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Population Based Cancer Registries
Consolidated Report – (1990-96)
This section provides a synopsis of the just published consolidated
report of the Population Based Cancer Registries (PBCRs) covering
the seven-year data of the years 1990-1996.
The registries covered in this data include all the Population Based
Cancer Registries under the NCRP. These include the five urban
Emphasis of Report:
Cancer Incidence and
Patterns of cancer
registries at Bangalore, Bhopal, Chennai, Delhi and Mumbai and
the rural registry at Barshi.
The main emphasis of this report is on cancer incidence and
patterns of cancer. The overall aim and objective is to provide
incidence data that are not only comparable among the cancer
registries reported, but also with cancer registries in different parts
of the world. It attempts to give clues to the burden and patterns
of cancer in these areas where the registries are located so as to
Cancer Incidence:
present a base for studies in cancer aetiology and control. Though
the geographic area and the population covered by the registries
Expressed as Crude or Age
is small, compared to the vastness of the country and its huge
Adjusted Incidence Rate
population, the data does give a fair idea of the cancer problem in
per 100,000 population.
the country. This study is the culmination of sustained efforts made
by cancer registries under the NCRP.
Incidence Rate
Cancer incidence rate is generally expressed as age adjusted or
age standardized (according to world standard population)
incidence rate per 100,000 persons. For all anatomical sites the
rates vary from 97.8 (in Bangalore) to 121.9 (in Delhi) in urban
males. In urban females the rates vary from 92.2 (in Bhopal) to
135.3 in Delhi. Incidence rates in the rural registry of Barshi are
lower (46.2 and 57.7 per 100,000 in males and females
respectively). The urban incident rates are similar to that seen in
Indians in Singapore (105.5 and 122.7 per 100,000 in males and
10
females respectively), but lower than the rates observed in the
registries of the developed countries in the west and Oceania or
Japan. Cancer incidence can also be expressed as crude rates.
Crude incidence rate is the total number of new cancer cases in a
particular year per 100,000 population in the defined geographic
area. Crude rates represent the actual burden of illness in the
country and changes in it over time. In the urban registries this
varies from 56.9 per 100,000 (in Bhopal) to 78.6 (in Chennai)
among males, and 55.6 (in Bhopal) to 91.4 (in Chennai) among
females.
Figure 1 gives the bar charts comparing the International Age
Adjusted Incidence Rates of cancer for all anatomical sites.
●
Coding of Malignant Neoplasms done according to
Cumulative Rate
the International Classifi-
The PBCRs have provided age (five year age group) specific cancer
cation of Diseases for
incidence rates in the different registry areas. Through these rates
Oncology.
it is possible to arrive or estimate the risk of the particular population
in developing cancer during their lifetime. This could be estimated
by sex and for any specific site of cancer. This is known as the
cumulative incidence rate or risk. Based on the cumulative risk
the probability of a person developing cancer in the absence of a
competing cause of death can be calculated and this is expressed
as "one in".
●
On an average about one
in about 15 men and one
in about 12 women in the
The cumulative rate can be estimated from the age specific rates
urban centres could
either for the five-year age groups from 0-64 years or for the age
develop cancer in their
group 0-74 years. Except for Indians in Singapore, the cumulative
lifetime.
incidence rates of cancer in cancer registries worldwide, especially
in the developed countries are substantially higher than that seen
among the registries in India.
Based on the above, and assuming that the age specific rates
(from 0-64 years) of the years 1990 to 1996 are sustained, and
there is no other competing cause of death, one could estimate,
that, on an average about one in about fifteen men and one in
about twelve women in the urban centres could develop cancer in
their lifetime. Specifically for Delhi, one in thirteen men and one in
ten women, can be expected to develop cancer in their lifetime.
