Pattern of Reproductive Cancers in India

Abstract

Background:
Reproductive cancers are those that affect the human organs that are involved in producing offspring. An attempt is made in the present communication to assess the magnitude and pattern of reproductive cancers, including their treatment modalities, in India. The cancer incidence data related to reproductive cancers collected by five population-based urban registries, namely Bangalore, Bhopal, Chennai, Delhi and Mumbai, for the years 2006-08 were utilized. The reproductive cancers among females constituted around 25% of the total and around 9% among males. Among females, the three major contributors were cervix (55.5%), ovary (26.1%) and corpus uteri (12.4%). Similarly among males, the three major contributors were prostate (77.6%), penis (11.6%) and testis (10.5%). For females, the AAR of reproductive cancers varied between 30.5 in the registry of Mumbai to 37.3 in the registry of Delhi. In males, it ranged between 6.5 in the registry of Bhopal to 14.7 in the registry of Delhi. For both males and females, the individual reproductive cancer sites showed increasing trends with age. The leading treatment provided was: radio-therapy in combination with chemo-therapy for cancers of cervix (48.3%) and vagina (43.9%); surgery in combination with chemo-therapy (54.9%) for ovarian cancer; and surgery in combination with radio-therapy for the cancers of the corpus uteri (39.8%). In males, the leading treatment provided was hormone-therapy for prostate cancer (39.6%), surgery for penile cancer (81.3%) and surgery in combination with chemo-therapy for cancer of the testis (57.6%).

Full text

Asian Pacic Journal of Cancer Prevention, Vol 15, 2014 599
DOI:http://dx.doi.org/10.7314/APJCP.2014.15.2.599
Pattern of Reproductive Cancers in India
Asian Pac J Cancer Prev, 15 (2), 599-603
Introduction
Cervix and Ovarian cancers are the two leading sites
of cancer among women in India. Based on the data of
13 Population Based Cancer Registries in India, Cervix
and Ovarian cancer are the second and the fourth most
common cancer in India, NCRP (2013). The cancer of
the Corpus uteri has also shown an emerging trend over
the years Takiar and Vijay (2010). Similarly, among men,
Prostate cancer has shown an emerging trend Takiar and
Vijay (2011). All these sites belong to Reproductive sites
of cancers. Reproductive cancers are those that affect the
human organs that are involved in producing offspring. In
India, while there are studies (Murthy et al., 2005, Takiar
and Srivastav 2008; Yeole, 2008; Nandakumar et al., 2009;
Takiar and Vijay, 2010; 2011) available related to one or
more sites of cancers that are associated with reproductive
cancers, hardly there is any study discussing all the sites
of cancers together related to reproductive cancers. An
attempt is therefore made in the present communication to
assess the magnitude and pattern of reproductive cancers
including their treatment modalities in India.
Materials and Methods
The cancer incidence data related to reproductive
1National Centre for Disease Informatics and Research, Bangalore, India *For correspondence: ramnath_takiar@yahoo.co.in
Abstract
Background: Reproductive cancers are those that affect the human organs that are involved in producing
offspring. An attempt is made in the present communication to assess the magnitude and pattern of reproductive
cancers, including their treatment modalities, in India. The cancer incidence data related to reproductive cancers
collected by ve population-based urban registries, namely Bangalore, Bhopal, Chennai, Delhi and Mumbai, for
the years 2006-08 were utilized. The reproductive cancers among females constituted around 25% of the total
and around 9% among males. Among females, the three major contributors were cervix (55.5%), ovary (26.1%)
and corpus uteri (12.4%). Similarly among males, the three major contributors were prostate (77.6%), penis
(11.6%) and testis (10.5%). For females, the AAR of reproductive cancers varied between 30.5 in the registry
of Mumbai to 37.3 in the registry of Delhi. In males, it ranged between 6.5 in the registry of Bhopal to 14.7 in
the registry of Delhi. For both males and females, the individual reproductive cancer sites showed increasing
trends with age. The leading treatment provided was: radio-therapy in combination with chemo-therapy for
cancers of cervix (48.3%) and vagina (43.9%); surgery in combination with chemo-therapy (54.9%) for ovarian
cancer; and surgery in combination with radio-therapy for the cancers of the corpus uteri (39.8%). In males,
the leading treatment provided was hormone-therapy for prostate cancer (39.6%), surgery for penile cancer
(81.3%) and surgery in combination with chemo-therapy for cancer of the testis (57.6%)
Keywords: Reproductive cancers - cervix - ovary - corpus uteri - prostate - penis - testis
RESEARCH ARTICLE
Pattern of Reproductive Cancers in India
Ramnath Takiar, Sathish Kumar
cancers collected by five urban registries namely
Bangalore, Bhopal, Chennai, Delhi and Mumbai for the
years 2006-08 were utilized. In women, the sites which
are included under reproductive cancers with respective
ICD10 codes are: Vulva (C51), Vagina (C52), Cervical
Uteri (C53), Corpus Uteri (C54), Uterus Unspecied
(C55), Ovary etc. (C56), Other Female genital (C57) and
Cancers of Placenta (C58). In men, it include Penis (C60),
Prostate (C61), Testis (C62) and Other Male Genital (C63)
NCRP 2013.
