Contrasts in cancer prevalence in Connecticut,Iowa, and Utah

BACKGROUND: Cancer prevalence--the proportion of a population with cancer, including those recently diagnosed, those in treatment, and survivors--is an important indicator of future health care requirements. Only limited information on cancer prevalence is available for the United States. In particular, comparative interstate studies are not available. In this study, we estimate and analyze the prevalence of seven major cancers in Connecticut, lowa, and Utah using the tried and tested PREVAL method applied to National Cancer Institute registry data. METHODS: We analyzed data on 242,851 carcinomas of the stomach, colorectum, pancreas, breast, uterus (corpus), ovary, and non-Hodgkin lymphoma (NHL), diagnosed in white Americans from 1973 through 1992. Observed prevalence was estimated by applying the PREVAL method to incidence and life status data from the cancer registries. Complete prevalence was estimated by applying correction factors obtained by modeling incidence and survival rates. RESULTS: The ratio of the highest to the lowest prevalence (as proportions) ranged from 1.69 for uterine carcinoma to 2.73 for stomach carcinoma, showing that marked differences in cancer prevalence exist within the United States. Utah had the lowest prevalence for each carcinoma. Connecticut and lowa had similar prevalence levels for carcinomas of the colorectum, pancreas, and ovary and for NHL. Breast carcinoma was the most prevalent, with 826 cases per 100,000 of population in Utah, 1518 per 100,000 in lowa, and 1619 per 100,000 in Connecticut. Cancer survival did not differ greatly among the three registry populations. The major determinants of prevalence differences were incidence and the population age distribution. CONCLUSIONS: PREVAL provides reliable estimates of the numbers of living people in a population who have had a cancer diagnosis. Prevalence depends on incidence and survival and on the age structure of population. All these factors have changed markedly in recent years and will continue to do so in the future. Cancer prevalence should be monitored over time to evaluate changes by area, sex, age, and cancer site. The prevalence figures presented are directly comparable with those from European cancer registries.     

Cancer Incidence and Mortality: District Cancer Registry,Trivandrum, South India

Background: Cancer is emerging as a major cause of morbidity and mortality in low and middle-income countries. Cancer registry figures help for planning and delivery of health services. This paper provided the first results of cancer incidence and mortality [Crude (CR) and age-standardized (ASR)] rates (world-standard population) of Trivandrum district, South India and compared with other registries under the network of National Cancer Registry Programme (NCRP), Government of India. Materials and Methods: Trivandrum district cancer registry encompasses a population of 3.3 million, compiles data from nearly 75 sources (hospitals and diagnostic laboratories) and included under the NCRP in 2012. During 2012-2014, registry recorded 15,649 incident cases and 5667 deaths. Proportion of microscopic diagnosis was 85% and ‘Death certificate only’ was 8%. Results: Total cancer incidence (CRs) rates were 161 and 154 (ASR: 142.2 and 126) and mortality rates were 66 and 49 (ASR: 54 and 37) per 105 males and females respectively. Common cancers in males were lung (ASR:19), oral cavity (ASR:15), colo-rectum (ASR:11.2), prostate (ASR:10.2) and lymphoma (ASR:7) and in females, breast (ASR:36), thyroid (ASR:13.4), cervix-uteri (ASR:7.3), ovary (ASR:7) and colo-rectum (ASR:7). Nationally, the highest CRs for breast, prostate, colo-rectum, corpus-uteri and urinary bladder cancers and low incidence of cervix-uteri cancer were observed in Trivandrum. Conclusion: Cancer incidence (CR) in Trivandrum was the highest in both genders in India (except Aizwal). This is mainly due to the highest life-expectancy in Kerala. Also, an epidemiologic transition in cancer pattern is taking place and is changing to more similar to "western" jurisdictions.     

Cancer prevalence in Italian regions with local cancer registries

OBJECTIVE: To provide estimates and projections of cancer incidence and prevalence for those Italian regions whose population is partially covered by a cancer registry (CR) and to determine to what extent local CRs can be considered representative of the region, thus improving the potential of the information provided by CRs. METHODS: A statistical method, MIAMOD (mortality-incidence analysis model), was used to estimate regional cancer incidence and prevalence from regional cancer mortality data and patient survival data recorded by the cancer registries. Estimates of the cancer incidence and prevalence in the various regions have thus been obtained for a number of major cancer sitas. A first and important step in validating the regional estimates has been the comparison of the MIAMOD estimates in the areas covered by the cancer registries with empirical incidence and prevalence observed by CRs, in order to assess the consistency in data, methods and assumptions. Empirical prevalence has been calculated by counting patients with a diagnosis of cancer who were alive on the reference date by PREVAL method. A correction factor has been applied to include patients diagnosed before the period of activity of the registry. RESULTS: General consistency was found between empirical and estimated (by MIAMOD) incidence and prevalence in the registry areas, which is indicative of the quality and the completeness of all data involved as well as the appropriateness of model choices. The prevalence of all cancers combined for Italian regions with CRs was estimated and projected to the year 2000 as ranging between 1,240 per 100,000 in Sicilia and 2,781 in Emilia-Romagna for men, while for women these figures were 1,765 in Sicilia and 4,019 in Liguria. Comparison of cancer prevalence in CR areas with regional estimates shows quite good consistency for Piemonte, Liguria and Lombardia, which means that the local CRs (of Torino, Genova and Varese, respectively) are representative of their respective regions. Prevalence in Emilia-Romagna appears to be rather well represented by only one, the Parma CR, of the three local CRs. The southern Italian registries of Latina and Ragusa recorded a lower cancer prevalence than was actually estimated in their respective regions. DISCUSSION: Cancer registries with a longer period of activity showed better agreement between empirical and estimated figures due to the more precise information provided, particularly regarding survival and incidence trends. In conclusion, this work shows the potential of the cancer registries not only to represent their population with respect to cancer morbidity but also as an invaluable tool to extrapolate this information to the larger areas they represent.     

