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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 11-15

Trend analysis of cancers from a hospital-based cancer registry in Kerala, India


Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Submission27-Nov-2019
Date of Decision05-Dec-2019
Date of Acceptance03-Mar-2020
Date of Web Publication31-Mar-2020

Correspondence Address:
Dr. Nisha Catherin
Department of Community Medicine, Amala Institute of Medical Sciences, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_45_19

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  Abstract 


Background: Noncommunicable diseases are assuming great importance among the adult population in both developed and developing countries. Cancer is major among them and has become one of the main health problems in the present era. Cancer registry reports in India may help to find distinct patterns in the types of cancer at a regional level, mainly due to the heterogeneity in underlying risk factors. Tailored interventions and services which intensifies the need for assessing the trends of common cancers are needed to deliver high-quality cancer care in future.
Objectives: We conducted the study to assess the trend of different types of cancers during 5 years from a hospital-based cancer registry in a tertiary care hospital and to assess the sociodemographic factors associated with different cancers.
Settings
and Design:
The register review study was conducted in a tertiary center in Thrissur, Kerala, India.
Materials and Methods: Data were collected for 5 years from a hospital-based cancer registry and analyzed using the SPSS software.
Results: The data consists of 10,670 cancer patients. The data of each year were analyzed separately. There were 2205 patients in 2012, 2214 patients in 2013, 2264 patients in 2014, 1848 patients in 2015, and 2189 patients in 2016. The most common cancer in each year was breast cancer, lung cancer, and colorectal cancer. Breast cancers are more prone in women 51–60 years age group. Lung cancer is more seen in 61–70 years age group.
Conclusion: The most common cancers among both sexes in all years from 2012 to 2016 were breast cancer, lung cancer, and colorectal cancer. Furthermore, there was an increasing trend of prostate cancer and decrease of esophageal, acute leukemia, and ovarian cancers.

Keywords: Breast cancer, colorectal cancer, hospital-based cancer registry, lung cancer, trend analysis


How to cite this article:
Aswin M, Catherin N, Racheal J, Vaz C. Trend analysis of cancers from a hospital-based cancer registry in Kerala, India. Int J Non-Commun Dis 2020;5:11-5

How to cite this URL:
Aswin M, Catherin N, Racheal J, Vaz C. Trend analysis of cancers from a hospital-based cancer registry in Kerala, India. Int J Non-Commun Dis [serial online] 2020 [cited 2020 Nov 26];5:11-5. Available from: https://www.ijncd.org/text.asp?2020/5/1/11/281667




  Introduction Top


Noncommunicable diseases have great importance among the adult population in both developed and developing countries, and cancer is one of the major among them. Although the knowledge on the prevention and treatment of cancer is increasing, the number of new cases grows every year.[1] Changes in lifestyle, reproductive patterns, urbanization, and an increase in life expectancy resulted in an increase in the burden of cancer.[2]

Cancer afflicts all communities worldwide. Approximately 10.9 million new cases are diagnosed, and 6.7 million deaths due to cancer every year.[3] A huge number of 16 million people will get diagnosed with cancer in 2020, two-thirds of them live in newly industrialized and developing countries, and the number of deaths would rise to 10.3 million unless acted promptly.[3] Several cancers are showing an increasing trend, and some are declining.[4] More than 70% of all cancer deaths occur in low-and middle-income countries, where resources available for the prevention, diagnosis, and treatment of cancer are limited or nonexistent.[5] Current projections suggest that the total cancer burden in India will double by 2026.[6] Nationally, common cancers in men were lung, oral cavity, stomach, colon-rectum, and pharynx (excluding nasopharynx) and in women, breast, cervix, uteri, colon-rectum, ovary, and oral cavity.[7] The most affected by cancer are the elderly and children, with 78% of all cancer diagnoses occurring in people ≥55 years of age. About 60% of cancer survivors were in the age of >65 years. Their numbers are expected to double between 2010 and 2030, contributing to a 31% increase in cancer survivors.[8] A proper understanding of the disease trend and its prompt implementation of programs based on the recent trends could decrease the incidence as well as the burden of cancer in developing countries.