11
Figure 1: International Comparisons of Age Adjusted Cancer Incidence Rates (ALL-SITES)
MALES
US, San Francisco: Black
465.4
ltaly, Triesto
414.0
414.0
397.7
397.7
US, Hawai: White
Brazil, Porto Alegre
326.4
326.4
Jap, Hiroshima
322.3
322.3
Zirn, Harare: Eur
290.6
290.6
US, Hawai: Filipino
216.7
216.7
ltaly, Ragusa
178.9
178.9
New Mex American lnd
151.3
151.3
Peru, Lima
123.8
123.8
India, Delhi
121.9
121.9
India, Mumbai
115.4
115.4
Algeria,Setif
107.1
107.1
Singapore Indians
105.5
105.5
India, Chennai
104.6
104.6
Kuwait: Kuwaitis
103.9
103.9
India, Bhopal
100.4
100.4
India, Bangalore
97.8
97.8
India, Barshi
46.2
46.2
0
100
200
300
400
500
FEMALES
NZ: Maori
339.7
US, San Franc: NonHisp.White
305.4
305.4
lsrael, Jews born in US & Eur
268.3
268.3
Denmark
261.6
261.6
Uruguay, Montevideo
255.2
255.2
Zim, Harare: Europeans
247.5
247.5
US, Hawai: Chinese
183.5
183.5
Peru, Lima
151.2
151.2
US, LA: Koreans
138.0
138.0
India, Delhi
135.3
135.3
Poland,Kielce
131.0
131.0
122.7
122.7
Singapore Indians
India, Bangalore
122.1
122.1
India, Mumbai
119.1
119.1
India, Chennai
115.3
115.3
India, Bhopal
92.2
92.2
89.4
89.4
Vietnam,Hanoi
Algeria,Setif
67.4
67.4
India, Barshi
57.7
57.7
0
100
200
12
300
400
Cancers of Sites associated with use of Tobacco
Sites of cancer that have been associated with use of tobacco
(Tobacco Related Cancers - TRCs) include oral cavity, pharynx
(including oropharynx & hypopharynx) oesophagus, larynx, lung
and urinary bladder.
Overall, among males, cancers of sites associated with use of
●
Among males, cancers
tobacco are the most frequent. Cancer of the lung is numerically
of sites associated with
the number one cancer. It is the leading site in Delhi, Mumbai and
use of tobacco are the
Bhopal, wherein it constituted around 10% of cancers of all sites.
most frequent. Cancer of
It is the second and third leading site among males in Bangalore
the lung is numerically
and Chennai respectively. In females also, cancer of the lung is
the number one cancer.
one of ten leading sites in four of the six registries at Bhopal,
Chennai, Delhi and Mumbai. Another site of cancer associated
with the use of tobacco, namely, cancer of the oesophagus is an
important leading site in both males and females. The age adjusted
●
The
age
incidence
incidence rate of oesophageal cancer in women in Bangalore is
adjusted
rate
of
oesophageal cancer in
again one of the highest (8.3 per 100,000) in the world. Cancer of
women in Bangalore is
the oesophagus is the second leading site of cancer in Bangalore,
one of the highest (8.3 per
Barshi and Mumbai and the third leading site in Chennai and fourth
100,000) in the world.
in Bhopal.
Based on currently available data, in registries in all continents,
males in Bhopal have the highest age adjusted incidence rate (8.8
per 100,000) of cancer of the tongue. Similarly the rates of cancer
of the oral cavity in both males and females in all the urban registries
are among the highest in the world.
●
Based
on
available
currently
data,
in
registries in all continents,
males in Bhopal have the
The total proportion of TRCs relative to all sites in males varies
highest age adjusted
from 35.6% in Bangalore to 50% in Bhopal, whereas in females
incidence rate (8.8 per
Bangalore has the highest proportion of TRCs (17.3%). In males,
100,000) of cancer of the
among the TRC sites, pharynx and lung are the common sites
tongue.
and among females oesophagus and oral cavity are the commoner
sites. These two sites together account for 80% of all TRCs in
females.
The above data underscore the role of tobacco in cancer causation.
Figure 2 illustrates the relative proportion of TRCs, relative to all
sites, in each of the six PBCRs.
13
Figure 2: Proportion (%) of Tobacco Related Cancers relative to all sites
MALES
FEMALES
60.0
60.0
50.0
40.0
38.3
35.6
%
40.0
44.7
43.6
42.8
20.0
20.0
17.3
15.7
10.4
10.1
Oral Cavity
Pharynx
Mumbai
0
Delhi
0
Chennai
10
Bhopal
10
Barshi
20
Bangalore
20
Oesophagus
Larynx
14
Chennai
Bhopal
Barshi
Lung
Mumbai
30
Mumbai
30
Delhi
40
Delhi
40
Chennai
50
Bhopal
50
Barshi
Bangalore
60
%
60
Bangalore
Mumbai
Delhi
Chennai
Bhopal
Barshi
0.0
Bangalore
0.0
17.0
16.9
Urinary Bladder
Other Leading Sites of Cancer and Regional Variations
Cancer patterns vary not only throughout the world but also
between different population groups within the same country. The
bar charts in Figure 3 give the ten leading sites (according to relative
proportion) of cancer in the different PBCRs among males (Fig.
