 period. The number of mortality rates of all cancer was also increased from 35.3 to 57.0 and 19.1 to 31.4 per 100,000 men and women, respectively, from the year 2007 to 2011 in KUD. The pooled ASR of mortality for the 5-year period is 51.4 and 28.5 per 100,000 men and women, respectively. A detailed description of incidence and mortality rates per year from 2007 to 2011 is shown in [Table 2].
Leading sites of Kamrup urban district
The leading sites of cancer for each gender were decided on the basis of proportion relative to all sites of cancer or, in other words, based on crude incidence rates. [Table 3] and [Table 4] show ten leading sites of cancer incidence for both males and females in KUD.
|Table 3: Ten leading sites of cancer (incidence) - number of cases, relative proportion (%), crude rate, age-standardized rate, and truncated rate - males (2007-2011)|
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|Table 4: Ten leading sites of cancer (incidence) - number of cases, relative proportion (%), crude rate, age-standardized rate, and truncated rate - females (2007-2011)|
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In male, esophagus was the leading site of cancer with an ASR of 26.9/100,000 contributing about 15.2% of the total cases followed by cancer of hypopharynx (ASR: 15.1, 8.9%,), lung (ASR: 13.8, 7.0%), stomach (ASR: 12.7, 6.9%,), tongue (ASR: 9.0, 5.5%,), and mouth (ASR: 7.7, 4.4%).
In female, breast cancer is the leading site with ASR 20.6/100,000 females with 16.8% of total cases followed by esophagus (ASR: 17.5, 10.7%), cervix uteri (ASR: 13.5, 9.6%), gallbladder (ASR: 12.6, 8.2%), ovary (ASR: 9.8, 7.8%), and stomach (ASR: 6.7, 4.5%). Most of the leading sites of KUD in both males and females are tobacco-related cancers (TRCs).
Sites of cancer associated with the use of tobacco
In planning tobacco control activity, the rates and proportions of TRCs are extremely important. In KUD, the relative proportion of cancers associated with the use of tobacco for male and female is 51.3% and 25.98% when compared to all sites. [Table 5] provides the number and relative proportion of sites of cancer associated with the use of tobacco as a whole relative to all sites of cancer in KUD as defined by IARC-1987 definition. Esophageal cancer alone contributes 15.23% in males to all cancer cases, followed by hypopharynx cancer 8.9% of cases. In female, the highest contributor is also esophageal cancer contributing a total of 10.73% to all cancer cases, followed by mouth cancer 4.05% and lung cancer with 4.02% of cases.
|Table 5: Proportion (%) of specific tobacco-related cancer sites relative to all sites of cancer|
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[Table 6] provides the number and relative proportion of sites of cancer associated with the use of tobacco as a whole relative to all TRC sites. Esophagus cancer was the leading contributor in both males and females to all TRC-related cancers contributing a total of 29.68% in males and 41.31% in females, respectively, followed by lung 13.72% and 15.46%, respectively.
|Table 6: Proportion (%) of specific tobacco-related cancer sites relative to all tobacco-related cancers|
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From [Table 6], we can illustrate that carcinoma of lip, mouth, esophagus, and lung was high in females compared to males, while it is also observed that carcinoma of tongue, oropharynx, hypopharynx, pharynx, larynx, and bladder is high in males compared to females. This comparison showed that all the men are more at risk of pharyngeal carcinoma compared to female; this difference may be associated with the form of tobacco use.
Part of data collection of the PBCRs involves visits to the municipal corporation units to collect information on reported cancer deaths. The information on deaths so collected is compiled and matched with incident/morbidity data of all the days, months, and years before the death of the individual. These contribute the matched deaths for the particular year. The unmatched deaths are included with that particular year's incident/morbidity data and constitute the category “Death Certificate Only.”
Mortality statistics are used to calculate the mortality-to-incidence (M:I) ratio for different cancer sites as a measure of completeness. The M:I ratio is an important indicator that is widely used – for example, in CI5 – to identify possible incompleteness. It is a comparison of the number of deaths, obtained from a source independent of the registry (usually, the vital statistics system), and the number of new cases of a specific cancer registered in the same time period.
