Trends in breast and cervical cancer in India under National Cancer Registry Programme: An Age-Period-Cohort analysis.

BACKGROUND: Trend analysis in cancer quantifies the incidence rate and explains the trend and pattern. Breast and cervical cancers are the two most common cancers among Indian women which contributed 39.4 % to the total cancer in India for the year 2020. This study aimed to report the time trends in cancer incidence of breast and cervical cancer using Age-Period-Cohort (APC) model from five Population Based Cancer Registries (PBCRs) in India for the period of 1985-2014. METHOD: Age-Period-Cohort model was fitted to five PBCRs of Bangalore, Chennai, Delhi, Bhopal and Barshi rural for breast and cervical cancer for 25-74 age-groups. The Estimated Annual Percent Change (EAPC) was calculated. Rate Ratio (RR) of cohort effects were estimated with a constraint of period slope to be zero (p = 0) since cohort has a stronger association with incidence than period. RESULT: A significant increase was noted in breast cancer in all PBCRs (EAPC, Range: Delhi, 1.2 % to Bangalore, 2.7 %) while significant decrease in cervical cancer (EAPC, Range: Bangalore -2.5 % to Chennai, -4.6 %) from all the PBCRs including Barshi rural during the period. RR estimates for breast cancer showed increasing trend whereas cervical cancer showed decreasing trend in successive birth cohorts across all five PBCRs. CONCLUSION: In both breast and cervical cancers, a significant age, cohort and period effect was noted in Bangalore, Chennai and Delhi. Despite period effect, the cohort effect was predominant and it may be attributed to the generational changes in risk factors among cancer breast and cervix.

Rural urban differences in breast cancer in India.

Context: Breast cancer incidence rates are high in developed countries and much lower in less developed countries including India. Aims: The aim of the following study is to compare breast cancer incidence rates in rural, urban and metro regions of India and to estimate risk of developing breast cancer associated with residence in a rural area. Settings and Design: Descriptive and analytical study design. Materials and Methods: We extracted age adjusted incidence rate from 26 population-based cancer registries and data from hospital-based case-control study to estimate rate and risk ratio for developing breast cancer in an urban region compared with a rural residence. Statistical Analysis: The rate ratios and 95% confidence interval (CI) for developing breast cancer in the urban and metro region compared with rural registry of Barshi were estimated. The odds ratio (OR) and 95% CI for developing breast cancer in women residing in a rural region was estimated by fitting unconditional logistic regression using hospital-based case-control study data. Average annual percentage change in most recent 15 years (1996-2010) for Barshi (rural), Aurangabad (urban), and Mumbai (metro) cancer registry was obtained by fitting a log-linear model using joint point regression. Results: Living first 20 years of life in a rural area reduces the risk of breast cancer (OR = 0.65, 95% CI: 0.56-0.76). Conclusions: The current study demonstrates that lifestyle operative in a rural area is protective against risk of developing breast cancer.

Cancer survival in Barshi, India, 1993-2000.

The rural cancer registry of Barshi, Paranda and Bhum, was the first of its kind in India and was established in 1987. Registration of cases is carried out entirely by active methods. Data on survival from 15 cancer sites or types registered during 1993-2000 are reported in this study. Follow-up has been carried out predominantly by active methods, with median follow-up time ranging between 2-49 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 73-98%; death certificates only (DCOs) comprised 0-2%; 98-100% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 96-100% for different cancers. The 5-year age-standardized relative survival rates for selected cancers were non-melanoma skin (86%), penis (63%), breast (61%), cervix (32%), mouth (23%), hypopharynx (11%) and oesophagus (4%). The 5-year relative survival by age group did not display any particular pattern. Five-year relative survival trend between 1988-1992 and 1993-2000 showed a marked decrease for cancers of the tongue, hypopharynx, stomach, rectum, larynx, lung and penis; but a notable increase for breast and non-Hodgkin lymphoma.