Assessing cancer burden in rural India: an analysis by cause of death statistics.

India lacks nationwide cancer registration and systematic death registration. Gaining insight into the magnitude of the cancer problem in India depends mainly on 14 population based cancer registries, which provide relatively accurate statistics although the area and population cover by these registries is minimal at about 7% (20% Urban and 1 % Rural). With estimation of cancer burden from other sources, paucity of adequate data on the one hand and the complex pathogenesis of disease on other makes for complexity in dealing with rural populations. However, surveys of cause of death do reveal some interesting patterns that may very well be of use for international comparisons. In this paper an attempt has been made to estimate the cancer burden in rural India using the information available from surveys of cause of death for rural populations conducted by the Government of India.

Population-based survival from cancers of breast, cervix and ovary in women in Mumbai, India.

BACKGROUND: Breast, cervix and ovarian cancers contribute more than 45% of the total in women in Mumbai and survival proportions for these neoplasms are very high in most developed populations in the World. The authors here report and discuss the population-based survival for these cancers in Mumbai, India. METHODS: Follow-up information on 4865 cancers of breast, cervix and ovary, registered in the Mumbai Population Based Cancer Registry for the period 1992-1994 was obtained by a variety of methods, including matching with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis and date of death, date of loss to follow-up or the closing date of the study (December 31(st), 1999). Cumulative observed and relative survival was calculated by the Hakulinen Method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used in univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent predictors of survival. RESULTS: The 5-year relative survival rates were 46.2% for breast, 47.7% for the cervix and 25.4% for the ovary. Higher survival was observed for those younger than 35 years for all these three sites. For each, survival declined with advancing age. Single patients who remained unmarried had better survival. For all sites Muslims had a better and Christians a lower survival as compared to Hindus. Education did not appear to be of significance. Survival decreased rapidly with advancing clinical extent of disease for all sites. With localized cancer, 5-year rates ranged from 54.7% to 69.3%, for regional spread 20.4% to 41.6% and distant metastasis not a single site recorded more than 5%. On multivariate analysis, age and extent of disease emerged as independent predictors of survival for all the sites. CONCLUSION: All the sites included in the study demonstrated moderate survival rates with significant variation. Comparison with other populations revealed lower survival rates as compared to developed countries, particularly for breast and ovary. In Indian populations survival proportions did not show much variation for these cancers. Early detection and treatment are clearly important factors to reduce the mortality from these cancers.

Population-based survival from cancers having a poor prognosis in Mumbai (Bombay), India.

BACKGROUND: Oesophagus, stomach, pancreas and lung cancers contribute more than 35% of the total cancer incidence in Mumbai and survival rates for these cancers are very poor in most populations in the world. The authors here report and discuss the population-based survival from these cancers in Mumbai, India. METHODS: Follow-up information on 5717 cancers patients having a low prognosis, registered in the Mumbai Population-Based Cancer Registry for the period 1987-1991, was obtained by a variety of methods, including matching with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis and date of death, loss to follow-up or the closing date of the study at the end of 1996. Cumulative observed and relative survival rates were calculated by the Hakulinen Method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used with univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent predictors of survival. RESULTS: The 5-year relative survival rates were 11.8% for oesophagus, 10.1% for the stomach, 4.1% for the pancreas, and 7.0% for lung. Females had higher survival rates than males, except with lung cancer. Lower survival was observed for those younger than 35 years for all 4 sites. For each site, survival declined with advancing age. Single patients who remained unmarried had better survival, except with pancreatic cancer. For all sites Muslims had a better survival and Christians had a lower survival as compared to Hindus. Education did not show any pattern for any site. Survival decreased rapidly with advancing clinical extent of disease for all sites. Survival for localized cancer ranged from 12.5% to 31.3%, for regional spread 1.3% to 3.4% and with distant metastasis not a single site recorded more than 1%. On multivariate analysis, extent of disease emerged as an independent predictor of survival with all the sites. Also, age for oesophagus, stomach and lung, religion for oesophagus and stomach, and education for stomach and lung, emerged as independent predictors of survival. CONCLUSION: All the sites included in the study demonstrated very low survival rates with significant variation. Comparison with other populations revealed lower survival rates than for Shanghai-China. In remaining populations, survival proportions did not show much variation for pancreas and lung cancers. For stomach cancer, European countries showed better survival rates. Early detection with treatment is clearly important to reduce the mortality from these cancers.