A hospital registry can contribute to the assessment, monitoring, and evaluation of patient care in several ways. Cancer registries have the potential to develop and support various research programs.[9] Cancer registry reports in India may help to find distinct patterns in the types of cancer at a regional level, mainly due to the heterogeneity in underlying risk factors. Tailored interventions and services which intensifies the need for assessing the trends of common cancers are needed to deliver high-quality cancer care in future.

This study was taken up to determine the trends of different types of cancers during 5 years from a hospital-based cancer registry in a tertiary care hospital in Thrissur, Kerala, and to assess the factors associated with these cancers.


  Materials and Methods Top


A review of the data from a hospital-based cancer registry was conducted in 2018 on the registered cases during the years 2012–2016. Registry contained details on age, sex, type of cancer, site of cancer, date of diagnosis, and stage at diagnosis. Available data were taken up for study for the above-mentioned years. The cancers were classified and coded as per the World Health Organization manual. International classification of diseases for oncology III had been used for coding of various cancers. Data were entered in Microsoft Excel sheet and analyzed using the IBM SPSS statistics base 23.0, (SPSS South Asia Pvt. Ltd. Bangalore, India).


  Results Top


The data consisted of details of 10,670 cancer patients. The data of each year analyzed separately. There were 2205 patients in 2012, 2214 patients in 2013, 2264 patients in 2014, 1848 patients in 2015, and 2189 patients in 2016.

In 2012, cancers of lung, colorectal, and stomach cancers are the most common among men. Among women, breast, ovary, and cervix cancers turned out to be the major cancers. Altogether there were 447 cases (20.27%) of breast cancer, 256 cases (11.60%) of lung cancer and 107 cases (4.85%) of colorectal carcinoma, 78 cases (3.53%) of ovarian cancer, 53 cases (2.40%) of stomach cancer, 44 cases (1.99%) of esophageal cancer, 29 cases (1.31%) of prostate cancer, 72 cases (0.99%) of cervical cancer and fewer cases of acute leukemia and lip and oropharynx 12 cases (0.54%), and 8 cases (0.36%), respectively.

In 2013, the trend was the same as that of 2012. Among men, lung, stomach, and colorectal came up as the first three major cancers. Among women, most common cancers were breast, colorectal, and cervix cancers. There were 405 cases (19.15%) of breast cancer, 279 cases (13.19%) of lung cancer, and 115 cases (5.43%) of colorectal carcinoma, 84 cases (3.97%) of stomach cancer, 61 cases (2.88%) of cervical cancer, 46 cases (2.17%) of ovarian cancer, 41 cases (1.93%) of esophageal cancer, 36 cases (1.70%) of prostate cancer, and few cases of acute leukemia and lip and oropharyngeal cancer 11 cases (0.52%), and 6 cases (0.28%), respectively.

In 2014, trend followed the same path for both men and women regarding the first three cancers affecting individual sexes. The most common three cancers were breast-494 cases (21.81%), lung-269 cases (11.88%), and colorectal carcinoma-134 cases (5.91%). Others being stomach-73 cases (3.22%), cervix-71 cases (3.13%), ovary-58 cases (2.56%), esophagus-48 cases (2.12%), prostate-38 cases (1.67%), acute leukemia-11 cases (0.48%), and lip and oropharynx-9 cases (0.39%).

In 2015, the three cancers that affected men the most were lung, colorectal, and prostate cancers. Breast, colorectal, and cervix cancers were the cancers that were seen commonly among women. The most common cancers were breast-410 cases (22.18%), lung-203 cases (10.98%), and colorectal carcinoma-120 cases (6.49%). Others being stomach-73 cases (3.24%), prostate-53 cases (2.86%), cervix-42 cases (2.27%), ovary-28 cases (1.51%), lip and oropharynx-8 cases (0.43%), acute leukemia-6 cases (0.32%), and esophagus-4 cases (0.22%).

