9.3 lakh cancer-related deaths in 2019, most of them attributed to this “Indian habit”

Between 1990 and 2019, there has been a staggering increase of 161 percent in reported cancer cases and a 147 percent rise in associated deaths. Also, India has 27.1 million disability-adjusted life years (DALYs).

DALYs, a metric used to measure the overall burden of disease in a population, combines the impact of premature death and the impact of living with a disability caused by a specific disease or health condition.

“Various cancers like stomach and breast cancers have witnessed increased mortality rates over the years, but evolving risk factors contribute to this upward trend. While dietary changes, such as high salt consumption, lifestyle shifts towards sedentary habits, and obesity are well-known contributing factors, factors such as air pollution have also led to an increase in cancer cases, affecting even non-smokers,” Dr Rajesh Sharma, lead author of the study and Assistant Professor at National Institute of Technology Kurukshetra, told South First.

He added that even limitations in infrastructure and diagnostic capabilities contribute to rising mortality rates. “In developed countries like the US, the five-year survival rate for cancer is around 70 percent, but in developing nations, including India, it is notably lower. Genetic predisposition to cancer also plays a role, highlighting the need for a robust healthcare system,” said Dr Sharma.

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Cancer and culture 

“High prevalence of smokeless tobacco such as khaini, gutkha, betel quid, and paan masala is a public health concern in South Asian countries such as India, Bangladesh, and Nepal,” the study said. It added, “As per our study results, India alone accounted for 32.9 percent of global deaths and 28.1 percent of new cases of lip and oral cavity cancer in 2019.”

“Most of the time, studies come from the perspective of the US or European countries, where the consumption of smokeless tobacco in almost nil, as people in the West don’t consume these products. So there is very little literature available on this,” Dr Sachin Marda, Senior Consultant Oncologist at Hyderabad’s Yashoda Hospital, told South First.

As per the global adult tobacco survey (GATS), 199.4 million adults in India consumed smokeless tobacco. Notably, more than 50 percent of the oral cancer burden has been attributed to smokeless tobacco whose prevalence has grown in recent times in South Asia, including India.

Smokeless tobacco not only increases the risk of oral cancers but also enhances the risk of oesophageal and pancreatic cancer.

“Amidst the high burden of smokeless tobacco-induced cancers, the smokeless tobacco control policies, such as taxes and regulatory mechanisms, seem to be either inadequate or poorly implemented in South Asia, resulting in the unabated burden of smokeless tobacco-induced diseases, including oral cancers,” the study noted.

“Smokeless tobacco products, primarily consumed by lower-income groups, pose a substantial health risk. These individuals often lack the financial means for proper diagnosis and treatment. While smoking is prevalent in the Western world, in India, unregulated smokeless tobacco products pose a significant challenge,” said Dr Sharma.

Dr Marda emphasised that oral cancer has becoming more prevalent over the past two to three decades. Contributing factors include inadequate dental hygiene and preneoplastic conditions within the mouth that possess a risk of progressing to cancer.

Dr Sharma also pointed out that rehabilitation services for low-income individuals are scarce, and the fear of losing earnings deters them from seeking help. Lack of awareness, compounded by illiteracy, presents a unique challenge.

“Celebrities endorsing these products through surrogate ads further exacerbate the issue. Profit-driven vendors capitalise on the huge consumer base in India, often selling harmful products at low margins, causing severe health repercussions for those affected,” Dr Sharma.

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In the air

In the study, the ambient particulate matter (PM) pollution remained dominant among the 34 risk factors for cancer. “The rising cancer burden due to increasing ambient air pollution is concerning in Asia,” they wrote.

Five of the top 10 countries with regards to population-weighted annual average of PM2.5 in 2019 are present in Asia — India, Nepal, Qatar, Bangladesh and Pakistan — they said, quoting the State of Global Air Report, produced annually in collaboration with the Institute for Health Metrics and Evaluation’s (IHME’s) GBD project.

The researchers said that the primary reasons for increasing air pollution in Asia were industry-led economic growth, along with urbanisation, rural-to-urban migration, and increasing usage of motor vehicles.

Speaking to South First, Dr Nitin Yashas, renowned medical oncologist at Manipal Hospitals, Bengaluru, said that lung cancer is observed not only among smokers but also among non-smokers due to pollutants potentially triggering tumour development.

