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An Alternative Approach to Study the Changes in the Cancer Pattern of Men in India (1988-2005)

Authors:

Abstract

Changes in cancer pattern are often studied with regard to rank of leading sites, variation in age adjusted rates of sites over the time or with the help of time trends. However, these methods do not quantify the changes in relation to overall changes that occurred in the total cancer cases over the period of time. An alternative approach is therefore necessary, particularly to identify emerging new cancers. The cancer incidence data of various sites for men, over the periods 1988-90 and 2003-05 in India, for five urban registries namely Bangalore, Bhopal, Chennai, Delhi and Mumbai, functioning under the network of National Cancer Registry Programme (ICMR), formed the sources of data for the present analysis. Changes in incidence cases by various cancer sites for men are assessed by calculating the differences in incidence cases over the two period of time. Based on the contribution of each site to total change, the ten most leading sites are identified separately for each registry. The relative changes in the sites with time are taken to identify the most emerging new cancer cases over the period of time. The pooled cancer cases for men among five urban registries increased from 30042 cases in 1988-90 to 46946 cases in 2003-05 registering an increase of about 55.8%. The lowest percentage of increase is observed in the registry of Mumbai (25.6%) and the maximum in Bhopal (96.4%). Based on the pooled figures of five urban registries, the lung cancer contributed the maximum % change (9.7%), followed by cancer of prostate (9.2%), mouth (7.5%), tongue (5.9%) and NHL (5.9%). Based on the pooled figures and the relative changes, the emerging new cancers are prostate (140%), liver (112%) and mouth (95%). The % change by sites and the emerging new cancers varied between the registries.
Asian Pacic Journal of Cancer Prevention, Vol 12, 2011 875
An Alternative Approach to Study the Changes in the Cancer Pattern of Men in India (1988-2005)
Asian Pacic J Cancer Prev, 12, 875-878
Introduction
The registered numbers of overall cancer cases in
selected ve urban registries of India have been shown to
be rising (Takiar and Vijay, 2010) and changes for many
body sites in India have been documented (Murthy et al,
2008; NCRP 2009; Takiar and Srivastava, 2008; Yeole,
2007; 2008a; 2008b; 2008c, 2008d).
The changes in the cancer pattern are often studied with
the help of changes in the rank of leading sites, changes in
the Age Adjusted Rates of the sites over the time or with
the help of time trends. However, these methods do not
quantify the changes in relation to overall changes that
occurred in the total cancer cases over the period of time.
An alternative approach was therefore used to assess the
changes in cancer pattern of women in relation to overall
changes in time and reported (Takiar and Vijay, 2010). In
the present communication, using the same alternative
approach, an attempt is made to present the changes in
cancer pattern of men in India.
National Cancer Registry Programme, Indian Council of Medical Research, Bangalore, India *For correspondence: ramnath_takiar@
yahoo.co.in
Abstract
Background: Changes in cancer pattern are often studied with regard to rank of leading sites, variation in
age adjusted rates of sites over the time or with the help of time trends. However, these methods do not quantify
the changes in relation to overall changes that occurred in the total cancer cases over the period of time. An
alternative approach is therefore necessary, particularly to identify emerging new cancers. Methods: The cancer
incidence data of various sites for men, over the periods 1988-90 and 2003-05 in India, for ve urban registries
namely Bangalore, Bhopal, Chennai, Delhi and Mumbai, functioning under the network of National Cancer
Registry Programme (ICMR), formed the sources of data for the present analysis. Changes in incidence cases by
various cancer sites for men are assessed by calculating the differences in incidence cases over the two period of
time. Based on the contribution of each site to total change, the ten most leading sites are identied separately for
each registry. The relative changes in the sites with time are taken to identify the most emerging new cancer cases
over the period of time. Results: The pooled cancer cases for men among ve urban registries increased from
30042 cases in 1988-90 to 46946 cases in 2003-05 registering an increase of about 55.8%. The lowest percentage
of increase is observed in the registry of Mumbai (25.6%) and the maximum in Bhopal (96.4%). Based on the
pooled gures of ve urban registries, the lung cancer contributed the maximum % change (9.7%), followed
by cancer of prostate (9.2%), mouth (7.5%), tongue (5.9%) and NHL (5.9%). Based on the pooled gures and
the relative changes, the emerging new cancers are prostate (140%), liver (112%) and mouth (95%). The %
change by sites and the emerging new cancers varied between the registries.
