2. Cancer in India
• Introduction
• Recent times have seen an increase
in the incidence of cancer. This is
mainly attributed to
urbanization, industrialization, lifesty
le changes, population growth and
increased life span (in turn leading to
an increase in the elderly
population).

3. • In India, the life expectancy at birth has
steadily risen from 45 years in 1971 to 62
years in 1991, indicating a shift in the
demographic profile.1 It is estimated that
life expectancy of the Indian population
will increase to 70 years by 2021–25.2
This has caused a paradigm shift in the
disease pattern from communicable
diseases to non-communicable diseases
like cancer, diabetes and hypertension.

4. Burden caused by Cancer
• Cancer prevalence in India is
estimated to be around 2.5 million,
with over 8,00,000 new cases and
5,50,000 deaths occurring each year
due to this disease. More than 70%
of the cases report for diagnostic and
treatment services in the advanced
stages of the disease, which has lead
to a poor survival and high mortality
rate.

5. • The impact of cancer is far
greater than mere numbers. Its
diagnosis causes immense
emotional trauma and its
treatment, a major economical
burden, especially in a developing
country like India.

6. • The initial diagnosis of cancer is perceived
by many patients as a grave event, with
more than one-third of them suffering from
anxiety and depression. Cancer is equally
distressing for the family as well. It could
greatly affect both the family’s daily
functioning and economic situation. The
economic shock often includes both the
loss of income and the increase of expenses
because of the treatment and health care.
This disease is associated with a lot of fear
and despair in the country.

7. Different cancers occur in different
states of our country
• Esophageal cancers: Southern states
of India like Karnataka and Tamil
Nadu and also in Maharashtra and
Gujarat.
• Stomach cancers: Southern India
with the highest incidence in
Chennai.

8. • Oral cancers: Kerala (South India)
• Pharyngeal cancers: Mumbai
(Western India)
• Thyroid cancers among women:
Kerala
• Gall bladder cancer: Northern
India, particularly in Delhi and
West Bengal.

9. Trends in Incidence of Cancer in
India
• A trend analysis of the data on
cancer incidence for the period
1964–96 has demonstrated that the
overall occurrence of cancer is
increasing with among females. The
greatest increase among females was
for cancer of the breast and among
males for cancer of the prostate.

10. • There was an increasing trend for
lymphoma, urinary bladder, gall
bladder and brain tumors in both
sexes. Cancer of the colon was
increasing in females and that of the
kidney in males. Esophageal and
stomach cancers were decreasing in
both sexes.

11. Risk Factors
• According to epidemiological studies, 80-90%
of all cancers are due to environmental factors
of which, lifestyle related factors are the most
important and preventable.10 The major risk
factors for cancer are tobacco, alcohol
consumption, infections, dietary habits and
behavioral factors.

12. • Tobacco consumption, either by way of
chewing or smoking accounts for 50% of all
cancers in men. Dietary
practices, reproductive and sexual practices
account for 20-30% of cancers.

13. Cancer Control in India
• India is one of the first few developing
countries where a nation-wide cancer control
programs were launched. Government of
India took its first initiative in 1971. The
National Cancer Control Program for India was
formulated in 1984 with four major goals 13

14. • Primary prevention of tobacco related cancer
• Early detection of the cancers of easily
accessible sites
• Augmentation of treatment facilities
• Establishment of equitable, pain control and
palliative care network throughout the
country

15. Cancer Prevention
• Avoid tobacco use: As already discussed,
tobacco is the major risk factor for cancer.
Hence, it is important to avoid tobacco in all
forms, like both active and passive smoking
and chewing tobacco.
• Eat a variety of healthy foods: It is important
to consume plant-based foods, rich in fruits
and vegetables, reduce the intake of fat and
alcohol.

16. • Stay active and maintain a healthy weight:
Regular exercise should be an integral part of
one’s daily routine.
• Protect yourself from the sun: Exposure to
sun is the major cause of skin cancer. It is
important to avoid the sun’s ultraviolet
rays, especially from 10 am to 4 pm and
applying adequate amounts of sunscreen
lotion with a sun-protecting factor (SPF) of at
least 15, especially before venturing outdoors
during these hours

17. • Get immunized: Vaccination against Hepatitis
B should be regularly administered, as this
infection could lead to liver cancer.
• Healthy practices: Sexually transmitted
diseases like human papilloma virus infection,
hepatitis B and HIV can lead to an increased
incidence of various cancers.

18. It is thus important to practice safe sex by
using condoms, limit the number of sexual
partners, or abstain from sex and never share
needles. In case of drug addiction, it is
important to seek help.
• Get screened: Regular screening and self-
examination for certain cancers helps in early
detection of cancer and improves the
prognosis.

