As it is, tobacco chewing can be the root of many ills and if the natives of the East Khasi Hills, and so may the residents of Imphal West district, heed to the warning spelt out clearly in the NCRP report, they would do best to give up chewing tobacco for all times.
By Salam Rajesh
For the tobacco-chewing men and women of the East Khasi Hills in Meghalaya, health issue is going to be precarious by the look of emerging reports on cancer incidence across India with specific focus on the North-East region.
Unimaginable as it is, most States in North East India account for the maximum number of reported cancer cases in India. Across the country, Meghalaya (East Khasi Hills district), Mizoram (Aizwal district), Assam (Kamrup urban, Cachar and Dibrugarh districts), Arunachal Pradesh (West Arunachal, Pasighat, Papumpare district), Nagaland, Sikkim, Tripura and Manipur (Imphal West district) are all in the lead on most counts, according to a recent report on the national cancer scenario.
Nationally, cancer of the lung, mouth, stomach and oesophagus were the most common cancers in men, while cancer of the breast and cervix uteri were the most common cancers in women. For the northeastern States, the highest burden of cancer was seen in the cancers of the oropharynx, nasopharynx, hypopharynx, oesophagus, stomach, liver, gall bladder, larynx, lung and cervix uteri.
The Report of National Cancer Registry Programme (NCRP), a joint assessment project of the Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research (NCDIR), provides a wide bird’s eye view of the cancer scenario in India during the study period between 2012 and 2016.
The summary of the report says it all: “The highest incidence of cancer in India was observed in the North Eastern region”, which after all is deafening, alarming and saddening for the people in the region. The NCRP report (2020) includes data from 28 Population Based Cancer Registries (PBCRs) and 58 Hospital Based Cancer registries (HBCRs) spread across the country.
It is no consolation whatsoever for the region when the report clearly indicates that Aizawl district in Mizoram State, one of the eight sister States in the North East, had the highest incidence rate of cancer lung in females across the whole of Asia.
Sadly again, the report profiles Aizawl district (Mizoram) in males and Papumpare district (Arunachal Pradesh) in females as having the highest incidence rate of cancer stomach when compared with the other non-Asian countries.
If it is any consolation for the region, the highest Crude Rate (CR) per 100,000 population among males for all sites of cancer in the 28 PBCRs assessed was observed in Aizawl district (206.2), followed by Kamrup urban (190.5), Thiruvananthapuram district (170.4), and Kollam district (159.4). Among the females, the highest CR was observed (again) in Aizawl district (174.6) followed by Thiruvananthapuram district (164.8), Kamrup urban (150.8), Chennai (141.4) and Kollam district (139.1).
In the assessment of cumulative risk of developing cancer of any site in the 0-74 years of age in the 28 PBCRs assessed under NCRP, for the North-East region Papumpare district in Arunachal Pradesh had the highest risk of one in four persons, both males and females, of developing cancer. Manipur had the risk of one in 14 males and one in 12 females of developing cancer as per the assessment.
For Manipur State, the ten leading sites of cancer in males are lung (18.9%), stomach (6.9%), nasopharynx (6.2%), oesophagus (5.3%), NHL (5.1%), other skin (4.3%), liver (3.8%), rectum (3.4%), larynx (3.3%), and colon (3.1%). In females, the ten leading sites are breast (15.4%), lung (14.4%), cervix uteri (9.5%), thyroid (7.6%), ovary (5.4%), gall bladder (5.2%), other skin (3.6%), NHL (3.6%), stomach (3.5%), and nasopharynx (2.7%).
Bad news in the offing for the country with the NCRP report profiling that the cancer burden is estimated to increase to 1.57 million by the year 2025 in India from 1.39 million in 2020, with tobacco-related cancers constituting a high of 27 per cent of all cancers analysed in India. As per the relative proportion of cancer sites associated with the use of tobacco, for all the sites of cancer in the 28 PBCRs assessed under NCRP, East Khasi Hills district in Meghalaya leads at 70.4% in males and 46.5% in females for the entire North East region.
Imphal West district in Manipur accounts for 37.3% in males and 19.1% in females for cancer-related to tobacco use. Cachar district in Assam also has a high at 54.0% in males and 23.4% in females, while Dibrugarh district in the State accounts for 51.8% in males and 21.8% in females for the same reading.
The assessment for anatomical sites of cancer related to the use of tobacco as assessed in the 58 HBCRs under study indicated that cancer oesophagus was more common among the females with 1179 individuals detected during the period of assessment in the north eastern region, while 2835 males were analyzed with cancer hypopharynx. For males, the next highest count was at 2397 individuals assessed with cancer oesophagus while for the females the next highest count was 717 individuals assessed with cancer mouth.
Cancer of the lungs related to the use of tobacco in the North East region also had a high count at 1262 males and 525 females during the period of assessment. This is followed by cancer of the tongue with 1290 males and 334 females detected for the same reading.
The NCRP report further assessed the childhood cancers for the 0-19 age group in the study period of 2012-2016, where it indicated that the proportion of childhood cancers relative to all cancers in all age groups varied between 1.0% to 4.9%. The relative proportion was highest in Delhi PBCR (boys- 6.2% and girls- 3.5%) in the north, Hyderabad district (boys- 4.4% and girls- 2.7%) in the south, and Aurangabad (boys- 5.7% and girls- 3.1%) in the west. The proportion was lowest in East Khasi Hills district (boys- 1.1% and girls- 0.9%) in the North East region as compared to the other regions in the country.
For the Age Adjusted Incidence Rates (AAR per million) of broad types of cancers in childhood (0-14 age group), the assessment for cancer leukaemia in Manipur accounted for 103 boys and 90 girls assessed as compared to 766 boys and 596 girls in Delhi during the period of study.
Sadly for the kids, the NCRP report suggested that cancer leukaemia and lymphoma were the most common types of childhood cancers, while the highest incidence rate of childhood cancer was seen in the national capital Delhi which is rated as one of the most polluted cities in Asia.
As it is, tobacco chewing can be the root of many ills and if the natives of the East Khasi Hills, and so may the residents of Imphal West district, heed to the warning spelt out clearly in the NCRP report, they would do best to give up chewing tobacco for all times.