Keywords: Cancer pattern - changes - alternative approach - emerging cancers
RESEARCH COMMUNICATION
An Alternative Approach to Study the Changes in the Cancer
Pattern of Men in India (1988-2005)
Ramnath Takiar*, CR Vijay
Materials and Methods
The cancer incidence data of various sites for men,
over the periods 1988-90 and 2003-05 in India, for ve
urban Population Based Cancer Registries (PBCRs)
namely Bangalore, Bhopal, Chennai, Delhi and Mumbai,
functioning under the network of National Cancer Registry
Programme (ICMR), formed the sources of data for the
present analysis. The incidence cases for 3 years are
mainly pooled to adjust for the possible uctuations in the
number of cases, likely to occur, from one single year to
another single year. The changes in incidence cases by
various cancer sites for men are assessed by calculating
the differences in incidence cases over the two period
of time. Based on the contribution of each site to total
change, the ten most leading sites are identied separately
for each registry. The relative changes in the sites with
time are taken to identify the most emerging new cancer
cases over the period of time. In terms of formulae
Change = (b-a);
Ramnath Takiar and CR Vijay
Asian Pacic Journal of Cancer Prevention, Vol 12, 2011
876
% Change = % C = [(b-a)/ (B-A)]* 100;
Relative Change = % RC = [(b-a)/a]*100 Where
a = No. of incidence cases for the period 1988-90 for the
site ‘X’ of cancer; b = No. of incidence cases for the period
2003-05 for the site ‘X’ of cancer; A = No. of incidence
cases for the period 1988-90 for All sites of cancer; B
= No. of incidence cases for the period 2003-05 for All
sites of cancer.
Results
The number of cancer cases covered by different
PBCRs and periods are shown in Table 1. The pooled
cancer cases for men among ve urban registries increased
from 30042 cases in 1988-90 to 46946 cases in 2003-05,
registering an increase of 16904 cases over the period of
time. The change in the cancer cases ranged from 803
cases in PBCR of Bhopal to 8341 cases in PBCR of Delhi.
The overall percentage change during the period is 55.8%
while the lowest percentage of increase is observed in the
registry of Mumbai (25.6%) and the maximum in Bhopal
(96.4%).
The number of cases covered by the leading sites,
period, their % and % relative changes for the PBCR
of Bangalore is shown in Table 2. The overall increase
(change) in the number of cases, over the period 1988-90
to 2003-05, is 2710. Among these, the maximum change
is due to lung cancer cases (274) which constituted about
10.1% of the total changed cases. This is followed by
the change in stomach cases (8.8%) followed by prostate
(7.8%), liver (6.0%) and brain and nervous system (6.0%).
The relative changes over the period are observed to be
0
25.0
50.0
75.0
100.0
Newly diagnosed without treatment
Newly diagnosed with treatment
Persistence or recurrence
Remission
None
Chemotherapy
Radiotherapy
Concurrent chemoradiation
10.3
0
12.8
30.0
25.0
20.3
6.3
51.7
75.0
51.1
30.0
31.3
54.2
56.3
27.6
25.0
33.1
30.0
31.3
23.7
31.3
Table 1. No. of Male Cases Covered by Registry area,
Period and Percentage Change
Registry Area 2003-05 1988-90 Change %Change
(b) (a) (b-a) (b-a)*100/a
Bangalore 6,725 4,015 2,710 67.5
Bhopal 1,636 833 803 96.4
Chennai 6,656 523 2,133 47.2
Delhi 17,611 9,270 8,341 90.0
Mumbai 14,318 11,401 2,917 25.6
Pooled 46,946 30,042 16,904 55.8
Table 3. Number of Male Cases Covered by Period , %
Change and % Relative Change - Bhopal
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
C03-06 Mouth 158 57 101 12.6 177.2
C33-34 Lung etc. 173 91 82 10.2 90.1
C01-02 Tongue 158 90 68 8.5 75.6
C32 Larynx 76 30 46 5.7 153.3
C61 Prostate 67 31 36 4.5 116.1
C15 Oesophagus 92 62 30 3.7 48.4
C67 Bladder 40 10 30 3.7 300.0
C77 Sec Lymph Nodes 40 10 30 3.7 300.0
C18 Colon 41 14 27 3.4 192.9