International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising

Lung cancer rates have peaked among men in many areas of the world, but rates among women continue to rise. Most lung cancers are squamous cell carcinoma, small cell carcinoma, or adenocarcinoma; trends vary according to type. We compiled population-based morphology-specific incidence data from registries contributing to the International Agency for Research on Cancer (IARC) databases. Unspecified cancers and carcinomas were reallocated based on a registry, time period, sex and age group-specific basis. Where available, data from several registries within a country were pooled for analysis. Rates per 100,000 person-years for 1980-1982 to 1995-1997 were age-adjusted by the direct method using the world standard. Squamous cell carcinoma rates among males declined 30% or more in North America and some European countries while changing less dramatically in other areas; small cell carcinoma rates decreased less rapidly. Squamous and small cell carcinoma rates among females generally rose, with the increases especially pronounced in the Netherlands and Norway. In contrast, adenocarcinoma rates rose among males and females in virtually all areas, with the increases among males exceeding 50% in many areas of Europe; among females, rates also rose rapidly and more than doubled in Norway, Italy and France. Rates of all lung cancer types among women and adenocarcinoma among men continue to rise despite declining cigarette use in many Western countries and shifts to filtered/low-tar cigarettes. Renewed efforts toward cessation and prevention are mandatory to curb the prevalence of cigarette smoking and to reduce lung cancer rates eventually.     

Cancer Occurrence in Iran in 2002, an International Perspective

For almost 30 years no population-based cancer statistics have been available with which to estimate the cancer ‍burden in Iran. In 2002 and 2003 two separate reports of population based cancer registries were published from ‍Iran and the cancer incidence rates from these sources have permitted informed estimates of cancer incidence and ‍mortality to be prepared. They suggest that more than 51,000 cases of cancer are diagnosed and 35,000 deaths due to ‍cancer occur each year. The 5 most common cancers in males (by ASR) are stomach (26.1 per 105), esophagus (17.6 ‍), colon-rectum (8.3), bladder (8.0) and leukemia (4.8), and in females are breast (17.1), esophagus (14.4), stomach ‍(11.1), colon-rectum (6.5) and cervix uteri (4.5). The incidence rates of esophageal and stomach cancer in Iran are ‍high, well above the world average, while the incidence of lung cancer is very low. Breast cancer, although the most ‍common cancer of females in Iran, has rates that are low by world standards, especially those observed in Europe ‍and USA. Similarly, the incidence of cervix cancer in Iran is very low, even lower than such low risk countries as ‍China, Kuwait and Spain. Comparing these rates with the data of 30 years ago, the incidence of esophageal cancer ‍has decreased dramatically, but gastric cancer has increased about two fold.     

Incidence and mortality of pancreatic cancer in the Nordic countries 1971-2000

Pancreatic cancer (PC) is the sixth most frequent cause of death from cancer in Europe in men as well as women. Apart from smoking, little is known about the aetiology of PC. This study examines trends in incidence and mortality of PC in Denmark, Finland, Iceland, Norway, and Sweden from 1971 to 2000, using the database NORDCAN, with data on incident cases of PC derived from the national cancer registries and data on deaths from PC from the national registries on causes of death. The analysis included 91 842 incident cases and 96 430 deaths from PC in a total population of about 23 million. The mean age at diagnosis was 69 years for males in the Nordic countries for the period 1996-2000 and 72 years for females. Using the age-specific rates from year 2000 to calculate the cumulative risk, 8.4 of 1 000 Nordic men and 6.7 of 1 000 Nordic women will develop PC before the age of 75 years. Over the past 30 years incidence and mortality rates have been decreasing in males and remained stable without any particular trend in females whether examined by calendar time or birth cohort. However, there are considerable difficulties in obtaining true estimates of the incidence and mortality from PC, since less than 60% of incident cases are verified histologically and autopsy rates have decreased over time.     

A comparative analysis of cancer prevalence in cancer registry areas of France, Italy and Spain.

