Cancer profile of Northeast

The latest cancer profile of India's northeast region released by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research (NCDIR) presents a gloomy picture of steady rise in cancer incidence in the region. This also raises the question over efficacy of current cancer prevention programmes in the region. The 'ICMR-NCDIR, Profile of Cancer and Related Health Indicators in the North East Region of India -2021' reveals that nearly half (49.3%) of cancers in males and close to one-fourth (22.8 %) in females in the region are tobacco use-related sites. Among these, oesophagus (13.6% in males; 7.0 % in females) followed by lung (10.9% in males; 6.8% in females) constitute the leading sites. Another worrying finding is that the number of cancer cases by the middle of the decade is projected to increase in the region by 13.5%, and among males, cancers of the oesophagus and among females, breast cancer are estimated to be the highest by 2025. These findings lead to believe that huge gaps continue to exist between cancer incidence in the region and prevention programmes like tobacco-free campaigns and cancer screening. The ICMR and NCDIR sound caution that in relation to cancer sites, in males, the probability of developing oesophageal cancer (1 in every 54 males) is the highest followed by lung cancer (1 in every 57 males) and stomach cancer (1 in every 78 males). In females, the probability of developing breast cancer (1 in every 76 females) is the highest followed by cancer of cervix uteri (1 in every 86 female) and lung cancer (1 in every 109 females). The probability of developing any cancer over a lifetime is the highest in Kamrup (Metropolitan) (1 in every 4 males and 1 in every 6 females) District which has set off the alarm bell for the Assam government.The National Family Health Survey-Round-5 conducted in 2019 brought to light that 51.8% males aged 15 years and above and 22.1% females in the same age group in Assam use any kind of tobacco while 25.1% males and 7.3 % females consume alcohol in the state. Cancer-attributed medical care costs cause huge financial burden not just for the families of cancer patients but also for public and private healthcare institutions providing treatment. It leads to erosion of household savings, loss of physical assets which are sold to mobilise cash for hospitalisation, surgeries, burden of repaying interest and capital of borrowings and drain on regular income for purchasing medicines and special diagnostic tests, meeting transport and accommodation cost. National Sample Survey data show that the average medical expenditure per case of hospitalisation is the highest in case of cancer care, ranging from three to ten times the average expenditure incurred in every case of hospitalisation in respect of other ailments. The 'National Fact Sheet' of the 'Global Youth Tobacco Survey' (GYTS-4), India -- 2019 reveals a disturbing picture of Arunachal Pradesh and Mizoram reporting the highest tobacco consumption (58% in each state) among students aged 13-15 in the country. The data show that 38% of cigarette, 47% of bidi smokers and 52% of smokeless tobacco users initiated the use before their 10th birthday and the median age at initiation of cigarette and bidi smoking, and smokeless tobacco use were 11.5 years, 10.5 years, and 9.9 years respectively which reveal a disturbing picture of widespread use of smoke and smokeless tobacco among minor children in the country. The fact sheet also reveals that 52% students who took part in the survey noticed anti-tobacco message in the mass media while 18% students noticed tobacco advertisements or promotions while visiting the points of sale.

States in the region need to lay more emphasis on anti-tobacco campaign reaching out the schools, students, parents as well as every section of the society to achieve the desired goal of tobacco-free northeast as part of the tobacco-free India campaign. Innovative campaigns are needed to make the anti-tobacco campaign more persuasive. Apart from avoidable risk factors, detection of cancer at the early stage of development is important to cure the disease and prolong life. Strengthening screening programmes is an important component of the strategy to deal with this public health emergency. Apart from central and state governments, local bodies and NGOs working in the Health sector need to play pro-active roles in cancer prevention, awareness, and early detection. Palliative care for cancer patients in advanced stage is needed to provide psychological support and provide comfort from acute pain; but the region has been lagging behind in providing such care. It is hoped that the ICMR-NCDIR report on cancer prevalence in northeast will be an eye opener for the states in the region to revisit their cancer -prevention strategies, identify the gaps and innovate new campaign programmes, augment cancer-care facilities before it is too late.