Cancer burden in Nagaland

The shock value of a cancer diagnosis is decreasing with improvement in technology and treatment modalities. The diagnosis of a cancer case was similar to receiving a ‘death warrant’ which incited fear and despair in the patient and relatives. Bollywood movies have used it to induce similar feelings in the viewers. We have come a long way from that. Many cancers have become potentially curable. But the good news of progress made in cancer detection and treatment is tempered by the bad news that the burden of cancer is on the rise. It is estimated that cancers in India may increase five-fold by 2025. The economic burden of cancer is also growing. The average cost of treatment of cancer in a government set-up is about half the annual income of an average Indian. And cancer centres with adequate facilities are far from adequate. So, cancer care is out of reach for millions of Indians.  

North East India is a hot bed of cancer incidence. As per the Population Based Cancer Registry (PBCR) 3 years report (2009 to 2011) of the ICMR, the highest incidence of many cancers are located in the North East Region. Aizawl district of Mizoram recorded highest incidence at 250.6 new cancer cases per 1,00,000 population every year. For Nagaland, the incidence rate is 98.15 per 1,00,000 population (males:126.1, females: 70.2). The incidence rates given here are age-adjusted incidence rates which give a clearer picture of the cancer situation because cancer incidence is influenced by the age of the population. The top 3 cancers in Nagaland among men are Nasopharynx, Stomach, and Oesophagus, and among females they are Cervix, Stomach, and Breast. Incidence rate of Cancer Nasopharynx among males in Nagaland is very high (21 per lakh population) and is only next to the highest incidence in the world which is in China (26.9). 

The four major risk factors of non-communicable diseases viz tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol are the major risk factors of cancer. The above data from ICMR correlates well with the Global Adult Tobacco Survey (GATS) 2009-10. The top 5 States in India in tobacco use are from the North East. Tobacco is by far the single most important risk factor of cancer which is responsible for 22% of cancer deaths. Mizoram (67%) has the highest percentage of tobacco use followed by Nagaland (57%).

WHO notes a ‘westernization’ trend in the progress of cancers, that as countries undergo societal and economic changes, the pattern of cancer also changes to become more like the scenario in the western countries. Cancers resulting from infections tend to decrease while cancers resulting from lifestyle and dietary habits, reproductive and hormonal factors increase. However, in the North East States, traditional and cultural food habits/lifestyle like smoked meat, salted fish, fermented food items, indoor smoke pollution, etc also still contribute heavily to the incidence of cancer. 

Wide spectrum of interventions, ranging from promotion of healthy lifestyle, prevention of risk behaviors, and early detection, to onco-surgery, chemotherapy, radiotherapy and palliative medicine are required in handling cancer. Political commitment and action are also vital in cancer control. Dr. Mohandas Mallath,  lead author of a series of reports on the cancer burden in India published in The Lancet said, ‘The need for political commitment and action is at the heart of the solution to India's growing cancer burden…The extent to which death and illness from cancer will actually increase in the next 20 years will depend a lot on the investments made in future decades in tobacco control, healthcare delivery, cancer research, clinical trials, and increasing the public awareness as to how we can all help to reduce the risk of cancer by eliminating risky behaviors such as smoking, vaccinating those at risk of cancer causing infections and following a healthy diet and lifestyle’.