Be careful of what you drink and eat, oncologists across India are repeatedly telling cancer patients, arguing why lifestyle and environment are among the leading risks for cancer.

The examples offered are both intriguing and interesting. Repeated studies have now conclusively proved that incidence of gall bladder cancer is highest in parts of northern, eastern and northeastern India and the lowest in southern India. Why? The Gangetic belt states of West Bengal, Bihar and Uttar Pradesh have high concentration of heavy metals in the soil and ground water—a serious reason for high incidence of gall bladder cancer. Similarly, common cases of cancers in the northeastern parts of India are of oesophagus, stomach and hypopharynx. The northeastern states have also recorded the country’s highest incidence of nasopharynx and gall bladder cancer, in Nagaland and Kamrup in Assam. 

For the records, rise in consumption of tobacco in eastern and northeastern India has led to an increase in lung cancer among men, says Dr Gautam Mukherjee, a Kolkata-based oncologist.

Dr Mukherjee says rapid changes in food habits have made women more vulnerable to breast cancer. “If it’s breast or lung cancer, the chances are high that over 70% patients would be from metros like Delhi, Bengaluru, Hyderabad, Chennai, Mumbai, than from the villages.” In Bengaluru and Chennai, more than a quarter of the total number of cancers in women are of the breast.

The first hint of such linkages was found when the government published its Million Death Study in 2012. 

“Environment and lifestyle are becoming major causes for cancer. For example, a young person from the northeastern state is highly prone to developing and succumbing to cancer than the one from Bihar, even Jharkhand,” says Dr Balendu Prakash, a top ayurvedic physician specialising in pancreatic cancer cases. Prakash says some cancers are common, others are specific to various regions. “Water in the Gangetic plains is highly polluted because of sediments and high consumption of animal protein and fish.” 

An estimated 2,500 people die of cancer in India every day, making it the second most common cause of death in India after cardiovascular disease. And nearly 2,000 new cancer cases are detected daily, claims the NICPR. Its projections put the number of new cases by 2020 at 17.3 lakh.

Early this year, a study by Lancet said India continues to have a low survival rate for breast cancer, with only 66.1% women diagnosed with the disease between 2010 and 2014, surviving. In comparison, the US and Australia had survival rates as high as 90%: “For women diagnosed during 2010-14, five-year survival for breast cancer is now 89.5% in Australia and 90.2% in the USA, but international differences remain very wide, with levels as low as 66.1% in India.”

CONCORD-3, a global programme for worldwide surveillance of cancer survival, led by the London School of Hygiene and Tropical Medicine, recently analysed individual records for 37.5 million patients diagnosed with cancer during the 15-year period from the year 2000 to 2014. The programme analysed data from 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage.

“Awareness about cancer and its treatment is very low in India and cases are first detected when the patient is in the third or fourth stage. Hence, treatment is difficult,” says Ravi Mehrotra, director, National Institute of Cancer Prevention And Research (NICPR).

The study said survival trends are generally increasing, even for some of the more lethal cancers. In some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung.

“In developed countries, only 25% of patients diagnosed die due to breast cancer, which means 70%-80% are cured because of early diagnosis. In India 60% patients die of breast cancer because of late diagnosis, which doubles the cases,” says Dr Ramesh Sarin, cancer surgeon at Delhi’s Indraprastha Apollo Hospital.

“India badly needs more screening methods, diagnostic centres and knowledgeable oncologists in tier two and tier three cities. Patients lack funds for treatment and don’t have centres closer to their home towns,” says Dr Sarin.

Agrees Bengaluru-based Dr P.P. Bapsy, who says corporates in India need to invest in such cancer screening and detection centres. “India needs low cost, accessible treatment, but that is not possible because there aren’t too many machines in India. But this can change if there are enough funds for such machines across the country.”

According to the Union Ministry of Health, breast cancer ranks as the number one cancer among Indian females, with the rate as high as 25.8 per 100,000 women and mortality of 12.7 per 100,000 women.

According to estimates, at least 1,797,900 women in India may have breast cancer by 2020.

Studies across the world are throwing up interesting cases that are baffling oncologists. For example, it is now conclusively proved that oestrogen, the female sex hormone that shields young women against cardiovascular diseases, plays a major role in her battle with cancer. What is interesting is that oestrogen not only increases her chances of getting the disease, but also increases her chances of survival. As a result, claims the World Health Organisation (WHO), more Indian men died due to cancer than women. Nearly 75% of men affected with cancer have low life expectancy, while the mortality rate of cancer in women is 60% in India.

Dr Rakesh Jalali, medical director of Apollo Proton Cancer Centre and Dr Rakesh Kapoor, department of radiotherapy at PGIMER, Chandigarh, both agree women are subjected to more medical attention in their lifespan as compared to men. “Men have prolonged exposure to lifestyle risk factors that cause cancer, such as tobacco use, substance abuse and alcohol consumption,” says Dr Kapoor. 

Dr Jalali says there are enough reasons why cancer mortality is higher among men. Lung and oral cavity cancers that are the leading cancers among men are usually detected at a late stage. “Now 95% of these cancers are due to tobacco consumption, and 40% due to tobacco abuse. Mortality is high as it is hard to detect these cancers. There is no screening of cancers in men.”

India needs more funds for cancer, the faster the better.

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