Percentage contribution of reproductive sites
All cancer cases of individual reproductive sites
when added will give the total number of reproductive
cancers. When this number is expressed as percentage
of all cancers, provides an idea about their percentage
contribution to all cancers. In order to decide the major
sites of reproductive cancers, the number of cancer
cases by individual reproductive site is expressed as the
percentage of total number of reproductive cancers. If
‘n’ represents the number of reproductive cancers and
‘x’ represents the number of cases by an individual
reproductive cancer site (S) then (x/n)*100 provides the
percentage contribution of site ‘S’ to total reproductive
cancers.
To form an idea about the burden of the Reproductive

Ramnath Takiar and Sathish Kumar
Asian Pacic Journal of Cancer Prevention, Vol 15, 2014
600
cancers in India, it is necessary to study their Crude Rates.
Crude Rate (CR): The Crude Rate is obtained by the
division of number of cases by the corresponding
estimated population (midyear) for given reproductive
site, sex, area and year (period) and multiplied by 100000.
In terms of formula it is given by: CR=(New cases of cancer
for a given site and year or period/Estimated mid-population of the
same year or period)5100000
Age specic rate (ASR)
Cancer incidence is known to increase with age.
Hence, it is important to assess the Age Specic Rates. It is
obtained by the division of the total number of cancer cases
of a given site by the corresponding estimated midyear
population for given age, sex, period and multiplying by
100000.
ASR=[New cancer cases of a site in the given age group,
sex and year (period)/Estimated mid-population of the same
year (period) for given age group and sex]5100000
Age adjusted rate (AAR)
In order to make the rates comparable between
developed and developing countries, an Age Adjusted
Rate is derived using a common world standard population
proportions as weightings to various age specic rates.
The details of it can be seen in the report NCRP 2010.
The formula for derivation of AAR is given below:
AAR=∑(ai5wi)/∑wi)5100000 for all i=1,2,3,................16.
Where: ai=Age specic rate for ith age group and; wi=World
standard population for ith age group. Note that i=1 refers
to 0-4 age group; i=2 refers to 5-9 age group and so on.
Treatment modalities for Reproductive cancers:
Hospital Based Cancer Registries (HBCR) working under
the co-ordination of National Cancer Registry Programme
(NCRP) are routinely collecting information on treatments
provided to all cancer patients. Same information was
utilized to throw light on the treatment modalities carried
out for reproductive cancers in India.
Results
The ve registries reported 47054 cases of cancers
during the period 2006-08 (NCRP 2010), out of which
12044 (25.6%) cases constituted that of reproductive
cancers. In case of females, the percentage of reproductive
cancers varied from 24.3% in the registry of Mumbai to
28.1% in the registry of Bhopal. While, for males, the
percentage of reproductive cancers varied from 5.4% in
the registry of Bhopal to 9.0% in the registry of Bangalore
(Table 1).
Among reproductive cancers for females, the three
major contributors are: Cervix (55.5%), Ovary (26.1%)
and Corpus uteri (12.4%). Each of the other sites, in
general, contributed less than 3% of the total reproductive
cancer cases (Table 2).
Among reproductive cancers in males, the three major
contributors are: Prostate (77.6%), Penis (11.6%) and
Testis (10.5%). Other male genital cases contributed only
0.3% of the total reproductive cancer cases (Table 3).
For females, the CR of reproductive cancers varied
between 22.0 in the registry of Bhopal to 29.6 in the
registry of Chennai. While, in the case of AAR, it varied
between 30.5 in the registry of Mumbai to 37.3 in the
registry of Delhi. In males, the CR (AAR) ranged between
4.0 (6.5) in the registry of Bhopal to 7.6(14.7) in the
registry of Delhi (Table 4).