C23-24 Gallbladder etc. 36 10 26 3.2 260.0
All sites 1,636 833 803 100.0 96.4
Table 4. Number of Male Cases Covered by Period , %
Change and % Relative Change - Chennai
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
C33-34 Lung etc. 701 449 252 11.8 56.1
C61 Prostate 279 95 184 8.6 193.7
C01-02 Tongue 360 215 145 6.8 67.4
C82-85,96 NHL 272 170 102 4.8 60.0
C32 Larynx 286 189 97 4.5 51.3
C19-20 Rectum 220 125 95 4.5 76.0
C16 Stomach 666 574 92 4.3 16.0
C70-72 Brain, Nervous
System 204 112 92 4.3 82.1
C15 Oesophagus 452 365 87 4.1 23.8
C67 Bladder 186 102 84 3.9 82.4
All sites 6,656 4,523 2133 100 47.2
Table 2. Number of Male Cases Covered by Period , %
Change and % Relative Change - Bangalore
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
C33-34 Lung etc. 564 290 274 10.1 94.5
C16 Stomach 603 365 238 8.8 65.2
C61 Prostate 380 169 211 7.8 124.9
C22 Liver 271 109 162 6.0 148.6
C70-72 Brain, Nervous
System 317 155 162 6.0 104.5
C82-85,96 NHL 306 164 142 5.2 86.6
C15 Oesophagus 460 321 139 5.1 43.3
C18 Colon 218 95 123 4.5 129.5
C90 Multiple
Myeloma 131 17 114 4.2 670.6
C92-94 Myeloid
Leukaemia 198 100 98 3.6 98.0
All sites 6,725 4,015 2,710 100 67.5
Table 5. Number of Male Cases Covered by Period , %
Change and % Relative Change - Delhi
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
C33-34 Lung etc. 1793 821 972 11.7 118.4
C61 Prostate 1105 349 756 9.1 216.6
C01-02 Tongue 978 447 531 6.4 118.8
C03-06 Mouth 779 254 525 6.3 206.7
C82-85,96 NHL 874 429 445 5.3 103.7
C32 Larynx 1098 660 438 5.3 66.4
C67 Bladder 823 396 427 5.1 107.8
C70-72 Brain, Nervous
System 781 398 383 4.6 96.2
C23-24 Gallbladder etc. 519 163 356 4.3 218.4
C40-41 Bone 445 177 268 3.2 151.4
All sites 17,611 9270 8341 100.0 90.0
maximum in multiple myeloma (670.6%) followed by the
cancer of liver (148.6%) and colon (129.5%). These can
be termed as the emerging cancers among men in PBCR
of Bangalore.
For the PBCR of Bhopal (Table 3), the rise in
the number of cases is 803. Of these, the maximum
contribution is due to mouth cancer cases (12.6%)
followed by the sites of lung (10.2%), tongue (8.5%),
larynx (5.7%) and prostate (4.5%). The relative changes
over the period are observed to be maximum for the site
of bladder (300%), followed by secondary lymph nodes
(300%) and gall bladder (260%). These sites can be termed
Asian Pacic Journal of Cancer Prevention, Vol 12, 2011 877
An Alternative Approach to Study the Changes in the Cancer Pattern of Men in India (1988-2005)
as the emerging sites of cancer among men in PBCR of
Bhopal.
For the PBCR of Chennai (Table 4), the rise in
the number of cases is 2,133. Of these, the maximum
contribution is due to lung cancer (11.8%), prostate
(8.6%), tongue (6.8%), NHL (4.8%) and larynx (4.5%).
Based on the relative changes, the emerging cancers are
prostate (193.7%), bladder (82.4%) and brain and nervous
system (82.1%).
For the PBCR of Delhi (Table 5), the rise in the number
of cases is 8,341. Of these, the maximum contribution
is due to lung (11.7%), prostate (9.1%), tongue (6.4%),
mouth (6.3%) and NHL (5.3%). Based on the relative
changes, the emerging new cancers are gallbladder
(218.4%), prostate (216.8%) and mouth (206.7%).
For the PBCR of Mumbai (Table 6), the rise in
the number of cases is 2,917. Of these, the maximum
contribution is due to mouth (17.1%), prostate (12.3%),
liver (10.2%), NHL (9.6%) and brain and nervous system
(8.4%). Based on the relative changes, the emerging new
cancers are liver (101.7%), pancreas (94.6%) and mouth
(80.7%).
For the pooled cases of PBCR (Table 7), the rise in
the number of cases is 16,904. Of these, the maximum
contribution is due to lung cancer (9.7%), prostate (9.2%),
mouth (7.5%), tongue (5.9%) and NHL (5.9%). Based on
the relative changes, the emerging new cancers are prostate
(140.1%), liver (111.9%) and mouth (95.3%).