19. Risk factors
• The most significant risk factor is age.
According to cancer researcher Robert A.
Weinberg, "If we lived long enough, sooner or
later we all would get cancer
• Over a third of cancer deaths worldwide are
due to potentially modifiable risk factors. The
leading modifiable risk factors worldwide are:

20. • tobacco smoking, which is strongly associated
with lung cancer, mouth, and throat cancer;
• drinking alcohol, which is associated with a
small increase in oral, esophageal, breast, and
other cancers;
• a diet low in fruit and vegetables,
• physical inactivity, which is associated with
increased risk of colon, breast, and possibly
other cancers

21. • obesity, which is associated with
colon, breast, endometrial, and possibly other
cancers
• sexual transmission of human
papillomavirus, which causes cervical
cancer and some forms of anal cancer.
• Men with cancer are twice as likely as women
to have a modifiable risk factor for their
disease.

22. • Other lifestyle and environmental factors
known to affect cancer risk (either beneficially
or detrimentally) include the use of exogenous
hormones (e.g., hormone replacement
therapy causes breast cancer), exposure
to ionizing radiation and ultraviolet radiation,
and certain occupational and chemical
exposures

23. • Every year, at least 200,000 people die
worldwide from cancer related to their
workplace.Millions of workers run the risk of
developing cancers such
as pleural and peritoneal mesotheliomafrom
inhaling asbestos fibers, or leukemia from
exposure to benzene at their workplaces.

24. • Currently, most cancer deaths caused by
occupational risk factors occur in the
developed world. It is estimated that
approximately 20,000 cancer deaths and
40,000 new cases of cancer each year in the
U.S. are attributable to occupation

25. Incidence and mortality
• In the United States, cancer is responsible for 25%
of all deaths with 30% of these from lung cancer.
The most commonly occurring cancer in men
is prostate cancer (about 25% of new cases) and
in women is breast cancer (also about 25%).
Cancer can occur in children and adolescents, but
it is uncommon (about 150 cases per million in
the U.S.), with leukemia the most common

26. • In the U.S. cancer is second only
to cardiovascular disease as the leading cause
of death; in the UK it is the leading cause of
death. In many Third World countries
cancer incidence (insofar as this can be
measured) appears much lower, most likely
because of the higher death rates due to
infectious disease or injury.

27. • Cancer is responsible for about 25% of all
deaths in the U.S., and is a major public
health problem in many parts of the world.
The statistics below are estimates for the U.S.
in 2008, and may vary substantially in other
countries. They exclude basal and squamous
cell skin cancers, and carcinoma in situ in
locations other than the urinary bladder

28. Most common cancers in US
males, by occurrence

29. Incidence of a second cancer in
survivors
In the developed world, one in three people will
develop cancer during their lifetimes. If all cancer
patients survived and cancer occurred
randomly, the normal lifetime odds of developing
a second primary cancer (not the first cancer
spreading to a new site) would be one in
nine.However, cancer survivors have an increased
risk of developing a second primary cancer, and
the odds are about two in nine

30. • About half of these second primaries can be
attributed to the normal one-in-nine risk
associated with random chance. The increased
risk is believed to be primarily due to the
same risk factors that produced the first
cancer, such as the person's genetic profile,
alcohol and tobacco use, obesity, and
environmental exposures, and partly due, in
some cases, to the treatment for the first
cancer, which might have included mutagenic
chemotherapeutic drugs or radiation.

31. Children
• Cancer can also occur in young children and
adolescents, but it is rare (about 150 cases per
million yearly in the
US). Leukemia (usually acute lymphoblastic
leukemia) is the most common cancer in
children aged 1–14 in the U.S., followed by
the central nervous system
cancers, neuroblastoma, Wilms' tumor,
and non-Hodgkin's lymphoma.

32. Infants
• The age of peak incidence of cancer in children
occurs during the first year of life, in infants. The
average annual incidence in the United
States, 1975–1995, was 233 per million
infants. Several estimates of incidence exist.
According to SEER, in the United States:
• Neuroblastoma comprised 28% of infant cancer
cases and was the most common malignancy
among these young children (65 per million
infants).

33. • The leukemias as a group (41 per million
infants) represented the next most common
type of cancer, comprising 17% of all cases.
• Central nervous system
malignancies comprised 13% of infant
cancer, with an average annual incidence rate
of nearly 30 per million infants.
• The average annual incidence rates for
malignant germ cell and malignant soft tissue
tumors were essentially the same at 15 per
million infants. Each comprised about 6% of
infant cancer.

34. • Teratoma (a germ cell tumor) often is cited as
the most common tumor in this age group,
but most teratomas are surgically removed
while still benign, hence not necessarily
cancer. Prior to the widespread routine use of
prenatal ultrasound examinations, the
incidence of sacrococcygeal
teratomas diagnosed at birth was 25 to 29 per
million births.

35. • Female and male infants have essentially the
same overall cancer incidence rates, a notable
difference compared to older children.
• White infants have higher cancer rates than
black infants. Leukemias accounted for a
substantial proportion of this difference: the
average annual rate for white infants (48.7 per
million) was 66% higher than for black infants
(29.4 per million).