The Age Specic Rates of Reproductive cancer sites
for females, pooled for all selected ve urban registries,
is shown in Table 5. The cervix incidence rate starts
increasing rapidly after the age of 35 years and reaches to
Table 2. Reproductive Cancers Sites and their
Percentage Contribution to Total Reproductive
Cancers-Females
Cancer Site Bangalore Bhopal Chennai Delhi Mumbai Pooled
Cervix uteri 57.2 62.3 59.4 54.5 52.8 55.5
Ovary 21.8 26.0 24.0 28.4 27.3 26.1
Corpus uteri 14.3 9.0 9.7 12.1 13.4 12.4
Uterus unspecied 2.7 0.4 2.0 2.1 2.7 2.3
Vagina 2.1 0.5 3.2 1.2 2.2 2.0
Vulva 1.8 0.5 1.5 1.2 1.3 1.3
Placenta 0.1 1.3 0.2 0.2 0.1 0.2
Other Female genital 0.1 0.0 0.1 0.2 0.2 0.1
Reproductive cancer cases -
Total 1910 546 1996 3364 4228 12044
Table 3. Reproductive Cancers Sites and their
Percentage Contribution to Total Reproductive
Cancers-Males
Cancer Site Bangalore Bhopal Chennai Delhi Mumbai Pooled
Prostate 77.0 75.0 66.4 81.4 78.5 77.6
Penis 13.0 8.3 22.2 9.1 10.0 11.6
Testis 9.8 16.7 11.4 9.5 10.9 10.5
Other Male genital 0.2 0.0 0.0 0.1 0.6 0.3
Reproductive cases
Total 522 108 428 1182 1281 3521
Table 1. Number and Percentage of Reproductive
Cancers by Sex and Selected Urban Registries of India
Cancer Registry Females Males
Reproductive All % of all Reproductive All % of all
Cancer cases cancers cancers Cancer cases cancers cancers
Bangalore 1910 7210 26.5 522 5812 9.0
Bhopal 546 1946 28.1 108 1992 5.4
Chennai 1996 7866 25.4 428 7392 5.8
Delhi 3364 12602 26.7 1182 13708 8.6
Mumbai 4228 17430 24.3 1281 15602 8.2
Pooled 12044 47054 25.6 3521 44506 7.8
*Source: National Cancer Registry Programme (2010): Three-year Report of
Population Based Cancer Registries (2006-2008)
Table 4. Crude Rate (CR) and Age Adjusted Rate (
AAR) per 100000 Person of Reproductive cancers by
Sex and Selected Urban Registries of India
Registry Females Males
CR AAR CR AAR
Bangalore 27.9 36.3 6.9 11.0
Bhopal 22.0 31.2 4.0 6.5
Chennai 29.6 32.9 6.2 7.2
Delhi 25.4 37.3 7.6 14.7
Mumbai 25.3 30.5 6.3 10.7
Range 22.0-29.6 30.5-37.3 4.0-7.6 6.5-14.7
Mean 26.0 33.6 6.2 10.0
SD 2.89 3.03 1.35 3.30

Asian Pacic Journal of Cancer Prevention, Vol 15, 2014 601
DOI:http://dx.doi.org/10.7314/APJCP.2014.15.2.599
Pattern of Reproductive Cancers in India
it peak in the age group of 55-64 years. Similar trend was
also seen in the case of corpus uteri and ovarian cancer.
In general, the Age Specic Rate (ASR) for reproductive
cancers increased rapidly with advancement of every 10
years after the age of 25 years. It starts from 0.9 for the
age group below 25 years to 131.0 in 55+ years age group .
In males the ASR of prostate cancer increases rapidly
particularly after the age of 55 years and reaches to its peak
after the age of 65 years (Table 6). For both males and
females, the Individual reproductive cancer sites showed
the increasing trend with age.
The type of treatment provided to female cancer
patients according to their reproductive cancer sites is
shown in Table 7. The leading treatment provided was
Radio-therapy in combination with Chemo-therapy for the
cancers of Cervix (48.3%) and Vagina (43.9%); Surgery in
combination with Chemo-therapy (54.9%) for the cancer
of Ovary; Surgery in combination with Radio-therapy for
the cancers of Corpus uteri (39.8%) and Uterus unspecied
(36.7%); Surgery for the cancer of Vulva (34.1%) and
Chemo-therapy for the cancer of Placenta (85.7%).