3.1) and females (Fig. 3.2).
The preliminary and subsequent reports of the NCRP have shown,
●
Cancer of the Stomach
cancer of the stomach as a consistent leading site of cancer among
in males continues to be
males in Bangalore and Chennai, whereas it is lower down among
the leading site of cancer
the leading sites of cancer in Bhopal, Delhi or Mumbai.
in the southern registries
In women, cancers of the cervix and breast together account for
of
Chennai
over 40% of cancers in urban women and over 65% of cancers in
Bangalore.
and
the rural registry in Barshi. There is a decline in the rates of cervical
cancer especially in Chennai (which has the highest age adjusted
incidence rate among the six registries). This trend requires careful
evaluation, as cytology screening as such is not widely practiced.
●
In women, cancers of the
One school of thought is that one is perhaps dealing with cohorts
cervix
of women who have an increasing age at marriage. The same
together account for over
analogy applies to the rather increasing trend in breast cancer
40% of cancers in urban
rates.
women and over 65% of
One of the sites of cancer that has been brought to sharp focus is
cancers in the rural
and
breast,
registry in Barshi.
that of cancer of the gall bladder, especially in females in Delhi
and Bhopal. This is important because the age adjusted incidence
rate (8.9 per 100,000) of cancer of the gall bladder in Delhi women
is one of the highest in the world. The NCRP has undertaken a
case control investigation on this site of cancer, in Delhi, to
●
The
age
adjusted
determine possible reasons for its high incidence. This study is
incidence rate (8.9 per
presently in progress.
100,000) of cancer of the
Lymphoreticular malignancies as a group are a very important set
of neoplasms. They comprise over 10% of malignant neoplasms,
have a potential for cure and are of interest in terms of aetiology
and epidemiology.
Apart from the above, cancer of the prostate is a leading site in all
urban registries, while cancer of the penis that is not seen in the
urban registries is the third leading site in Barshi. Similarly cancer
of the brain and nervous system is the third and sixth leading site
in males and females respectively in the capital and one of ten
leading sites in males in all other urban registries.
15
gall bladder in Delhi
women is one of the
highest in the world.
Figure 3.1: Ten Leading Sites of Cancer - Males
Age Adjusted Rates given in parentheses
BANGALORE
9.3 (9.5)
Stomach
8.6 (9.1)
Oesophagus
7.0 (7.4)
Lung
5.5 (5.8)
Hypopharynx
4.0 (4.2)
Larynx
NHL
3.8 (3.5)
3.8 (4.3)
Prostate
Brain-NS
3.5 (2.8)
Tongue
3.4 (3.5)
3.2 (3.1)
Rectum
0
2
4
6
8
10
12
14
%
BARSHI
10.7 (5.2)
Hypopharynx
8.5 (4.2)
Oesophagus
6.6 (3.0)
Penis
5.2 (2.4)
Oral Cavity
4.7 (2.2)
Tongue
Larynx
4.7 (2.3)
4.1 (1.9)
Liver
Rectum
3.3 (1.5)
Lung
3.3 (1.6)
3.3 (1.4)
Leuk. Myelo.
0
2
4
6
8
10
12
14
%
BHOPAL
11.9 (13.1)
Lung
8.1 (8.8)
Tongue
7.2 (7.3)
Oral Cavity
6.9 (7.5)
Oesophagus
6.5 (7.3)
Hypopharynx
4.2 (5.1)
Prostate
4.1 (3.1)
Brain-NS
Larynx
3.5 (3.9)
Stomach
3.5 (3.4)
2.8 (1.8)
Leuk. Myelo.
0
2
4
6
8
%
16
10
12
14
Figure 3.1: Ten Leading Sites of Cancer - Males (Contd...)