Discussion
It is evident that the number of cases covered by
different PBCRs is on rise. The rise is shown to be ranging
from 25.6% in Mumbai PBCR to 96.4% in Bhopal. The
lung cancer is found to be the leading contributor to
changes over the years in the PBCR of Bangalore (10.1%),
Chennai (11.8%) and Delhi (11.7%). For the PBCR of
Bhopal and Mumbai, the mouth cancer is the leading
site contributing to 12.6% and 17.1% of total changes,
respectively. Prostate cancer is another common site of
cancer which contributed signicantly to changes and
ranked 2nd in terms of contribution to total changes in the
registry of Chennai, Delhi and Mumbai and ranked 3rd and
5th in the registry of Bangalore and Bhopal respectively.
Tongue cancer also gured in top 5 sites contributing to
changes in the registry of Bhopal, Chennai and Delhi.
Based on the data provided in tables, liver cancer can
be claimed as one of the emerging cancers in the PBCR
of Bangalore and Mumbai while Prostate cancer can be
claimed as an one of the emerging cancers in the PBCRs
of Chennai, Delhi and Mumbai. Gall bladder is another
site of cancer which can be claimed as emerging cancer
in the registries of Delhi and Bhopal. Thus registries
showed variation with respect to their emerging cancers.
However, based on the pooled data of all the registries,
it can be claimed that the top three emerging cancers in
India are prostate, liver and mouth.
The approach described thus gives us an alternative
approach to study the changes in the cancer pattern. It is
to be noted that this type of analysis totally depends upon
the number of cases rather than on rates on two selected
points of time. The knowledge of estimated population
gures for inter-census years is also not needed in the
present type of analysis.
Acknowledgements
The authors of the paper are grateful to the Ofcer-
in-Charge, Dr. A. Nandakumar, National Cancer
Registry Programme, Indian Council Of Medical
Research, Bangalore, India, for his constant support and
encouragement for pursuing the problem and writing of
the manuscript.
Table 6. Number of Male Cases Covered by Period , %
Change and % Relative Change - Mumbai
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
CC03-06 Mouth 1117 618 499 17.1 80.7
C61 Prostate 820 460 360 12.3 78.3
C22 Liver 589 292 297 10.2 101.7
C82-85,96 NHL 682 401 281 9.6 70.1
C70-72 Brain, Nervous
System 598 353 245 8.4 69.4
C67 Bladder 502 314 188 6.4 59.9
C01-02 Tongue 734 569 165 5.7 29.0
C25 Pancreas 327 168 159 5.5 94.6
C18 Colon 463 313 150 5.1 47.9
C19-20 Rectum 410 261 149 5.1 57.1
All sites 14,318 11,401 2917 100.0 25.6
Table 7. Number of Male Cases Covered by Period , %
Change and % Relative Change - Pooled
ICD Site 2003 1988 Change % %
- 05(b) -90(a) (b-a) C RC
CC33-34 Lung etc. 4,423 2,780 1,643 9.7 59.1
C61 Prostate 2,651 1,104 1,547 9.2 140.1
C03-06 Mouth 2,596 1,329 1,267 7.5 95.3
C01-02 Tongue 2,454 1,458 996 5.9 68.3
C82-85,96 NHL 2,176 1,181 995 5.9 84.3
C70-72 Brain, Nervous
System 1,942 1,036 906 5.4 87.5
C67 Bladder 1,732 933 799 4.7 85.6
C22 Liver 1,437 678 759 4.5 111.9
C32 Larynx 2,466 1,723 743 4.4 43.1
C18 Colon 1,273 653 620 3.7 94.9
All sites 46,946 30,042 16,904 100.0 56.3
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Background: The Pakistan Atomic Energy Commission Cancer Registry (PAECCR) program has made availability of a common cancer incidence database possible in Pakistan. The cancer incidence data from nuclear medicine and oncology institutes were gathered and presented. Materials and methods: The cancer incidence data for the last 30 years (1984-2014) are included to describe a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 10 years (2004-2014). Results: The total population of provincial capital Lahore is 9,800,000. The total number of cancer cases was 80,390 (males 32,156, females 48,134). The crude incidence rates in PAECCR areas were 580.8/105 during 2010 to 885.4/105 in 2014 (males 354.1/105, females 530.1/105). The cancer incidence rates for head and neck (15.70%), brain tumors (10.5%), and non-Hodgkin lymphoma (NHL, 9.53%) were found to be the highest in male patients, whereas breast cancer (46.7%), ovary tumors (6.80%), and cervix (6.31%) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer patients from 15 different cities of Punjab province treated at the Institute of Nuclear Medicine and Oncology, Lahore are also included. Leukemia was found to be the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for males and 41-50 years for female cancer patients. Conclusions: Overall cancer incidence of the thirty years demonstrated that head and neck and breast cancers in males and in females respectively are the most common cancers in Punjab province in Pakistan, at rates almost the highest in Asia, requiring especial attention. The incidence of brain, NHL, and prostate cancers among males and ovarian and cervix cancers among females have increased rapidly. These data from a major population of Punjab province should be helpful for implementation of appropriate planning, prevention and cancer control measures and for determination of risk factors within the country.
