A recent in-depth study by Amrita Hospital, Kochi, in collaboration with the International Agency for Research on Cancer (IARC), has highlighted a worrying trend in India’s battle against cancer: An increase in mortality rates among women.
Analysing data from 2000 to 2019, the study sheds light on the changing patterns of cancer mortality across 23 major cancers, contributing to a comprehensive understanding of the nation’s cancer burden.
“To our knowledge, this is the first national-level cancer mortality trend analysis on the basis of 23 major cancer site mortality data from GHO (Global Health Observatory) between 2000 and 2019. The heterogeneity in mortality trends and poor prognosis suggest that changes are needed in cancer-causing behaviours in the population, including lifestyle habits and dietary practices, as well as in the healthcare system and cancer awareness,” the study noted.
What is this cancer study about?
The study has unveiled notable trends in cancer mortality in India, presenting a complex picture over the past two decades.
According to the study, which analysed the mortality trends of 23 major cancers causing 12.85 million deaths between 2000 and 2019, there has been a slight annual decrease in cancer mortality among men (0.19 percent), while an increase of 0.25 percent annually has been observed in women.
Certain cancers like lung, breast, colorectal, and others showed increased mortality.
In contrast, mortality from cancers like stomach, oesophagus, leukemia, and others decreased. Meanwhile mouth, oropharynx, thyroid showed stable age-period-cohort (APC) values, indicating no significant change in their mortality rates over time.
Why is this study important?
According to lead author Ajil Shaji, the main aim of the study was to analyse the overall and individual cancer mortality trends for 23 major cancers. The author said, “Cancer mortality trends have not been documented across the population in India. We, therefore, analysed the overall and individual cancers between 2000 and 2019 on the basis of the GHO database.”
The study says that Globocan estimated that 8,50,000 cancer deaths occurred in India in 2020. However, 28 PBCRs (Population Based Cancer Registry) in India alone recorded 1,39,646 cancer deaths between 2012 and 2016, whereas the representing population made up only 10 percent of the population.
So, this study aimed to analyse 23 major cancers and, briefly, for other leading cancer sites among men and women. The study is of utmost importance for several reasons, particularly in the context of public health policy, cancer research, and healthcare planning in India — it helps to understand cancer trends.
Understanding these trends is essential for identifying which cancers are becoming more prevalent and which are declining, thereby guiding research and healthcare priorities.
The study sheds light on gender disparities in cancer mortality, such as higher rates of certain cancers in women. This information is vital for developing gender-specific health interventions and for raising awareness about cancers that disproportionately affect women. The findings of the study can inform public health policies in India, especially regarding cancer prevention, screening, and treatment programmes.
The study not only provides valuable data but also highlights the limitations and challenges in current data collection methods in India. This can spur improvements in the national cancer registry and data collection processes, leading to more accurate and comprehensive data in the future.
Which cancers affect women more?
The study found that amongst the data of 23 cancers looked into, breast cancer, gallbladder cancer, thyroid cancer, and ovarian cancers are most concerning in women and the mortality rate for these is increasing.
The statistics showed that breast cancer was one of the most significant areas of concern, with breast cancer mortality among women increasing by 1.1 percent per year. The trend in mortality for breast cancer rose by 1.7 percent per year in the second decade of the study period.
It can be noted that, recently, Apollo Proton Cancer Centre (APCC) had analysed 1,50,000 screenings from 2019-2023 and found that 25 percent of these breast cancer cases were among women under 40 years of age. This contrasts with Western countries, where the median age of breast cancer diagnosis is higher.
Dr Manjula Rao, Breast Cancer Specialist and Oncoplastic Surgeon, APCC, told South First, “More than 60 percent of breast cancer patients in India present in more advanced stages, with increased breast cancer-related mortality when compared to the West, which reports lower mortality rate, despite higher incidence of the disease. This highlights the relevance of public awareness and breast cancer screening, which helps in early detection.”
Gallbladder cancer, a silent killer
The Kerala study showed that gallbladder cancer also showed an increasing trend in mortality rates among women. In the first decade (2000-2009), the annual increase was 0.7 percent and this trend continued in the second decade.
Dr Manjiri Somashekhar, Lead and Senior Consultant, Paediatric Surgery, at Aster CMI Hospital, had earlier told South First that “gallbladder cancer is indeed a serious and aggressive disease”.
“Its tendency to be diagnosed late, often due to the absence of early symptoms or their similarity to less serious conditions, complicates treatment. Once diagnosed, we’re dealing with a cancer that can progress rapidly, leading to low overall survival rates. Risk factors like gallstones, chronic inflammation, obesity, and age play a significant role,” she added.
Thyroid and ovarian cancer
While thyroid cancer showed a stable annual decrease of 0.3 percent among women, according to the study, it had higher age-standardised mortality rates (ASMR) values among women compared to men and both sexes combined.
Meanwhile, ovarian cancer also exhibited an increasing mortality trend, with an annual increase of 1.8 percent. In the second decade, the increase was even more pronounced at 2.4 percent.These trends highlight the growing impact of these cancers on women in India.
Dr Devika Gunasheela, renowned gynaecologist from Bengaluru, told South First, “The study’s findings highlight the need for targeted healthcare interventions, including increased awareness, improved screening and diagnostic facilities, and more effective treatment strategies tailored for women. The higher mortality rates in cancers like breast, gallbladder, and ovarian cancer particularly call for urgent attention in public health policies and women’s health initiatives.”
‘No system to know accurate cancer prevalence in India’
The study highlights a critical gap in the Indian healthcare system, particularly regarding the government’s role in maintaining a comprehensive and efficient cancer registry. The study noted that absence of a nationwide cancer registration system in India significantly hampers the ability to track and analyse cancer trends effectively.
This limitation is not just a technical shortfall but also reflects a broader oversight in healthcare policy and infrastructure.
Without a reliable and extensive cancer registry, the government and healthcare providers are hindered in their ability to understand the full scope of the cancer burden, making it challenging to allocate resources appropriately, design targeted interventions, and evaluate the efficacy of public health initiatives.
Also, the fact that only a small percentage of deaths are medically certified exacerbates the issue, leading to potential underreporting or misclassification of cancer-related deaths.
Dr Mohmmed Hussain J, Radiation Oncologist at Pandit BD Sharma Post Graduate Institute of Medical Sciences, Rohtak told South First, that according to Globocan estimates, there were 19.3 million cancer cases worldwide in 2020 and India ranked third after China and the US.
“Globocan predicted that cancer cases in India would increase to 2.08 million, a rise of 57.5 percent in 2040 from 2020. Unfortunately, we don’t have a robust system of cancer registration nor screening. Sadly, the accurate prevalence of cancer in India is unknown,” he explained.
Cancer is still not a notifiable disease
Dr Hussain said that cancer is not a notifiable disease in India like TB, cholera, or HIV. The National Cancer Registry Programme has been working since 1982 through the Population Based Cancer Registry (PBCR) and the Hospital Based Cancer Registry.
“The panel says only 10 percent of Indian population is covered under PBCRs. So in the war against cancer, the foremost thing is to understand how many cancer patients and deaths happen in India and then formulate screening protocol and awareness at grassroot levels by PHCs, CHCs,” Dr Hussain suggested.
He added, “The urgent need of time is to make cancer a notifiable disease. We can also create an app similar to Cowin and register the cancer cases.”