Clinics of Oncology

ISSN: 2640-1037

Volume 4

Jain N1*, Sharma J2, Biswal DD3, Gupta G4, De D5, Mazumdar A6, Ojha S7, Dubey A8 and Kumar V8

1Department of Transfusion Medicine & Immunohematology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

2Department of Surgical Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

3Department of Medical Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

4Department of Radiation Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

5Department of Haemato-oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

6Sr. Consultant Pain and Palliative Medicine, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

7Department of Histopathology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

8Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India

*Corresponding author:

Neelesh Jain, Consultant, Transfusion Medicine & Immunohematology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, Sector-36, Atal Nagar, Naya Raipur, Raipur, Chhattisgarh, India, Tel: 009874592738; E-mail: drneeleshjain@gmail.com

Keywords: Cancer; Incidence; Males; Females; Chhattisgarh

1. Abstract

Received: 02 Mar 2021

Accepted: 22 Mar 2021

Published: 27 Mar 2021

Copyright:

©2021 Jain N, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

All around the world, cancer manifesting in any form is one of the leading causes for death. In our country approximately 1 million cancer cases are detected every year and the annual deaths due to cancer is around 0.63 million. While lung and oral cancers are the commonest cancer for men, breast and cervical cancers are the commonest cancers for women in our country. Our study was undertaken to find the incidence of cancer burden in Chhattisgarh state of Central India. A retrospective analysis was done involving collection of data of 15 months from 1st Jan-2019 till 31st March 2020. Total reported number of cancer cases during this period was 2296. Females were more affected with malignancies than males with female to male ratio of 1:0.88. In our study the most commonly reported cancer among male patients was found to be oral cancer (42.28%) followed by lung (5.57%) and stomach cancer (5.48%). Similarly, in females the cervical cancer (27.13%) is found to be most common followed by breast (24.34%) and oral

Citation:

Jain N, The Growing Burden of Cancer in Chhattisgarh State of Central India: A Tertiary Cancer Centre Study. Clin Onco. 2021; 4(3): 1-6 cancer (10.65%). Overall the commonest cancer observed here is Oral cancer (25.47%).

2. Introduction

India, with a population of more than 1·3 billion, and growing, while is epidemiologically interesting but poses a huge challenge for health-care planners. The population demographics, health policies, health-data recording, access to health care, and affordability have all improved substantially during the period between 1990 and 2016, as reported by the India State-Level Disease Burden Initiative Cancer Collaborators in their Global Burden of Disease paper in The Lancet Oncology. [1]

According to estimates from the World Health Organization (WHO), Cancer ranks as first and second leading cause of death before age 70 years in 91 of 172 countries, and it ranks third or fourth in an additional 22 Countries. [2] It is the leading cause of death globally after cardiovascular diseases. Patients with cancer generally have poor prognosis in low-income and middle income countries, including India, relatively because of lack of cancer awareness, delayed diagnosis, inequitable access to affordable curative services compared with patients in high-income countries. India spread across 28 states and 8 union territories, with geographical variations, diversified development, population genetics, environments and lifestyles, leading to a heterogeneous distribution of disease burden and health loss. There have been attempts to describe national-level patterns of cancer prevalence and epidemiology in different parts of India and areas of importance for cancer control. But a systematic and comprehensive understanding of the magnitude and time trends of different types of cancers across India is not readily available which is of utmost importance for cancer control, to commensurate with the need of delivery of health care. [3-4]

The National Cancer Registry Program in India was established in 1981 to generate data on the magnitude and patterns of cancer through population-based registries. The number of registries have grown since then and other population-based registries have also been started in recent years. [5] However, many densely populated states have no cancer registries yet. Most registries in India are in urban areas, leading to difficulties in assessing cancer burden trends in all parts of the country. The India State-Level Disease Burden Initiative is a collaboration with the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to produce subnational disease burden estimates for India. This initiative recently reported the variable health transition across the states of India from 1990 to 2016 based on analysis done as part of GBD 2016. [6]

The epidemiology of cancer involves a study of the cancer etiology to infer the possible trends. Such epidemiological data based studies assist in formulating the national cancer control program based strategies. Although there are few studies highlighting trends in cancer burden across our country, there is paucity of knowledge base in the state of Chhattisgarh. Hence the present study was undertaken as a novel attempt to assess the incidence of cancer in a tertiary care cancer center of Chhattisgarh.

This retrospective observational study was carried out on patients treated in our institute at Nava Raipur, Chhattisgarh, from 1st Jan2019 till 31st March 2020.

3.1. Study Design: Retrospective open label observational study

3.2. Study Location: This was a tertiary cancer centre based study located at Nava Raipur, Chhattisgarh.

3.3. Study Duration: 1st Jan-2019 till 31st March 2020 (15 Months)

3.4. Subjects & Selection Method: The study population was drawn from patients who registered in our institute from 1st Jan2019 till 31st March 2020.

Procedure Methodology Patient data of last 15 months stored in the Hospital Management Information System (HMIS) was analyzed to study the incidence of various cancers along with the demographic details of the patients encountered.

