Explore the vast range of titles available.

Colorectal cancer (CRC) is a common malignancy and cause for death around the world. In India, it ranks as the fourth most incident cancer in both sexes, with 64,863 cases and 38,367 deaths in 2022. With such high mortality, CRC survival in India is way lesser than that of developed countries. While western countries are facing an overall decline in CRC incidence, various regions in India are seeing an increasing trend. Within India, urban regions have markedly higher incidence than rural. Risk factors include consumption of red and processed meat, fried and sugary food, smoking and alcohol, comorbidities such as obesity, diabetes and inflammatory bowel disease (IBD), family history of CRC, adenomas and genetic syndromes, radiation exposure, pesticides and asbestos. Consumption of nutrient-rich well-balanced diets abundant in vegetables, dairy products, whole grains, nuts and legumes combined with physical activity are protective against CRC. Besides these, metformin, aspirin and micronutrient supplements were inversely associated with the development of CRC. Since a considerable proportion of CRC burden is attributed to modifiable risk factors, execution of population level preventive strategies is essential to limit the growing burden of CRC. Identifying the necessity, in this review, we explore opportunities for primary prevention and for identifying high-risk populations of CRC to control its burden in the near future.

Screening for cervical cancer is not a component of health care in rural India. This article reports on a trial of cervical-cancer screening by human papillomavirus (HPV) testing, cytologic analysis, or visual inspection of the cervix with acetic acid in rural villages. The results, as compared with those in a group that received no screening, showed that a single round of HPV testing significantly reduced the incidence of invasive cervical cancer and mortality in rural Indian villages. A trial in rural Indian villages of cervical-cancer screening by human papillomavirus (HPV) testing, cytologic analysis, or visual inspection of the cervix with acetic acid showed that a single round of HPV testing significantly reduced the incidence of invasive cervical cancer and mortality. In developing countries, there is a lack of effective screening programs for cervical cancer. In these countries, no clinically significant reduction in the incidence of cervical cancer has occurred during the past three decades. 1 – 4 In developed countries, by contrast, there has been a major decline in cervical-cancer mortality after the introduction of large-scale cytologic testing. The limited success of such screening in developing countries has stimulated evaluation of testing for human papillomavirus (HPV) and visual inspection of the cervix with acetic acid (VIA). In October 1999, we initiated a cluster-randomized, controlled trial to evaluate the effectiveness of a single . . .

Background Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. Methods This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. Conclusions Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.

Head and neck cancer (HNC) is a major public health problem in India. This article presents the HNC burden in different regions of India. The published population-based cancer registries (PBCRs) data from the National Cancer Registry Programme, Bengaluru, and the Tata Memorial Centre, Mumbai, India, were utilised. The 37 PBCRs were divided into six regions including central, east, north, northeast, west and south. The age-standardised incidence rate of HNC was 25.9 (95% CI 25.7–26.1) and 8.0 (95% CI 7.9–8.1) per 100,000 population, respectively, in males and females. HNC accounted for about 26% of all cancer cases in males and 8% in females. The risk of developing HNC was 1 in 33 for males and 1 in 107 for females. The northeastern registries reported the highest incidence rate 31.7 per 100,000 population in males followed by northern (28.5), central (28.3), western (24.4), southern (23.9) and eastern (18.3). In females, the incidence was in the range of 6.2–10.1 per 100,000 population. For all PBCRs together, the HNC burden was two to three times higher in the age group 60+ as compared to 20–39 years. The HNC burden in India is higher than in the USA, UK, Australia, Africa and Brazil. The PBCRs from the south-east Asia region such as the Colombo district, Sri Lanka, as well as Siraha, Saptari, Dhanusha and Mohattari – Nepal have also reported a high burden of HNC. All regions reported mouth as a leading cancer site followed by tongue, larynx, hypopharynx and tonsil except the northeastern region registries where hypopharynx was the top leading cancer. The burden of other sites of HNC is low. Raising awareness of the disease and associated risk factors, providing early detection services, as well as easy access to diagnosis and treatment are required. The government should focus on building the infrastructure and capacity building to control this disease.

Objective To provide the regional pediatric cancer (age-group 0–14 years) burden and pattern in India utilizing published data of population-based cancer registries established under the National Cancer Registry Programme and Tata Memorial Centre, Mumbai. Methods Based on the geographic locations, the population-based cancer registries were categorized into six regions. The age-specific incidence rate was calculated using the number of pediatric cancer cases and population in the respective age-group. Age-standardized incidence rate per million and 95% CI were calculated. Results In India, 2% of all cases were pediatric cancer. The age-standardized incidence rate (95% CI) for boys and girls is 95.1 (94.3–95.9) and 65.5 (64.8–66.2) per million population, respectively. Registries from northern India reported the highest rate; while the lowest rate was in northeastern India. Conclusion There is a need to establish pediatric cancer registries in different regions of India to know the accurate pediatric cancer burden.