Age Adjusted Rates given in parentheses
CHENNAI
Stomach
12.6 (13.6)
10.5 (11.2)
Lung
8.1 (8.8)
Oesophagus
5.9 (6.4)
Oral Cavity
Hypopharynx
4.8 (5.2)
Tongue
4.7 (5.1)
4.1 (4.5)
Larynx
NHL
3.7 (3.4)
Prostate
3.1 (3.8)
2.8 (2.5)
Brain-NS
0
2
4
6
8
10
12
14
16
18
%
DELHI
Lung
9.4 (12.9)
6.9 (9.3)
Larynx
4.8 (4.6)
Brain-NS
Tongue
4.7 (6.0)
NHL
4.7 (5.1)
Oesophagus
4.6 (6.2)
4.2 (6.1)
Uri. Blad.
Prostate
4.0 (6.5)
Oral Cavity
3.3 (4.1)
3.1 (3.9)
Stomach
0
2
4
6
8
10
12
14
%
MUMBAI
Lung
9.4 (12.0)
6.8 (8.5)
Oesophagus
5.6 (7.0)
Larynx
5.5 (5.7)
Oral Cavity
5.3 (6.4)
Stomach
Hypopharynx
5.3 (6.4)
5.0 (5.7)
Tongue
Prostate
4.6 (7.1)
NHL
4.3 (4.3)
3.8 (3.3)
Brain-NS
0
2
4
6
8
%
17
10
12
14
Figure 3.2: Ten Leading Sites of Cancer - Females
Age Adjusted Rates given in parentheses
BANGALORE
Cervix
21.5 (26.1)
18.6 (22.1)
Breast
Oral Cavity
6.2 (8.0)
Oesophagus
6.0 (8.3)
4.4 (5.0)
Ovary
Stomach
3.9 (5.1)
Thyroid
2.9 (3.0)
Rectum
2.3 (2.8)
Body Uterus
2.0 (2.6)
NHL
1.9 (2.4)
0
5
10
15
20
25
30
%
BARSHI
Cervix
50.7 (29.3)
15.1 (8.8)
Breast
4.2 (2.6)
Oesophagus
2.2 (1.3)
Ovary
Oral Cavity
1.4 (0.9)
Stomach
1.4 (0.8)
Skin. Other
1.4 (0.8)
Hypopharynx
1.3 (0.7)
Leuk. Myelo.
1.3 (0.7)
Tongue
1.0 (0.6)
0
10
20
30
40
50
60
70
%
BHOPAL
Cervix
23.9 (21.7)
22.2 (19.9)
Breast
6.5 (5.6)
Ovary
Oral Cavity
4.6 (5.1)
Oesophagus
4.4 (4.9)
Lung
2.4 (2.6)
Brain-NS
2.4 (1.7)
Gall Bladd.
2.4 (2.5)
Stomach
1.9 (1.8)
Leuk. Myelo.
1.9 (1.4)
0
5
10
15
%
18
20
25
30
Figure 3.2: Ten Leading Sites of Cancer - Females (Contd...)
Age Adjusted Rates given in parentheses
CHENNAI
26.9 (30.8)
Cervix
19.1 (21.7)
Breast
Stomach
5.5 (6.5)
Oesophagus
5.0 (6.1)
Ovary
5.0 (5.5)
Oral Cavity
4.9 (6.0)
Rectum
2.0 (2.4)
Lung
2.0 (2.4)
NHL
1.9 (1.9)
Hypopharynx
1.6 (1.9)
0
5
10
15
20
25
30
35
40
%
DELHI
Breast
21.3 (28.1)
19.9 (26.6)
Cervix
6.3 (8.3)
Ovary
5.8 (8.9)
Gall Bladd
2.8 (4.4)
Oesophagus
Brain-NS
2.8 (3.2)
NHL
2.3 (3.1)
Body Uterus
1.9 (2.9)
Leuk. Myelo.
1.9 (1.9)
Lung
1.9 (2.8)
0
5
10
15
20
25
30
%
MUMBAI
24.7 (28.6)
Breast
15.2 (17.2)
Cervix
6.4 (7.3)
Ovary
5.0 (6.7)
Oesophagus
3.4 (4.2)
Oral Cavity
Lung
2.6 (3.4)
Stomach
2.5 (3.2)
NHL
2.4 (2.9)
Brain-NS
2.3 (2.3)
2.3 (3.0)
Colon
0
5
10
15
%
19
20
25
30