Geriatric cancers in India: an epidemiological and demographic overview.

This article provides an overview of aspects of the burden of cancer in the elderly, in India highlighting certain demographic and epidemiological data. In India the normal retirement age is 60 years, so the definition of the elderly, in India is considered above the age of 60 years. Information on the aging of the Indian population is based on various census figures, cancer incidence figures are taken from Mumbai registry data. Men and women aged > or = 60 years are at high risk for major cancers. Men have a risk 15 times greater risk and in women 8 times greater risk than the persons having age < 60 years. Lung and prostate cancers are most prominent cancer in men having age > or = 60 years while in women breast is the leading site followed by cervix and ovary in the same age group. Demographic and epidemiologic data characterize the aging / cancer interface. The changing demographic structures underscore the current incidence imperative for elderly; suggesting a starting demand will be made in the future requiring physician's abilities and skills to meet these needs.

Geographic variation in cancer incidence and its patterns in urban Maharashtra, 2001.

In this paper an attempt has been made to study the geographic variations in cancer incidence and its pattern in Urban Maharashtra. Data collected by Mumbai, Poona, Nagpur, and Aurangabad, Population based Cancer Registries, for the year 2001 have been utilized. The incidence patterns by sex, age, and religion has been compared between these four agglomerations. Besides this childhood cancers and tobacco related cancers for each registry are also described. Age specific cancer incidence rates show increasing trend with increasing age in all the four populations. The curves for Mumbai, Poona, Nagpur are closed together with fluctuations, indicating similarities in the rise. In all the four registries, amongst males, cancers of the lung, larynx, oesophagus, tongue and prostate while in females breast, cervix, ovary, oesophagus, mouth and leukemias occupy places in ten leading sites. The proportion of childhood cancers varies from 1.9% in females in Poona to 4.5% in males in the Nagpur populations. The proportion of tobacco related cancers varies in males from 38.9% in Poona to 54.4% in Aurangabad, where as in females from 14.1% in Nagpur to 21.7% in Aurangabad. Considerable variations was observed in the incidence of cancer of various sites in both the sexes, professing different religious faiths within this populations. The findings of this paper can be used to estimate the incidence and prevalence of cancer for future for whole Maharashtra state and studies in cancer etiology and control can be planned.

Social inequalities in cancer with special reference to South Asian countries.

There are major differences in cancer burden across socioeconomic classes, as is evident from the data for cancer incidence and mortality from Greater Mumbai, India. Changes over time are also evident and recently there has been a clear shift to increasing breast cancer particularly in well-educated women, who conversely are at much lower risk of cervical cancer. With infection-related and tobacco-related cancers, programs of prevention and early detection will yield desirable results only if it is associated with a program directed towards elimination of poverty, illiteracy and restoring social inequality. Similarly education must play a role in combatting diet-related neoplasia but here the target population may differ, requiring a specific awareness of psychological profiles.

Breast cancer in limited-resource countries: treatment and allocation of resources.

Treating breast cancer under the constraints of significantly limited health care resources poses unique challenges that are not well addressed by existing guidelines. We present evidence-based guidelines for systematically prioritizing cancer therapies across the entire spectrum of resource levels. After consideration of factors affecting the value of a given breast cancer therapy (contribution to overall survival, disease-free survival, quality of life, and cost), we assigned each therapy to one of four incremental levels--basic, limited, enhanced, or maximal--that together map out a sequential and flexible approach for planning, establishing, and expanding breast cancer treatment services. For stage I disease, basic-level therapies are modified radical mastectomy and endocrine therapy with ovarian ablation or tamoxifen; therapies added at the limited level are breast-conserving therapy, radiation therapy, and standard-efficacy chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil [CMF], or doxorubicin and cyclophosphamide [AC], epirubicin and cyclophosphamide [EC], or 5-fluorouracil, doxorubicin, and cyclophosphamide [FAC]); at the enhanced level, taxane chemotherapy and endocrine therapy with aromatase inhibitors or luteinizing hormone-releasing hormone (LH-RH) agonists; and at the maximal level, reconstructive surgery, dose-dense chemotherapy, and growth factors. For stage II disease, the therapy allocation is the same, with the exception that standard-efficacy chemotherapy is a basic-level therapy. For locally advanced breast cancer, basic-level therapies are modified radical mastectomy, neoadjuvant chemotherapy (CMF, AC, or FAC), and endocrine therapy with ovarian ablation or tamoxifen; the therapy added at the limited level is postmastectomy radiation therapy; at the enhanced level, breast-conserving therapy, breast-conserving whole-breast radiation therapy, taxane chemotherapy, and endocrine therapy with aromatase inhibitors or LH-RH agonists; and at the maximal level, reconstructive surgery and dose-dense chemotherapy and growth factors. For metastatic or recurrent disease, basic-level therapies are total mastectomy for ipsilateral in-breast recurrence, endocrine therapy with ovarian ablation or tamoxifen, and analgesics; therapies added at the limited level are radiation therapy and CMF or anthracycline chemotherapy; at the enhanced level, chemotherapy with taxanes, capecitabine, or trastuzumab, endocrine therapy with aromatase inhibitors, and bisphosphonates; and at the maximal level, chemotherapy with vinorelbine, gemcitabine, or carboplatin, growth factors, and endocrine therapy with fulvestrant. Compared with the treatment of early breast cancer, the treatment of advanced breast cancer is more resource intensive and generally has poorer outcomes, highlighting the potential benefit of earlier detection and diagnosis, both in terms of conserving scarce resources and in terms of reducing morbidity and mortality. Use of the scheme outlined here should help ministers of health, policymakers, administrators, and institutions in limited-resource settings plan, establish, and gradually expand breast cancer treatment services for their populations.

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.