The type of treatment provided to male cancer patients
according to their reproductive cancer sites is shown in
Table 8. The leading treatment provided was Hormone-
therapy for Prostate cancer (39.6%); Surgery for penile
cancer (81.3%); Surgery in combination with Chemo-
therapy for cancer of testis (57.6%).
Discussion
The data has shown that among females, about 25% of
the total cancers constitutes that of reproductive cancers
while among males its percentage is around 8%. In
females, the leading three sites of reproductive cancers
are Cervix, Ovary and Corpus uteri. In males, they are
Prostate, Penis and Testis. These leadings sites contributed
more than 90% of the total reproductive cancers. The data
has shown that the age specic rates in women above 55
years increases to almost 4 folds as compared to that seen
in 35-44 years age group of women. In men, above 55
years age, the rise was found to be 5 to 20 times higher
as compared to that seen in 35-44 years age group. Thus,
like any other cancer, the age specic rates of reproductive
cancers show an increasing trend.
There were an estimated 530000 cases of cervical
cancer and 275000 deaths from the disease in 2008.
Cervical cancer is generally caused by sexually acquired
infection with certain types of HPV; Schiffman M,
Solomon D (2013). Two HPV types (16 and 18), almost
cause 70% of cervical cancers and precancerous cervical
lesions WHO (2013). Sexual activity that increases the
risk for infection for cervical cancer includes: Having
multiple sexual partners or Sexual intercourse at a young
age (WHO 2013, Reproductivecancer.com). Regular
screening via Pap Smears greatly reduces the risk
for developing invasive cervical cancer by detecting
precancerous changes in cervical cells. Women who do
not receive regular Pap smears have a higher risk for
Table 5. Age Specic Rate (ASR) per 100000 person of
Reproductive Cancer sites-Females-Pooled
(2006-2008)
Site of Cancer <25 25-34 35-44 45-54 55-64 65+
Cervix Uteri 0.1 3.2 20.2 48.7 69.8 61.9
Corpus Uteri 0.0 0.4 2.4 8.8 22.6 17.6
Ovary 0.8 2.9 7.4 19.5 31.6 30.3
Other female genitals 0.0 0.4 1.2 3.9 7.5 11.7
Pooled 0.9 6.8 31.2 80.9 131.5 121.5
Table 6. Age Specic Rate (ASR) per 100000 person of
Reproductive cancer sites-Males-Pooled (2006-2008)
Site of Cancer <25 25-34 35-44 45-54 55-64 65+
Prostate 0.0 0.0 0.2 2.3 20.1 101.8
Penis 0.0 0.2 0.7 1.8 3.8 6.6
Other male genitals 0.4 1.3 0.9 0.6 0.8 1.3
Pooled 0.4 1.5 1.8 4.8 24.7 109.7
Table 7. The distribution of Treatment by Different Reproductive Cancer Sites-Females
Treatment Cervix Uteri Ovary Corpus Uteri Vagina Vulva Placenta Uterus unspecied
Radio therapy (R) 39.2 0.5 5.9 39.5 18.8 0.0 6.7
Chemo thearpy (C) 2.3 33.1 3.5 7.8 15.3 85.7 10.0
Surgery (S) 3.3 8.7 32.0 2.4 34.1 2.0 10.0
R+C 48.3 1.1 2.8 43.9 9.4 2.0 0.0
R+S 3.3 0.5 39.8 1.0 3.5 0.0 36.7
C+S 0.6 54.9 5.8 1.5 12.9 6.1 23.3
S+R+C 2.9 0.5 8.6 2.9 4.7 4.1 13.3
Other combinations 0.1 0.7 1.6 1.0 1.3 0.1 0.0
Number 5604 1464 538 205 85 49.0 30
*Based on Pooled HBCR data of Bangalore, Chennai, Mumbai, Thiruvananthapuram, Dibrugarh (2004-06)
Table 8 The Distribution of Treatment by Different
Reproductive Cancer Sites-Males
Treatment Prostate Penis Testis
Radio therapy (R) 10.2 0.9 0.0
Chemo therapy (C) 2.0 4.7 21.2
Harmone therapy (H) 39.6 0.0 0.0
Surgery (S) 8.6 81.3 12.4
R+H 20.1 0.0 0.0
R+S 1.2 4.4 4.7
H+S 3.5 0.0 0.0
S+C 0.0 7.0 57.6
S+R+C 1.8 1.6 2.9
Other combinations 13.0 0.1 1.2
Number 512 316 170
*Based on Pooled HBCR data of Bangalore, Chennai, Mumbai, Thiruvananthapuram,
Dibrugarh (2004-06)

Ramnath Takiar and Sathish Kumar
Asian Pacic Journal of Cancer Prevention, Vol 15, 2014
602
the condition (WHO 2013, Reproductivecancer.com,
Ofce of Population Affairs). The early stages of cervical
cancer may be completely symptom free. The possible
symptoms in early stages may include: Vaginal bleeding;
contact bleeding; moderate pain during sexual intercourse;
vaginal discharge. The symptoms of advanced cervical
cancer may include: loss of appetite; weight loss; fatigue;
pelvic pain; single swollen leg; heavy bleeding from the
vagina (WHO 2013, Reproductivecancer.com, Ofce of
Population Affairs).