In 2016, lung, prostate, and colorectal cancers were the cancers that commonly affected men. Among women, breast, colorectal, and cervix cancers were the most common cancers. The most common cancers were breast-475 cases (21.69%), lung-228 cases (10.41%), and colorectal carcinoma-161 cases (7.35%). Others being prostate-90 cases (4.11%), cervix-72 cases (3.33%), stomach-60 cases (2.74%), ovary-26 cases (1.18%), lip and oropharynx-15 cases (0.68%), acute leukemia-6 cases (0.27%), and esophagus-2 cases (0.09%) [Table 1].
Table 1: Gender wise distribution of different cancers from 2012 to 2016

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Breast cancers are more prone to women 51–60 years age group. In 2012, there is 29.4%; in 2013, there is 28%; in 2014, there is 26.8%; in 2015, there is 29.2%; and in 2016, there is 28.7%. There is also a high prevalence seen under the 41–50 years age group [Table 2].
Table 2: Trends of breast cancer among different age groups

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Lung cancer is more seen in the 61–70 years age group. In 2012, there is 36.9%; in 2013, there is 32.4%; in 2014, there is 33%; in 2015, there is 39.6%; and in 2016, there is 39.6% [Figure 1].
Figure 1: Prevalence of Lung Cancer from 2012 - 2016

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  Discussion Top


The most common cancers in our study are breast cancer, lung cancer, and colorectal cancer, but this is different from the trend in other recent studies involving all over India, the most common are breast, oropharyngeal, and cervical cancer. The lung and colorectal cancer had higher prevalence than oropharyngeal and cervical cancer in our study. Study about the transition of cancer in population in India indicates that the leading male cancers are lung, stomach, colorectum, and prostate at the time of 2012[10] and in the year 1991, the most common were the lung, pharynx, esophagus, and tongue,[11] which means there is the transition of cancers occurring when the time progress. The same trend follows in our study, though the incidence of lung cancer is coming down, its still one of the most prevalent cancers in our study. The transition has seen in the case of females, leading cancer in 1991 were cervix, breast, ovary, esophagus, and mouth,[11] but when it reaches 2012, the picture changed to breast, cervix, colorectum, ovary, and stomach.[10] Studies from the Regional cancer center, Trivandrum and National Cancer Registry Programme by National Center for Disease Information and Research, the most frequent cancers were breasts, thyroid, lung, tongue, and cervix.[12],[13]

We found the number of lip and oropharyngeal cancer, as well as cervical cancer in our study, is lower than the rest of the cancers. Early detection of premalignant lesions of cervical and oral lesions might be the reason behind.[14],[15],[16] This reduction can also be acclaimed to Kerala's health care, and social reforms, which has the health indicators of the state that are even close to those of developed countries.[17] This is supported by the data in the Global Adult Tobacco survey-2 reports, where tobacco control had dropped from 21.4% in 2009–2010 to 12.7% in 2016–2017.[18] A study done in Central and South America on cancer patterns and trends follows a similar pattern as this study.[12]

After analyzing the data, it is clear that reported prostate cancer is increasing as the year advances. In 2012, it was 1.31%, but in 2016, it rises to 4.11%. At the same time, esophageal carcinoma, acute leukemia, and ovarian cancer are decreasing as the year advances. In 2012, the prevalence was 1.99%, 0.54%, 3.53%, respectively, when it reached 2016 it was 0.09%, 0.27%, and 1.18%. The common cancers, i.e., breast, lung, and colorectal carcinoma, are not showing an increase in prevalence even though the numbers are high compared to other carcinomas.

Regarding trends based on the age of cancer patients, breast cancers were more seen under 51–60 years, but there was also a high prevalence under 41–50 years. Hence, we can say that 41–60 years age group are more prone to breast cancers. These data are comparable with a cross-sectional study done in Kerala in 2014,[19] where breast cancer incidence was high at 41–50 and 51–60 years age group. Lung cancer prevalence is high between 61 and 70 years, which is not comparable with the study done by Noronha [20] in 2012, where high incidence is seen (57%) in the 40–60 years age group.


  Conclusion Top


The common cancer found from 2012 to 2016 are breast cancer, lung cancer, colorectal cancer. Furthermore, there is an increase of prostate cancer and decrease of esophageal, acute leukemia, and ovarian cancers. Data from hospital-based cancer registry provide the magnitude of the burden of disease in the country, which helps the policy-makers to plan accordingly. As this research is based on the hospital registry, true trend of the disease in the community cannot be ascertained from this data, which remains as the limitation of the study.

