1. Demographic and Epidemiological Transition and Cancer in India
ALEYAMMA MATHEW PROFESSOR TRIVANDRUM CANCER REGISTRY Regional Cancer Centre, Thiruvananthapuram
2019 NAACCR-IACR, Vancouver, BC, Canada, June 9-13, 2019

2. Transition of Cancer Demographic Epidemiological Access to Care
Population ↑
Life Expectancy ↑
Risk factors ↑
Tobacco
Alcohol consumption
Dietary habits
Obesity
Infection
Protective factors ↓
Physical activity
Fruits and vegetables
Diagnostic facilities ↑
Screening programmes ↑
Treatment facilities ↑

3. Objectives To asses the transition of cancer in India according to
Transition in Demographic factors
Transition in Epidemiologic risk and protective factors
Transition in Detection practices
during the past 30 years

4. MATERIALS: REPORTES OF NATIONAL CANCER REGISTRY PROGRAMME, GOVT
MATERIALS: REPORTES OF NATIONAL CANCER REGISTRY PROGRAMME, GOVT. OF INDIA
1986
2016
Currently 29 PBCRs under NCRP network
South: Trivandrum, Kollam, Bangalore, Chennai
West: Ahmedabad, Aurganbad, Mumbai, Pune
Central: Barshi, Bhopal, Nagpur, Wardha
North: Delhi, Patiala
North East: Cachar, Dibrugargh, Kamrup, Kolkata, Manipur, Meghalaya, Mizoram, Nagaland, Pasighat, Sikkim, Tripura
Mumbai
Bangalore
Chennai
Bhopal
Delhi
Rural Barshi
1982
1985
1986

5. Cancer Registry: Case-ascertainments methods
RCCs
Radiotherapy centres
Vital statistics office
Private hospitals
Medical college hospitals
Pathology departments
Govt. hospitals
National Cancer registry (NCRP)
State/central Government
Research
IARC
Publish Report
Some Registries have Administrative orders

6. Statistical Methods The various measures used are
i) crude cancer incidence rate (CR)
ii) age-standardized incidence rate (world population) (ASR)
iii) annual percent change (APC) using JointPoint linear
regression.

7. Demographic Transition vs. Transition of Cancer Burden in Men
42 %
12.8 %
8.7 years

8. Demographic Transition vs. Transition of Cancer Burden in Women
44.0 %
49.7 %
10.1 years

9. Transition in rank ordering and proportion of leading cancer sites (1990 vs. 2014)6 4 1 7
Oesophagus (6.7%) 2 5
Lung( 11.3%) 3 8 9 10
Lung (10.6%)
NHL (1.9%)
Stomach (5.7%)
Tongue(6.6%)
Prostate (4.5%)
Mouth(4.2%)
Colo - Rectum (2.9%)
Leukemia (2.7%)
Stomach (9.1%)
Tongue (7.6%)
Pharynx (6.7%)
  Oesophagus (5.7%)
RANK
1990
2014
MALE
Pharynx (9.1%)
Total 10 sites (76.6%)
Total 10 sites (75.8%)
Colo-Rectum (7.7%)
Prostate (7.7%)
Oesophagus (5.7%)
Larynx (4.8%)
Mouth (4.0%)
Leukemia (4.0%)

10. Transition in rank ordering and proportion of leading cancer sites (1990 vs. 2014)6 4 1 7
Ovary (5.5%) 2 5
Breast (27.0%) 3 8 9 10
Cervix uteri (23.5%)
Tongue (1.9%)
Mouth (3.9%)
Oesophagus (4.4%)
Stomach (3.0%)
Colo-rectum (2.0%)
Corpus uteri (2.0%)
Lung (2.0%)
Cervix-uteri (22.9%)
Corpus uteri (4.0%)
Stomach 3.7%)
RANK
1990
2014
Female
Breast (19.3%)
Total 10 sites (76.6%)
Total 10 sites (75.8%)
Colo-Rectum (5.1%)
Ovary (5.0%)
Lung (3.1%)
Oesophagus (2.7%)
Tongue (2.0%)
Mouth (2.0%)

11. Epidemiological Transition in Tobacco prevalence and Transition in related cancers
Tobacco-related cancers mainly include: Lung, Mouth, Tongue, Pharynx (excluding nasopharynx), Oesophagus, Larynx, Urinary bladder
Population attributable fraction (PAF) due to tobacco
Lung: 60%
Oral cavity: 37%
Other pharynx : 37%
Oesophagus : 37%
Urinary bladder : 21%
Mouth and other
Pharyngeal cancers
is mainly tobacco chewing

12. Transition in Tobacco prevalence vs
Transition in Tobacco prevalence vs. transition in the burden of related cancers in Women
Mouth and other Pharyngeal
cancers

13. Transition in Prostate and Breast cancers in India (1982-2014)
Epidemiological Transition of Cancer in Men – Obesity

14. Transition in Alcohol prevalence vs
Transition in Alcohol prevalence vs. transition in the burden of related cancers in men
PAF due to alcohol for colo-rectal cancers < 5%

15. Transition in Economic status vs
Transition in Economic status vs. Transition in infection-related cancer in India
Population attributable fraction of cancers infection : 23%
GDP and Poverty

16. Transition in prevalence of Obesity vs
Transition in prevalence of Obesity vs. Transition in Corpus uteri and Ovarian cancers ( )

17. Transition in Access to care vs. Transition in Thyroid cancer incidence

18. Summary Burden of cancer has been increasing in India.
Transition in economic status and life-style modification happened in many parts of the country reflect increased incidence of breast cancer and reduction in infection-related cervix uteri cancer.
Decline in tobacco prevalence reflected slight decline in some related cancers in many parts of the country.
The future burden of cancer in India will already expect to be large due to demographic effects.
The increase in alcohol consumption, increased prevalence in overweight, obesity and physical inactivity and with the tobacco epidemic, the burden of related cancers in India will be very heavy.

19. Conclusion
To assess the burden of cancer in terms of both incidence and mortality more accurately, cancer should be included as a notifiable disease in India.
Public health efforts for the increasing prevalence in overweight, obesity, physical inactivity and alcohol consumption in addition to the tobacco prevention and control are needed especially among females to reduce the cancer burden.