Ovarian cancer is the fourth most common cancer
among women in India. Based on the data of Mumbai
PBCR, the AAR of death rate in ovarian cancer was 3.7
as compared to AAR of 3.9 seen in cervix cancer NCRP
(2010). For ovarian cancer, the risk factors are: Family
history of ovarian cancer; Fertility Drugs; Hormone
replacement therapy (HRT) with estrogens only (without
progesterone); Late menopause (after age 52); Never
given birth or delivering first child after the age 30
(Reproductivecancer.com, Ofce of Population Affairs).
The symptoms that are often found to be associated
with ovarian cancer are: Loss of appetite, full feeling,
Unexplained weight gain, Swelling and Pain in the lower
abdomen, Lower back pain, Abnormal vaginal bleeding
and Pain during sex (Reproductivecancer.com, Ofce of
Population Affairs, Can Teen).
For cancer of corpus uteri, the risk factors are:
Exposure to estrogen increases the risk for developing
the disease and estrogen often affects tumor growth.
The following factors increase estrogen exposure: Early
menarche (before the age 12 years), Hormone replacement
therapy (HRT) with estrogens only (without progesterone);
Late menopause (after age 52); Never given birth or
delivering rst child after the age 30 (Reproductivecancer.
com, Can Teen). The symptoms that are often found to
be associated with Abnormal uterine bleeding, abnormal
menstrual periods, Bleeding between normal periods
in premenopausal women, vaginal bleeding and/or
spotting in postmenopausal women, Lower abdominal
pain and Anemia caused by chronic loss of blood
(Reproductivecancer.com, Ofce of Population Affairs,
Can Teen).
In men, Prostate cancer constitutes about 80% of
newly diagnosed reproductive cancer cases. The risk for
developing prostate cancer rises signicantly with age.
It’s AAR increases rapidly after the age of 55 years (20.1)
and reaches to its peak (101.8). It has been found to be
an emerging cancer in India Takiar and Vijay (2011).
A family history of prostate cancer increases the risk
(Reproductivecancer.com, Ofce of Population Affairs,
Can Teen). Other possible risk factors include: Diet
high in saturated fat, Sedentary lifestyle and Smoking.
Early prostate cancer usually causes no symptoms.
However there are some symptoms and they are: frequent
urination, increased urination at night, difculty starting
and maintaining a steady stream of urine, blood in
the urine, and painful urination, problems with sexual
function(Reproductivecancer.com, Ofce of Population
Affairs, Can Teen).
The main risk factor for testicular cancer is a problem
called undescended testicle(s) and accounts for 10% of the
cases. A family history of prostate cancer increases the risk.
Other possible risk factors include: HIV infection, Cancer
of the other testicle, Body Size(Reproductivecancer.com,
Can Teen). Symptoms may include one or more of the
following: a lump in one testis or a hardening of one of
the testicles, pain and tenderness in the testicles, loss of
sexual activity, build-up of uid in the scrotum, a dull ache
in the lower abdomen or groin, an increase, or signicant
decrease, in the size of one testis, blood in semen(Ofce
of Population Affairs, Can Teen). Possible signs of penile
cancer include sores, discharge, and bleeding. The risk
factors include: Being age 60 or older. Having phimosis
(a condition in which the foreskin of the penis cannot be
pulled back over the glans), Having poor personal hygiene,
Having many sexual partners, Using tobacco products (
Ofce of Population Affairs).
For cancer patients in PBCRs, the detailed information
on treatment is not available. Therefore, the HBCR data
(2009) was utilized to throw light on treatment details.