A total of 2296 patients were registered at the BMC during the 15 months’ period (from 1/1/2019 to 31/3/2020) from across the Chhattisgarh state. The distribution of types of cancer is depicted in table-1. Females were more affected with malignancies than males with female to male ratio of 1:0.88. (Figure 1) Majority of the patients of both sexes (male and female) registered at BMC were belongs to the age group of 41-60 years i.e. 1193 (51.9%). Second most common age group among males and females were 61 to 70 years i.e. 391(17%). Amongst pediatric patients the commonest age group registered was 11-20 years i.e. 43 (1.8%) Figure 2 & 3. Most commonly reported cancer among male patients was found to be oral cancer followed by lung and stomach cancer. The top five most common cancer reported among male patients were oral cavity, lung, stomach, colorectal and esophageal cancer. (Figure 2) Most commonly reported cancer among female patients was cervical cancer followed by breast and oral cancer. Top five most commonly reported cancer among female patients were cervical, breast, oral cavity, ovary, and uterine cancer (Figure 3). We noted 3 cases of male breast cancer i.e. 1% amongst total breast cancer.

This study was conducted to evaluate the variations and factors affecting the epidemiology of cancer in Chhattisgarh state, which is evident from the above observations. We observed the most common cancer in males are as follows; Oral cavity, followed by Lung > Stomach > Colo-rectal> Oesophagus. Similarly, in females the most common cancer found was Cervical followed by Breast>Oral cavity> Ovary> Uterine. The three most common cancers among males and females in this study correlates with the results of previous study conducted here in Chhattisgarh in 2018. [7] The difference we found here is the fifth most common cancer in female is uterine cancer in our current study while it was stomach and colorectal cancer in the previous study. On comparison of our findings with the National cancer trend as per GLOBOCAN-2018 data, we inferred that among male patients, the five most common cancers corroborate with our study (Figure 4). But in female patients there are major differences in the findings. Like, Breast cancer is the most common cancer in India as per GLOBOCAN-2018 report followed by Cervical> Ovary> Oral cavity > Colorectal while we reported Cervical cancer as the commonest one followed by Breast>Oral cavity> Ovary> Uterine (Figure-5) [8]. In the current study we found maximum number of patients were of Oral cavity cancer (25.47%). High incidence of oral cancer in India as well as in Chhattisgarh attributes to a number of etiological factors including tobacco consumption habit among the patients, either as smokeless tobacco or smoking and alcohol consumption are the common causes for oral cancer. Positive family history of oral cancer, viral infections like HPV, poor oral hygiene are the other causes for oral cancer. Based on the TNM classification, 48% of the oral cancer cases presented in the late stages. [9] Estimates indicate 57% of men and 11% of women between 15- 49 years of age use some form of tobacco. [10]

Similarly, cervical cancer is the leading type of cancer in Indian women and the second most common cancer in women worldwide. Though there are several methods of prevention of cervical cancer, prevention by vaccination is emerging as the most effective option, with the availability of vaccines. Sexually transmitted Human Papilloma Virus (HPV) infection is the most important risk factor for cervical intraepithelial neoplasia and invasive cervical cancer. [11]

Indian women face a 2.5% cumulative lifetime risk and 1.4% cumulative death risk from cervical cancer. At any given time, about 6.6% of women in the general population are estimated to harbor cervical HPV infection. HPV serotypes 16 and 18 account for nearly 76.7% of cervical cancer in India. Warts have been reported in 2–25% of sexually transmitted disease clinic attendees in India. [12]

Apart from HPV there are other cofactors which are necessary for progression from cervical HPV infection to cancer. Long-term use of hormonal contraceptives, high parity, and early initiation of sexual activity, multiple sex partners, tobacco smoking and co-infection with HIV have been identified as established cofactors; co-infection with Chlamydia trachomatis and herpes simplex virus type-2, immunosuppression, low socioeconomic status, poor hygiene and diet low in antioxidants are other probable cofactors. Genetic and immunological host factors and viral factors such as variants of type, viral load and viral integration are likely to be important, but have not been clearly identified. [13] To prevent HPV infection the Indian Academy of Pediatrics (IAP) recommended vaccination schedule as 2 doses of either of the two available HPV vaccines at interval of 6 months for girls aged 9-14 years. For girls 15 years and older, and those with HIV/AIDS, on chemotherapy or after organ transplant require 3 doses at 0, 1-2 and 6 months. [14]

The Government of India has initiated the National Cancer Control Program in 1975 to equip tertiary care cancer hospitals and institutions to implement systematic, equitable, and evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliative care using available resources. [15] State cancer institutes and tertiary care cancer centres have been established under this program, responsible for improved cancer awareness amongst population and management at the state level. Despite these attempts, access to critical cancer treatment is low in the country. For example, lesser availability of radiotherapy machines, delays in treatment and geographic inequity in the distribution of such resources. [16] With the launch of the National Program for Control of Cancer, Diabetes, CVD and Stroke in 2010 in India, the cancer control efforts are now part of this umbrella program for non-communicable diseases. [17]