Cancer tentacles grip Northeast

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com)  

Northeast India is witnessing an alarming rise in the number of cancer patients, along with a correspondingly high fatality rate in recent years. As per a report released by the Indian Council of Medical Research (ICMR) in 2021, the Northeast has the highest incidence of cancer in India—approximately three times the national average. Within the region, Mizoram reports the highest incidence of cancer (207 men and 172.3 women per 1,00,000 people). Among men, the cancer incidence rate is highest in the Aizawl district of Mizoram (269.4 per 1,00,000), followed by the East Khasi Hills district of Meghalaya (227.9 per 1,00,000) and Kamrup Metro district of Assam (213.0 per 1,00,000). For women, the highest rate is recorded in the Papum Pare district of Arunachal (219.8 per 1,00,000), followed by the Aizawl district (214.1 per 1,00,000) and Kamrup Metro district (169.6 per 1,00,000). Extensive research is required to determine the exact causes—genetic or otherwise—behind the high incidence of cancer in this region.

Lifestyle-related cancers top the chart in the Northeast. Data from various population-based cancer registries and hospital-based cancer registries in India show that the most common cancer sites in men are the oesophagus, lung, stomach, hypopharynx, and mouth. For women, the most affected sites are the breast, cervix uteri, gall bladder, oesophagus, and lungs. These cancers are primarily associated with lifestyle-related risk factors. According to a report compiled by the National Centre for Disease Informatics and Research under the ICMR in 2021, oesophagal cancer (13.6%) is the most prevalent among men, followed by lung (10.9%), stomach (8.7%), hypopharynx (7.0%), and mouth cancer (5.0%). Among women, breast cancer (14.5%) is the most common, followed by cancers of the cervix uteri (12.2%), gallbladder (7.1%), oesophagus (7.0%), and lungs (6.8%) in Northeast India.

Certain lifestyle choices, including local addictive habits and dietary practices, contribute to the increased cancer incidence in the Northeast. Excessive tobacco consumption—either in smoked or smokeless forms, with the latter being more common—is a notable risk factor in the region. Six NE states, namely, Mizoram, Meghalaya, Manipur, Nagaland, Tripura, and Assam, rank among the top in India for tobacco consumption. According to the fifth National Family Health Survey (NFHS-5), 2019-21, about 70% of people in the Northeast consume tobacco, 26% higher than the national average. Mizoram has the highest rate of tobacco consumption. As per recent data, approximately 49.3% of all cancers in men and 22.8% in women are directly linked to tobacco consumption in the Northeast.

The consumption of raw and fermented varieties of betel nuts is also widespread in the region. Chewing tobacco, betel nuts, and areca nuts are still very customary here. They contain confirmed carcinogens, which substantially contribute to the high cancer rates in NE. Other unhealthy practices include regular alcohol consumption and the intake of foods such as shidol and shutki (fermented and salted dry fish), smoked pork, and other meats rich in nitrosamines, which cause DNA damage leading to cancer. The extensive use of pesticides in tea gardens and the consumption of pesticide-laden fruits and vegetables increase carcinogenic risk. The high incidence of oesophagal and stomach cancers has been linked to the regional dietary habit of consuming heavily spiced and chilli-laden foods, as well as large quantities of hot beverages like tea and coffee. A 2009 study by Tata Memorial Hospital in Mumbai showed that people who consumed very hot tea were four times more likely to develop oesophagal cancer.

Dietary factors aside, the high incidence of sexually transmitted cancers in the Northeast has been linked to general lifestyle practices. Breast cancer has been associated with late pregnancies and obesity, while cervical cancer is often attributed to a lack of sexual hygiene. Genetic factors are also widely suspected to play a role in the increasing cancer rates in the region.

Despite the significant burden of cancer in Northeast India, the region faces a severe shortage of oncologists and adequate cancer care infrastructure. Many patients, therefore, are compelled to seek treatment outside the region. The state and central governments must make efforts to provide the best possible cancer treatment to all cancer patients for free, irrespective of their socio-economic status. No one should be denied access to treatment due to financial constraints. Data on the availability of a specialised workforce should be collected and used to address shortages.

There is an urgent need for trained personnel at the primary and secondary-level healthcare facilities to identify risk factors, screen patients, and guide them to appropriate treatment facilities. Facilities for palliative care, radiotherapy, and other services need to be established and strengthened. Specialised childhood cancer care centres also need to be set up, given the increasing incidence of childhood cancers. There should be satellite clinics in remote areas for patients unable to travel long distances. Oncologists should go to the villages to provide treatment, teleconsultations, and follow-up care. Home care services should be launched as well as facilities to train family members for taking care of terminally ill patients. NGOs should also come forward to help the patients and provide necessary support and information on availing financial aid under different schemes.

A comprehensive cancer control programme is urgently needed in the Northeast. Besides government initiatives, this requires the collective efforts of hospitals, administrative bodies, medical organisations, NGOs, and the media to raise awareness and promote healthier lifestyles. Vaccination against cervical cancer must be intensified. Tobacco control programmes should be implemented more aggressively to combat the deep-rooted habit of tobacco consumption. People must adopt healthier lifestyles by quitting harmful practices such as smoking, chewing tobacco, consuming betel nuts and alcohol, and reducing the intake of overly spicy foods, smoked meat, and piping hot beverages.