Guwahati: Mizoram has once again lived up to its dubious distinction of being called the ‘cancer capital’ of India. As per a new report published by medical journal The Lancet, the Northeast Indian state registered the second highest rise in cancer cases, after Kerala, from 89.1 (per 1 lakh population) in 1990 to 121.7 (per 1 lakh population) in 2016.
Mizoram also recorded the highest crude cancer DALY (disability-adjusted life-years) rate in 2016, followed by Kerala, Assam, Haryana, and Meghalaya. Crude rate equals the total number of new cancer cases during a specific year in the population category of interest, divided by the at-risk population for that category and multiplied by 100,000.
Cancer is the second leading cause of death globally after cardiovascular diseases. The number of deaths due to cancer in India increased from 3,82,000 in 1990 to 8,13, 000 in 2016. The crude cancer death rate in India in 2016 was 61.8 per 100,000, as compared with 44.2 in 1990.
For a long time now, Mizoram has been battling the growing menace of cancer, recording high incidence of cancer cases among Indian states. The new Lancet report for 2016 does not present a different picture either. Mizoram ranks first in terms of lung cancer among females, second in case of males, with a 502.8 7 crude DALY rate (per 100,000 population) against the all-India average of 133.8.
The Northeast state also ranks first in case of stomach cancer among males and second in case of females, with a 555.2 crude DALY rate (per 100,000 population) against a national average of 159.5. Mizoram also holds the third position in cases of breast cancer among females and oesophageal cancer in males. In terms of colon and rectum cancer, Mizoram ranks third with the crude DALY rate being 130.3. The state also ranks fourth so far as the crude incidence rate for liver cancer in males is concerned.
The study was authored by DDG of WHO Dr Soumya Swaminathan and Dr Lalit Dandona of the Public Health Foundation of India along with researchers from several ICMR institutes across the country. The study also draws a comparison between the rise in cancer cases between 1990 and 2016. The comparison ranks Mizoram in the second position with 89.1 in 1990 and 121.7 million in 2016, just next to Kerala which has witnessed an increase from 74.1 in 1990 to 135.3 million in 2016.
As per a Population Based Cancer Registries (PBCR) report, cancer had killed over 700 people every year in Mizoram from 2012-14. The report also revealed that there were 4,656 new cases of cancer reported between 2012 and 2014 with number of females at 2,089 and males at 2,567. It means on an average, there were 1,552 new cancer cases reported per year in Mizoram.
Why is cancer on the rise?
The report states that certain eating habits, lifestyle choices and addictions have caused a rise in cancer cases among the people. As per the report, factors such as smoking and unhealthy dietary habits are leading to stomach cancer and high fasting plasma glucose as well as second-hand smoke, among other things, is triggering breast cancer.
Speaking to EastMojo, Dr. Lalit Dandona of the Public Health Foundation of India, a co-author of the study, cited, “Tobacco use and indoor as well as outdoor air pollution are the leading risk factors for lung cancer in India.”
Dr. Amal Kotoky, director of B Borooah Cancer Institute, another co-author of the study, said, “Although tobacco consumption has come down nationally from 34% in 1990 to 28% in 2016, in case of Assam, there is a 48% increase in 2016 from about 39% in 1990, while Tripura has witnessed a 55% increase, and in case of Manipur., it is nearly 50%”.
The study further attributes “low cancer awareness, late diagnosis, and the lack of or inequitable access to affordable curative services compared with patients in high-income countries” for the high incidence of cancer.
Dr. Kotoky further attributes the cancer cases to the peculiar eating habits of the Northeast such as chewing betel nuts and consuming fermented or smoked meat and fish, which are generally kept hanging from the ceiling of the kitchen for months together. “This gives way to nitroso compounds having carcinogens apart from fungus to grow into the food. Apart from the food choices, the use of wood as a source of fuel and consumption of alcohol are other major risk factors for cancer,” he added.
However, not everything is so bad in Mizoram, though. two villages in the state -- Thingsul Tlangnuam in Aizawl district and Ruantlang in Champhai district -- were declared ‘smoke free’ on September 12, on the occasion of State Anti-Tobacco Day, this year. The feat was achieved after dedicated intervention by the Mizoram branch of the Indian Society on Tobacco and Health (ISTH). It is the excessive use of tobacco that is leaving a large chunk of the population of the state vulnerable to the life-threatening disease of cancer.
Other NE states gripped by cancer
Apart from Mizoram, there are other North-eastern states as well which have figured in the Lancet study. In terms of crude lung cancer incidence among females, Manipur ranks second, just next to Mizoram. The DALY rate for oesophageal cancer was highest in Meghalaya, Assam, and Nagaland apart from Mizoram, while the DALY rate for brain and nervous system cancer was second highest by Sikkim.
The study further reveals that in terms of the crude incidence rate for larynx cancer in males, it was the fourth highest in Assam in 2016. The study attributes smoking and alcohol use as one of the leading factors causing the cancer. Similarly, the crude incidence rate for liver cancer in males was highest in Arunachal Pradesh, followed by Kerala, Sikkim, and Mizoram. The state of Arunachal Pradesh also doesn’t lag far behind as it ranks third so far as the crude incidence of ovarian cancer is oncerned.
In the context of cancer incidence in the Northeast, Dr Kotoky mentioned, “The research done by the participating centres including the Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research points out that the incidence of cancer is particularly very high in Mizoram, Papumpare district of Arunachal Pradesh, East Khasi Hills district of Meghalaya and the urban Kamrup district of Assam”.
He further added, “The prevalence of cancer in Assam is 29,000 out of 39,000 new cancer patients added every year in the whole of Northeast.”
The study has put forward some worrying facts regarding the status of cancer in the Northeast, and it calls for some serious and immediate intervention on the part of the state to ensure that these numbers come down. A first step in this direction would be to make the region tobacco free by banning the consumption as well as sale of tobacco inviting stringent punishment, apart from spreading awareness on the prevention measures that can be taken by people to keep a disease such cancer at bay.