Recommendations

From this study, breast, lung, and colorectal cancers top the list. Furthermore, prostate cancer prevalence has increased over the years. Awareness regarding different cancers and screening methods have to be promoted. As the analysis shows an increase in the cancer patterns, awareness activities regarding risk factors and symptoms of cancers have to be promoted. Utilization of the cancer registry data has to be promoted so that national programs can be planned according to the data outcomes. Improved data coverage of the registry may help in planning the health services of the hospitals for cancer patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO. Global Action Against Cancer. Updated edition. Geneva: WHO Publications; 2003.  Back to cited text no. 1
    
2.
Atun R, de Andrade LO, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. Lancet 2015;385:1230-47.  Back to cited text no. 2
    
3.
WHO. Global Action Against Cancer. Updated edition Geneva: WHO Publications; 2005  Back to cited text no. 3
    
4.
NCRP – Three-Year Report of Population Based Cancer Registries: 2012-2014, National Cancer Registry Programme (Indian Council of Medical Research), Bengaluru; 2016.  Back to cited text no. 4
    
5.
WHO. Cancer Control: Knowledge Into Action, WHO Guide for Effective Programmes Module 2: Prevention, Geneva: WHO; 2007.  Back to cited text no. 5
    
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Kishor J. Kishore's National Health Programmes of India. 7th ed. New Delhi: Century Publications; 2007.  Back to cited text no. 6
    
7.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.  Back to cited text no. 7
    
8.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016;66:7-30.  Back to cited text no. 8
    
9.
Babita SK, Krishnadas VT, Saju CR, Vidhu J, Catherin N. Prevalence of cancers from a hospital based cancer registry in a tertiary care hospital in South India. IJSRE 2015;3:4638-40.  Back to cited text no. 9
    
10.
Mathew A, George PS, Ma JK, Vasudevan D, James FV. Transition of cancer in populations in India. Cancer Epidemiol 2019;58:111-20.  Back to cited text no. 10
    
11.
GLOBOCAN 1991; International Association of Cancer Registry. Available from: http:// www. iacr.com.fr. [Last accessed on 2018 Dec 27].  Back to cited text no. 11
    
12.
Regional Cancer Center Trivandrum. Available from: http://www.rcctvm.org, RCC_AR_2014-15. [Last accessed on 2019 Aug 18].  Back to cited text no. 12
    
13.
National Cancer Registry Programme by National Center for Disease Information and Research; Annual Report; 2014-2015.  Back to cited text no. 13
    
14.
Parkin DM, Muir CS, Whelan SL, Gao YT, Ferlay J, Powell J. Cancer Incidence in five continents. IARC 1992;6:101-7.  Back to cited text no. 14
    
15.
Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC, et al. Accuracy of visual screening for cervical neoplasia: Results from an IARC multicentre study in India and Africa. Int J Cancer 2004;110:907-13.  Back to cited text no. 15
    
16.
Kujan O, Glenny AM, Oliver RJ, Thakker N, Sloan P. Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev 2006;3:CD004150.  Back to cited text no. 16
    
17.
Sauvaget C, Ramadas K, Fayette JM, Thomas G, Thara S, Sankaranarayanan R. Socio-economic factors and longevity in a cohort of Kerala State, India. Indian J Med Res 2011;133:479-86.  Back to cited text no. 17
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18.
Ministry of Health and Family Welfare, Government of India. Global Adult tobacco Survey/India Fact Sheet 2016-2017. Available from: https://mohfw.gov.in/sites/default/files/GATS-2%20FactSheet.pdf. [Last accessed on 2019 Jun 16].  Back to cited text no. 18
    
19.
Rajan G, Culas TB, Jayalakshmy PS. Estrogen and progesterone receptor status in breast cancer: A cross-sectional study of 450 women in Kerala, South India. World J Surg Oncol 2014;12:120.  Back to cited text no. 19
    
20.
Noronha V, Dikshit R, Raut N, Joshi A, Pramesh CS, George K, et al. Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience. Indian J Cancer 2012;49:74-81.  Back to cited text no. 20
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