Background Oral cancer (C03-C06) is a major public health challenge in India, particularly in rural regions where tobacco consumption is widespread. Despite the high burden, literature on survival data from rural populations is scarce. This study aims to assess overall survival and to identify prognostic factors associated with survival of oral cancer (OC) patients, using data from rural Population-Based Cancer Registries (PBCRs) in the Konkan area of Maharashtra, India. Methods This study was conducted on OC cases registered in the Ratnagiri and Sindhudurg PBCRs from 2017 to 2019. Survival was calculated from the date of diagnosis, with follow-up until December 31, 2023, or the date of death. Observed survival (OS) was calculated using the Kaplan-Meier method, and relative survival (RS) was calculated using the Pohar Perme method. Sociodemographic and treatment-related prognostic factors were assessed using the Cox proportional hazards model. Results Of the 656 OC patients, 245 patients (37.3%) were alive, while 411 (62.7%) had died by the end of follow-up period. The 5-year age-standardized relative survival (ASRS) for all ages was 38.01%. In multivariate analysis, no statistically significant differences in survival were observed across socio-demographic variables except income. Patients in the high-income group had better survival compared with those in the lower-income groups (HR: 0.56; 95% CI: 0.35–0.88). The highest 5-year survival was observed among patients treated with surgery combined with radiotherapy (57.75%), followed by surgery alone (55.57%). In contrast, patients treated with chemotherapy alone had poor survival (10.37%), reflecting presentation at advanced stages or management with palliative intent. Patients who completed the prescribed treatment protocol had significantly better survival compared with those who received no treatment after diagnosis (HR: 5.74; 95% CI: 4.09–8.07) and those who did not complete the prescribed treatment protocol (HR: 2.54; 95% CI: 1.83–3.51). Conclusion Oral cancer survival in Konkan area is lower than that reported in urban regions, owing to socioeconomic disadvantage, late diagnosis, and low treatment uptake. Strengthening early detection, ensuring timely access to care, and raising awareness about tobacco cessation services and government health schemes can improve survival.

Background Breast cancer emerged as number one cancer among women worldwide in terms of incidence and mortality. Majority of breast cancers diagnosed in India are among women aged 45 years and above. A low proportion of Indian female population in reproductive age group (30–49 years) underwent breast cancer screening. The national operational framework includes mammography as one of the investigation modalities under the algorithm for early detection and management of breast cancer. This study describes prevalence and associated factors of mammography uptake in women aged 45 years and above. Methods We utilized data from 35,083 women aged ≥ 45 years in the Longitudinal Aging Study of India, a nationwide representative survey of the Indian population. The outcome variable was self-reported history of undergoing mammography in past two years before the survey as a representation of early detection of breast cancer. Demographic, behavioural, and clinical characteristics were taken as independent variables. Univariable and multivariable models were applied for the following age groups: 45–59 years and ≥ 60 years, and unadjusted and adjusted odds ratios were calculated. Results The prevalence of mammography was 1.3% among Indian women aged 45 years and above, 1.7% among 45–59 years and 0.9% among women ≥ 60 years. The highest prevalence was reported in Kerala and the lowest was in Nagaland. Among women in 45–59 years age group, secondary or higher education, being currently in union, having diabetes, neurological illness, hearing problems, and reproductive health problems, better cognition level, and self-history of cancer were found to be associated with increased mammography uptake. Urban residence, being currently in union, having bone/joint disease, hearing problem, and one or multi-morbidity, better cognition level and self and family history of cancer were associated with higher mammography uptake among elderly women. Conclusions Low rates of mammography among women across the country, along with inter-state disparities, highlight inadequate coverage of early detection of breast cancer under National program. Increasing burden of breast cancer in all states underscores need to implement early detection program proactively. Disparities in mammography uptake by age, residence and co-morbidities reflect the need for special focus and context-specific research for pragmatic interventions.

Nepal is one of the high prevalent countries for tobacco use in Southeast Asia regions. Tobacco related cancer share the major burden since a decade, however, population-based estimates is still lacking. This study provides results from population-based cancer registries on tobacco-related cancer (TRCs) burden in Nepal. The data were collected by population-based cancer registry conducted in nine districts by Nepal Health Research Council. The districts were categorized in urban, semi-urban and rural regions on the basis of geographical locations and facilities available in the regions. Analysis was done to identify tobacco-associated cancer incidence, mortality and patterns along with cumulative risk of having cancer before the age of 75 years. Tobacco-related cancer was 35.3% in men and 17.3% in women. We found that every one in 36 men and one in 65 women developed tobacco-related cancer before age 75 in Nepal. Cancer of lung, mouth, esophagus and larynx were among the five most common tobacco-related cancers in both men and women. The incidence of tobacco-associated cancers was higher in urban region with age adjusted rate 33.6 and 17.0 per 100,000 population for men and women respectively compared to semi-urban and rural regions. Tobacco-associated cancer mortality was significantly higher compared to incidence. The prevalence of tobacco-related cancer found high in Nepal despite of enforcement of tobacco control policy and strategies including WHO framework convention on tobacco control. Concerned authorities should focus towards monitoring of implemented tobacco control policy and strategies.

Relative survival (RS) is an essential statistic for evaluating cancer outcomes utilising data from population-based cancer registries (PBCRs). Despite India having 52 PBCRs, the availability of survival information is constrained, one of the challenges being producing population mortality (PopMort) files required for RS calculations. To address this challenge, we created an Excel-based application (PopMortGen-India) that automates the generation of PopMort files from abridged life tables supplied by India's Sample Registration System (SRS). The program calculates age- and sex-specific mortality rates by inverting traditional life table formulas and determines survival probabilities for any particular single-year age. The application, developed in Microsoft Excel, employs organised worksheets, formula-driven automation and macros to facilitate the effortless creation of PopMort files, compatible with statistical software such as STATA, R and SAS. 'PopMortGen-India' markedly decreases the time needed to produce PopMort files, reducing it from several hours manually to less than 10 minutes for a decade-long dataset. Utilising the life tables of rural Punjab and Maharashtra, PopMort files were generated swiftly and precisely. RS estimates obtained from these files in STATA are closely aligned with published data, including age-standardised RS statistics. The tool offers a quick, precise and scalable method for producing PopMort data vital for RS analysis. Its alignment with manual techniques, coupled with substantial time efficiency, renders it especially appropriate for implementation in resource-limited environments. We propose its formal implementation into PBCR procedures and capacity-building measures to standardise and improve survival statistics among cancer registries in India.

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.