Growing cancer burden of Northeast

The latest findings on the high incidence of cancer in North-eastern states as compared to the rest of India has set off the alarm bell of another public health emergency when the country is already grappling with the COVID-19 pandemic. High prevalence and rise in cancer cases reflect poor awareness about the disease in the region. A report titled "Profile of Cancer and Related Health Indicators in the North East Region of India" prepared jointly by the Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics and Research (NCDIR), Bengaluru reveals a gloomier picture of the region. The highest age-adjusted cancer incidence rate in males (269.4 per 100,000) has been recorded in the Aizawl district in Mizoram, among females (219.8 per 100,000) in Papumpare district, Arunachal Pradesh, which happens to be the highest in the region and the country, it says. Other key indicators are also equally alarming and call for urgent action by states in the region. In males, the leading sites include cancer of the oesophagus (13.6%) followed by lung (10.9%), while in females, the breast is the leading site (14.5%), followed by the cervix uteri (12.2%). The probability of developing any cancer over a lifetime is highest in Kamrup (Metropolitan) district in Assam- 1 in every 4 males and 1 in every 6 females- reveals the report sounding alert of the impending health crisis, if not checked. In males, the probability of developing oesophageal cancer (1 in every 54 males) is highest, while in females, it is breast cancer (1 in every 76 females). The finding that the proportion of women who have undergone screening is only 0.2% for breast cancer, 0.2% for oral cancer and 0.2% for cervical cancer in Assam, while only 1.4% of men had a history of screening for oral cancer speaks volumes about poor awareness and inadequate cancer screening camps. It is a matter of grave concern that the median age at diagnosis in males is found to be less in the region compared to the rest of India- 56 years in the region against 62 years in the rest of India for oesophageal cancer and 58 years in the region compared to 62 years in rest of India for cancer of hypopharynx. In females, the median age at diagnosis was less in the top four leading cancer sites except lung (Breast: 47 years in NER and 54 years in rest of India, cervix uteri: 49 years in NER and 56 years in rest of India, gall bladder: 56 years in NER & 57 years in rest of India, oesophagus: 57 years in NER & 61 years in rest of India), reveals the report which requires anchoring the cancer awareness and screening programme on such findings in deciding the target population. Nearly half (49.3%) of cancers in males and close to one-fourth (22.8 %) in females are tobacco use-related sites—oesophagus (13.6% in males; 7.0 % in females) followed by lung (10.9% in males; 6.8% in females). This calls for reviewing existing tobacco control strategies for the region and identifying the gaps. Voluntary screening can increase early detection and treatment of cancer but will require awareness drive on a mass scale. The ICMR-NCDIR report presents statewide cancer profile and analysis based on data from eleven Population-Based Cancer Registry in all the eight states of the region and seven Hospital-Based Cancer Registry in four states of Assam, Manipur, Mizoram, and Tripura. Messaging in local languages, innovative use of social media apart from traditional mass media can bolster awareness of cancer. Apart from Non-governmental organizations, roping in panchayats and urban local bodies, autonomous councils for frequent awareness and screening programmes in each village and town can produce result-oriented outcomes. Messaging on the disease can be improved to expand the coverage and reach out to a wider population by clubbing it some flagship programmes of the Central government such as Swachh Bharat Mission, Jal Jeevan Mission and flagship programme of states in the region such as Orunodoi programme in Assam. The report states that the proportion of cancer patients who sought treatment outside the region is reported to be more for Sikkim (95.3%) and Nagaland (58.1%), but less for Assam (5.1%), Mizoram (6.5%) and Tripura (6.9%). This is indicative of improvement in cancer treatment in the region as it cuts down expenses of travel and accommodation of patients and relatives as most cancer patients had to travel outside the region to Mumbai, Vellore, Kolkata, Delhi once for treatment and follow up. Setting up more cancer hospitals in all states of the region has become an urgent necessity as the number of cancer cases is projected to increase to 57,131 in 2025 from 50,317 in 2020. Building awareness on cancer on a mass scale and organizing intensive screening camps for early detection of cases is an urgent necessity for each state in the region.