Dr Dharmakanta Kumbhakar
(The writer can be reached at email@example.com)
According to the 'Profile of Cancer and Related Health Indicators in the North East Region of India -2021' released by the Indian Council of Medical Research (ICMR) recently, the region is witnessing an alarming rise in the number of cancer patients and a corresponding high fatality rate in recent years. As per that report, the Northeast has the highest incidence of cancer in India and the number of cancer cases is projected to increase in the region by 13.5% by 2025. Within the NE region, Mizoram has the highest incidence of cancer-affected people (207.0 men and 172.3 women per 100,000 populations). Within this regional belt, the cancer incidence rate in men is highest in the Aizawl district of Mizoram (269.4 per 100,000 populations) followed by the East Khasi Hills district of Meghalaya (227.9 per 100,000 populations) and Kamrup Urban district of Assam (213.0 per 100,000 populations). In the case of women, it is the highest in Papaumpare district of Arunachal Pradesh (219.8 per 100,000 populations) followed by Aizawl district (214.1 per 100,000 populations) and Kamrup Urban district (169.6 per 100,000 populations).
The lifestyle-related cancers top the chart in the NE region. Data from different Population-Based Cancer Registries and hospital-Based Cancer Registries in India show that in Northeast India, the most common anatomical sites of cancers in men are the oesophagus, lung, stomach, hypopharynx and mouth, while in women these are the breast, cervix uteri, gall bladder, oesophagus and lungs. Cancers of these anatomical sites are mostly linked to lifestyle-related risk factors. As per the recent report compiled by the National Centre for Disease Informatics and Research under the ICMR, oesophageal cancer (13.6%) is the highest in men followed by cancers of lungs (10.9%), stomach (8.7%), hypopharynx (7.0%) and mouth (5.0%) in the Northeast. In women, breast cancer (14.5%) is the highest followed by cervix uteri (12.2%), gall bladder (7.1%), oesophagus (7.0%) and lung (6.8%) in Northeast India.
There are certain lifestyle choices including local addictive habits and dietary habits that play a role in the increased incidence of cancer in Northeast India. Excessive tobacco consumption, either in smoking and/or smokeless forms, the latter being more common, stands out as a common lifestyle trait in the NE states. Six NE states, namely, Mizoram, Meghalaya, Manipur, Nagaland, Tripura and Assam, are among the top states for the consumption of tobacco in any form in India. According to the National Family Health Survey, about 70% of people in the NE consume tobacco which is 26% higher than the national average. The highest tobacco-consuming state is Mizoram. Global Adult Tobacco Survey, 2017 also shows a rise in tobacco use in Assam, Tripura, and Manipur. In Northeast India, people mainly suffer from cancer due to tobacco consumption. As per the recent report of the ICMR, about 49.3% of all cancers in northeastern males and 22.8% of all cancers in northeastern females are directly linked to tobacco consumption.
The people in the NE region also show addictive behaviour for raw betel nuts and fermented varieties of betel nuts. It is still very customary here to chew tobacco, betel nuts, and areca nuts. These contain confirmed carcinogenic substances, and contribute hugely towards the high cancer occurrence in Northeast India. The other unhealthy practices, predominant among the NE people and responsible for the increased incidence of cancer in Northeast India are regular alcohol consumption, consumption of shidol, shutki (fermented and salted dry fish), smoked pork and other meat that contain high amounts of nitrosamines which cause DNA damage leading to cancer; extensive exposure to
pesticides that pose carcinogenic potential during widespread use of pesticides in the tea gardens and consumption of fruits and vegetables having residual pesticides. The high incidence of oesophageal and stomach cancer among the northeastern people is linked to the region's dietary habits of taking foods high on spices and chillies and consuming large quantities of hot beverages such as tea and coffee. A study by the Tata Memorial Hospital in Mumbai in 2009 showed that people who gulped down very hot tea (simmering temperature) were four times more prone to oesophageal cancer.
Aside from dietary habits, the high incidence of sexually-transmitted cancer in the NE region has also been linked to general lifestyle practices within the native populations. A breast cancer incidence in the region has been linked to late pregnancies and obesity. Cervical cancer incidence rates have been attributed to a lack of sexual hygiene. It is also widely suspected that genetic factors could have a role in the spurt in cancer cases in the north-eastern region.
Despite the heavy burden of cancer in Northeast India, the available infrastructure for cancer care is inadequate. Hence, people are compelled to seek treatment outside the NE. A good proportion of people from the NE visit Mumbai's Tata Memorial Hospital (TMH) every year for the diagnosis and treatment of cancer. Nearly 4% of the cancer cases detected in TMH are in patients from the NE. There is still an acute lack of expert oncologists and adequate treatment infrastructure – hospitals, diagnostic centres, etc, – for the cancer-affected people of Northeast India.
There is an urgent need to develop a comprehensive cancer control programme in the NE region. Extensive research is needed that is focused on the NE to highlight the different aspects (e.g. to know the exact causes, genetic or otherwise) for reducing the incidence of cancer. The State and Central governments should make efforts to offer the best treatment possible to all the cancer patients of the NE for free, irrespective of their socio-economic status. The data on specialized workforce should be collected and collated for the entire NE. There is an urgent need for trained personnel at the primary and secondary level healthcare facilities that could identify risk factors, screen the patients, and guide them to the relevant facilities. Cancer treatment facilities for palliative care, radiotherapy, etc., need to be established and strengthened. Remote expert consultations are essential to facilitate the right treatment planning and delivery. There should be satellite clinics in the remote areas of the NE for cancer patients who are unable to travel long distances to visit the hospital. The oncologists of the region should start going to the villages to provide treatment to cancer patients. They should provide phone or internet consultations and stay in touch with cancer patients who have returned home with prescriptions. Home Care Services, as well as facilities to train the family members for taking care of terminally ill cancer patients, should be launched. The NGOs should also come forward to help the cancer patients of the NE region in their treatment, and by providing information and support for getting financial aids from different schemes.
Efforts toward cancer prevention will be immensely helpful to lower the burden of cancer in Northeast India. Apart from Government initiation, it requires the cumulative efforts of hospitals, administrative bodies, medical organizations, NGOs, media and more – to impart the right awareness and lifestyle guidance. Since the problem of tobacco consumption is so deeply rooted in the NE region, tobacco control programmes need to be more aggressive. People in the NE need to adopt healthier lifestyle habits. At an individual level, people need to quit the bad habits (smoking, chewing tobacco, consumption of betel nut and alcohol, etc), change the food habit (reduce the consumption of extremely spicy and salted foods, smoked meat and piping hot beverages) and lifestyle.