Dr Sharma added that globally, the incidence and mortality rates of cancer are higher in developing nations due to changes in lifestyle, behaviours, and socio-economic factors accompanying development. As countries progress, the burden of non-communicable diseases (NCDs), including cancer, tends to escalate due to increased wealth, comfort, and lifestyle changes.

“Two decades ago, the appearance of a lung would typically exhibit a pink hue. However, due to pervasive air pollution, the lung’s colour has shifted to a concerning black tone. This alteration is attributed to the presence of over 4,000 carcinogens in the air, which pose a significant threat by infiltrating our oesophagus and lungs,” said Dr Marda.

He added that this issue demands collective action from both governmental bodies and individuals.

“The government ought to relocate industries or establish Special Economic Zones (SEZs) away from residential areas to mitigate the impact on the population. Additionally, a collaborative effort between governmental bodies and industries is crucial to implement stringent measures for monitoring industrial effluents that pollute environmental water bodies and underground reservoirs. Stricter regulations enforced by pollution control boards are imperative,” he said.

He also advised, at the individual level, that proactive measures include spending time outdoors, engaging in regular exercise and walking, and undergoing annual cancer screenings similar to those conducted for NCDs. Individuals employed in industries associated with occupational hazards or chemical production need to exercise caution and prioritise safety measures, he stated.

Dr Yashas said that making generalised claims about reducing lung cancer risk in the face of air pollution without substantial evidence is unwarranted. Policy measures to enhance environmental sustainability and reduce pollution should be a priority for governments and industries.

“Scientific institutions must conduct studies to establish the efficacy of such approaches before implementing them. Evidence-based medicine guides our decisions, requiring concrete proof of effectiveness before practical application, despite theoretical correctness,” said Dr Yashas.

Urgent public policy measures should address not only tobacco-related issues but also alcohol consumption, dietary habits, sedentary lifestyles, and even the impact of night-shift work. Awareness campaigns should disseminate information to encourage screenings and healthier lifestyles, he added.

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Cancer cases in Asia

Researchers found that India, along with China and Japan, were the three leading countries in Asia in terms of number of new cases and deaths, where they say cancer has become a more significant public health threat with 94 lakh new cases and 56 lakh deaths in 2019.

Of these, while China contributed the most with 48 lakh new cases and 27 lakh deaths, Japan recorded about 9 lakh new cases and 4.4 lakh deaths, the international team of researchers including those from the National Institute of Technology Kurukshetra and All India Institute of Medical Sciences (AIIMS), Jodhpur and Bathinda, said.

“We examined the temporal patterns of 29 cancers in 49 Asian countries between 1990 and 2019 using estimates from the Global Burden of Disease, Injuries and Risk Factors 2019 study (GBD 2019),” they wrote in their study.

They found that in Asia, the leading cancer was that of tracheal, bronchus, and lung (TBL), resulting in an estimated 13 lakh cases and 12 lakh deaths. It was also found to be most frequent in men and third-most frequent in women.

Specifically among women, cervical cancer is ranked second or among the top 5 cancers in several Asian countries. However, the human papillomavirus (HPV) vaccine, introduced in 2006, has proved to be effective in preventing the disease and reducing HPV-related deaths, the researchers noted.

Overall, in the continent and individual countries, TBL, breast, colon and rectum cancer (CRC), stomach, and non-melanoma skin cancer were among the top five most frequent cancers in 2019 with few countries having leukemia, prostate, liver, and pancreatic cancers on the list, they said in the study.

The researchers wrote that improved water and sanitation can help reduce the transmission of Helicobacter pylori (H. pylori) and, in turn, potentially lower the risk of stomach cancer.

The researchers wrote that as countries underwent development, they observed a common pattern of reducing cancer burden in younger age groups and increasing cancer burden associated with increasing life expectancy.

They found a reduced burden of cancers such as leukemia among those under 5 years of age between 1990 and 2019. Simultaneously, they found an increased burden of cancers associated with longer lifespan such as prostate, pancreatic, and breast cancer over the same time period.

“Mere availability of screening might not improve the survival rates if cancer treatments are either unavailable or unaffordable,” the team wrote.

In the low- and medium-income countries (LMICs) of Asia, oncologic infrastructure is either scarce or unaffordable, particularly in rural areas. Combined with a weak referral system, patients end up getting delayed diagnosis and treatment, leading to lower survival rates, the researchers said.

Therefore, along with timely availability of cancer screening and treatment, its cost-effectiveness or coverage of treatment expenses must also be a policy priority, they said.

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