The treatment depends on the type of cancer. Reproductive
cancers are often treated with Chemotherapy (medicine
to kill cancer cells), Hormone therapy (medicine to
block hormones that are related to cancer growth) or
Radiation. Depending on the type of cancer, one or more
treatments may be used together. Radiotherapy alone or
in combination with Chemo-therapy was the preferred
choice of treatment in the cancers of Cervix uteri and
Vagina. Surgery alone or surgery in combination with
Radio-therapy was the preferred choice of treatment
in the cancers of Corpus uteri and in cancers of Uterus
unspecied. In the case of cancers of Ovary or Placenta,
the preferred choice of treatment was essentially Chemo-
therapy or Chemo-therapy in combination with Surgery.
In case of men, for Prostate cancer, the preferred choice
of treatment was mainly Hormone therapy while it was
Surgery for Penile cancer. In case of Cancer of Testis,
Chemo-therapy or Chemo-therapy in combination with
Surgery was the main course of treatment.
Survival rates are important for prognosis, for example
whether a type of cancer has a good or bad prognosis
can be determined from its survival rate. Cervix cancer
is considered as one of the major leading sites among
females. Survival studies carried out in India (IARC,
2011) have shown that the 5 years absolute % survival for
Cervix cancer is around 42% while for Ovarian cancer it is
relatively less and is around 23%. Among males, Prostate
cancer has the least absolute % survival of 24% while
Penile cancer (43.6%) and Testicular cancer (53.0%) have
relatively higher 5 years absolute % survivals.
It is to remember that an early diagnosis leading to
an early treatment can increase the chances of survival
signicantly among the Reproductive cancer cases. The
success of early detection and cancer treatment may be
measured by improvement in survival from cancer.
References
Can Teen: Reproductive Cancers: the Australian Organisation
for Young People Living with Cancer (www.nowwhat.org.
au/info/cancer-types/reproductive-cancers)
IARC (2011). Cancer Survival in Africa, Asia, the Caribbean
and Central America; Edited by Sankaranarayanan R,

Asian Pacic Journal of Cancer Prevention, Vol 15, 2014 603
DOI:http://dx.doi.org/10.7314/APJCP.2014.15.2.599
Pattern of Reproductive Cancers in India
Swaminathan.
Murthy NS, Chaudhary K, Saxena S (2005). Trends in cervical
cancer incidence - Indian scenario. Eur J Cancer Prev, 14,
513-18.
Nandakumar A, Ramnath T, Chaturvedi M (2009). The
magnitude of cancer cervix in India. Indian J Med Res,
130, 219-21.
NCRP (2009): Consolidated Report of HBCR 2006-08, National
Cancer Registry Programme, Indian Council of Medical
Research.
NCRP (2010): Three year Report of Population Based Cancer
Registries 2006-08, National Cancer Registry Programme,
Indian Council of Medical Research.
NCRP (2013): Three year Report of Population Based Cancer
Registries 2009-11, National Cancer Registry Programme,
Indian Council of Medical Research.
Ofce of Population Affairs: Female Reproductive Cancer
Factsheets: US Department of Health and Human Services.
Office of Population Affairs: Male Reproductive Cancer
Factsheets: US Department of Health and Human Services.
Reproductivecancer.com. September is Gynecological Cancer
Awareness Month.
Schiffman M, Solomon D (2013). Cervical-Cancer Screening
with Human Papillomavirus and Cytologic Cotesting, N
Engl J Med, 369, 2324-31.
Takiar R, Srivastav A (2008). Time trend in breast and cervix
cancer of women in India- (1990-2003), Asian Pac J Cancer
Prev, 9, 777-80.
Takiar R, Vijay CR (2010). An alternative approach to study the
changes in the cancer pattern of women in India (1988-2005).
Asian Pac J Cancer Prev, 11, 1253-56
Takiar R, Vijay CR (2011). An alternative approach to study the
changes in the cancer pattern of men in India (1988-2005).
Asian Pac J Cancer Prev, 12, 875-78
WHO (2013). Human Papilloma virus (HPV) and Cervical
Cancer Fact sheet N0 380.
Yeole BB (2008). Trends in cancer incidence in female breast,
cervix uteri, corpus uteri and ovary in India. Asian Pac J
Cancer Prev, 9,119-22.
Yeole BB (2008). Trends in prostate cancer incidence in India.
Asian Pac J Cancer Prev, 9, 141-44.