Leading sites of Kamrup urban district (mortality)
The leading sites of cancer for each gender were decided on the basis of proportion relative to all sites of cancer or, in other words, based on crude incidence rates. [Table 7] and [Table 8] show ten leading sites of cancer mortality for both males and females in KUD.
Cancer mortality was the leading cause of death among the residents of KUD, followed closely by heart disease. In male, esophagus is the leading cause of cancer death contributing about 18.1% to the total cancer death, followed by death due to lung cancer (10.8%,), stomach (7.9%), larynx (5.4%), and liver (5.3%,). In female, gallbladder cancer is the leading cause of death with a total of 12.9% death to all cancer death, followed by esophagus (11.3%), ovary (9.2%), breast (9.0%), and cervix uteri (7.0%). The mortality incidence percentage ratios for male and female were observed as 27.8 and 18.2, respectively, and the overall mortality incidence percentage is 23.7 [Table 9].
|Table 7: Ten leading sites of cancer (mortality) - number of cases, relative proportion (%), crude rate, age-standardized rate, and truncated rate - males (2007-2011)|
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|Table 8: Ten leading sites of cancer (mortality)- number of cases, relative proportion (%), crude rate, age-standardized rate, and truncated rate - females (2007-2011)|
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| » Discussion|| |
The present study was based on data from the population-based Guwahati cancer registry. We observed a significant increase in the incidence (ASR male = 175.4 and ASR female = 144.7) in KUD over a period of 5 years and the rates are almost 2-folds higher than the Indian national average (ASR male = 92.4 and female = 97.4) as per GLOBOCAN 2012 report. The reported rise in incidence suggests an increase in risk behavior in the population, with changes in lifestyle and dietary habits. Some of the specific types of cancers in this region are highest or some of the highest incidence in rates in the world; particularly cancers of upper aerodigestive tract consist of anatomical sites such as oral cavity, pharynx, hypopharynx, nasopharynx, larynx, esophagus, and stomach. Cancer of the esophagus is the most commonly diagnosed cancer in males in Assam, Northeastern India, and ranks second for females. Betel quid chewing with or without tobacco consumption is associated with the development of esophageal cancer in Assam. Kalakhar, a unique and locally made food item, has emerged as a significant risk factor (odds ratio [OR] =8.0, 95% confidence interval [CI] =5.1–11.5, P< 0.001) associated with esophageal cancer. The incidence of hypopharynx cancer is also increasing in males and females of Assam and Northeastern states region. In females, it is observed that KUD has the highest incidence rates in the country; this may be related to the tobacco and dietary habits of the population in this region. The genes coding for Phase II metabolic enzymes such as glutathione S-transferase T1 and M1 (GSTT1 and GSTM1) were found to be associated with lung cancer in different ethnic groups of Assam and Northeast India. Another study finds that the GSTM1 and GSTT1 null genotypes were also associated with an increased risk of breast cancer (OR = 10.80, 95% CI = 1.16–100.43) in Northeast India. In KUD, the relative proportion of cancers associated with the use of tobacco for male and female is 51.3% and 25.98% when compared to all sites. More than one-third (35%) of adults in India use tobacco in some form, and in Assam, the prevalence of tobacco use is 39%. The increasing incidence in the population is projected to continue over the next two to three decades.
| » Conclusion|| |
Overall cancer incidence and mortality rates have increased since 2007. A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and use of early detection tests.
We would like to thank Dr. A. Nandakumar and his team for providing guidance and valuable information in making this manuscript. We would also like to thank NCRP, NCDIR, Bengaluru, and ICMR, India, for financial support. We sincerely acknowledge the cooperation from all the sources of registration and oncologists of Dr. B. Borooah Cancer Institute, Guwahati. We also appreciate the hard work and sincerity of all the staff members at PBCR-HBCR, Guwahati, and are grateful to the patients and their relatives for participating voluntarily in our study.
Financial support and sponsorship
Authors sincerely acknowledge the National cancer registry Programme(NCRP), Indian Council of Medical Research (ICMR), Department of Health Research, Government of India for funding this study vide letter No. NCDIR/COU/NE/433/2009.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]
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