... The incidence of PCa in India has been steadily increasing concomitant with an increase in life expectancy. According to the National Cancer Registry program by the Indian Council of Medical Research, New Delhi, PCa is estimated to increase by 140% in the next few years [1,2]. The challenges posed in diagnosing and treating prostate cancer is attributed to the clinical and molecular heterogeneity associated with this disease. ...
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... 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, Office of Population Affairs, Can Teen). ...
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Information relating to cancer incidence trends forms the scientific basis for the planning and organization of prevention, diagnosis and treatment of cancer in a community. An attempt was here made to study the trends in the age adjusted incidence rates for the sites of head and neck cancers in Mumbai, Bangalore, Chennai, Delhi, Bhopal, and Barshi registry's populations. For carrying out trend analysis the gum, the floor of mouth, the mucosa of cheek, the hard and soft palate and the uvula were grouped together and assigned as cancers of mouth. The trend analysis was carried out for all sites together, tongue, mouth, hypopharynx and larynx in males and all sites together and mouth in females. Sites such as lip, hypopharynx and nasopharynx were not considered. In males, for all sites together linear regression showed no increase or decrease in age adjusted rates overall for Bangalore and Delhi registries, a significant decrease for Mumbai and Delhi registries, but a rising trend for Chennai and Bhopal registries over a period of time. In females, for all sites together no change was observed in age adjusted incidence rates for Mumbai, Chennai, Bhopal, Bangalore and Barshi registries while a decreasing trend was noted for Delhi registries over a period of time. For the specific sites, variation among registries was also apparent. The results point to local differences in sub-site specific risk factors which might be elucidated by analytical epidemiological assessment.
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Trends in prostate cancer in five population-based cancer Registries (Mumbai, Chennai, Bangalore, Delhi & Bhopal) in India were studied over a period of two decades using a model that fitting the data as the logarithm of Y=ABx which represents a Linear Regression model. This approach showed increasing trends in the age adjusted incidence rates throughout the entire period of observation for most of the registries, especially in Chennai and Bhopal and to the least extent in Mumbai. Particularly in Asia we face a future major increase in the rates of prostate cancer. Collaborative action now is a high priority to allow the preparations necessary for effective control of prostate cancer.
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Trends in breast, cervix uteri, corpus uteri and ovarian cancers in six population based cancer registries (Mumbai, Bangalore, Chennai, Delhi, Bhopal, and Barshi) were evaluated over a period of the last two decades. For studying trends we used a model that fits this data is the logarithm of Y=ABx which represents a Linear Regression model. This approach showed a decreasing trend for cancer of the cervix and increasing trends for cancers of breast, ovary and corpus uteri throughout the entire period of observation in most of the registries. The four cancers, breast, cervix, corpus uteri and ovary, constitute more than 50% of total cancers in women. As all these cancers are increasing, to understand their etiology in depth, analytic epidemiology studies should be planned in a near future on a priority basis.
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Time trends in cancers of the esophagus, stomach, colon, rectum and liver cancers among the male population in five Indian urban population based cancer registries (Mumbai, Bangalore, Chennai, Delhi, and Bhopal) were examined over the period of the last two decades. The model applied fits data to the logarithm of Y=ABx. This Linear Regression method showed decreasing trends in age-adjusted incidence rates for cancers of the stomach and esophagus, especially in Bjopal, and increasing trends for colon and rectum and liver, throughout the entire period of observation in most of the registries. The five cancers together constitute more than 80% of the total gastro intestinal cancers and are serious diseases in both sexes. To understand the etiology of these cancers in depth, analytic epidemiological studies should be planned in the near future on a priority basis.
Time trends in cancer incidence rate
NCRP (2009). Time trends in cancer incidence rate (1982-2005), National Cancer Registry Programme (ICMR), Bangalore.
  • Ramnath Takiar
  • C R Vijay
Ramnath Takiar and CR Vijay Asian Pacific Journal of Cancer Prevention, Vol 12, 2011