A comparative analysis of cancer prevalence in France, Spain and Italy is presented as part of the EUROPREVAL project. The three countries are culturally and sociologically relatively homogeneous compared with Europe as a whole. However, in all three countries, the cancer registries (CRs) providing the data for prevalence calculation cover only small fractions of the populations, and have been operating for relatively short periods. This leads to problems of representativity and to prevalence underestimates as surviving cases diagnosed before operation of the CR are not recorded. Partial prevalences obtained directly from CR data were therefore corrected using a completeness index obtained by modelling to provide estimates of the complete prevalence. For CRs operating for only 5 years, only approximately half the prevalence was observed. Thus, due to the rather recent start of most of southern European CRs, the role of correction is very important. The prevalence of all cancers was highest in Italy for women and in France for men, while lowest in Spain. Differences in the age structures of the populations were the major cause of these discrepancies and after age adjustment only the prevalence of stomach cancer remained highest in Italy, although differences in incidence also contributed to the prevalence differences. Survival varied little between the three countries and differences in incidence are more important determinants of prevalence. Prevalence of cancer in the elderly represents an increasing load for the community, particularly for France, Italy and Spain due to the ageing population in these countries. Elderly patients with cancer frequently suffer from problems of co-morbidity and disability factors, thus placing a burden on the local medical system where this proportion is high. Prevalent cases diagnosed 1-5 years before the prevalence date formed approximately one-third of the total prevalence, with higher proportions for melanoma, and prostate cancer in males and breast and colorectal cancer in females, and lower proportions for uterine cancer. This subset of the prevalent population consists of those probably on intensive follow-up, or being treated for cancer recurrence or sequelae to primary therapy.     

Cancer prevalence in Northern Europe: the EUROPREVAL study.

BACKGROUND: Information on cancer prevalence is of importance for health planning and resource allocation, but is not always available. In order to obtain such data in a comparable way a systematic evaluation of cancer prevalence in Europe was undertaken within the EUROPREVAL project. PATIENTS AND METHODS: Standardised data were collected from 38 population-based registries on almost 3 million cancer patients diagnosed between 1970 and 1992. The prevalence of 11 specific cancer types was estimated at the index date of 31 December 1992. This study deals with the northern countries Denmark, Estonia, Finland, Iceland and Sweden. RESULTS: There were large differences between these countries, Sweden having the highest prevalence rate of 3050 per 100 000 and Estonia the lowest, 1339 per 100 000. This difference is mainly due to a high proportion of cancers with favourable prognosis such as breast cancer, prostate cancer and melanoma, better survival and longer life expectancy in Sweden, whereas Estonia has a higher proportion of stomach and lung cancer with poor prognosis, worse survival and much shorter life expectancy, especially for males. For most tumour types, the Nordic countries did better than Estonia. There are indications that cancer patients in Estonia, as well as in Denmark, have a more advanced stage at diagnosis and that the Estonian health-care system is less efficient. CONCLUSIONS: Despite many similarities and a common historical background, the northern countries in Europe that participated in the EUROPREVAL study display quite different cancer patterns and prevalence. Reasons for these variations are discussed.     

Cancer mortality in Shanghai during the period 1963-77.

In Shanghai a population-based Cancer Registry has been in operation since 1963 covering the urban area, with total population of about 5.6 million. In this report methods of collecting cancer deaths and population data are described in detail, and cancer mortality data for the period 1963-77 presented. The main fatal cancers were those of stomach, lung, liver, oesophagus and colon-rectum; among females, in addition there were cancers of uterus and breast. During the 15-year period a rapid increase in cancer-mortality rate was seen for lung, colon-rectum, pancreas in both sexes, and for bladder in males. A notable decrease in mortality rate for cancer of the uterus (mainly for cancer of cervix uteri) occurred.     

Cancer prevalence in the UK: results from the EUROPREVAL study.

BACKGROUND: Cancer incidence, mortality and survival statistics for the UK are routinely available; however, data on prevalence, which is generally regarded as an important measure for health planning and resource allocation, are relatively scarce. MATERIALS AND METHODS: Eight cancer registries in the UK, covering more than half the population, provided data based on >1.5 million cases of cancer. Total prevalence was calculated using methods developed for the EUROPREVAL study, based on modelling incidence and survival trends. The prevalence of cancers of the stomach, colon, rectum, lung, breast (in females), cervix uteri, corpus uteri and prostate, melanoma of skin, Hodgkin's disease, leukaemia and all malignant neoplasms combined, was estimated for the UK for the end of 1992. RESULTS: Overall, approximately 1.5% of males and 2.5% of females in the UK population at the end of 1992 were living with a diagnosis of cancer. These proportions increased steeply with age, with approximately 7.5% (7.3% and 7.8%, in males and females, respectively) of people aged > or =65 years living with a diagnosis of cancer. Of the individual cancers, by far the highest prevalence (almost 1%) was seen for breast cancer in females; more than one in three of all living female cancer patients had been diagnosed with breast cancer. For males, around half of prevalent cases had been diagnosed >5 years previously and 30% >10 years previously; for females, these figures were both higher, at approximately 60% and 40%, respectively. CONCLUSIONS: The estimates of prevalence presented here comprise: recently diagnosed patients in need of treatment and monitoring; long-term survivors, some of whom will nevertheless eventually die from the cancer, while others may be cured of the disease; and patients in the terminal phase who are dying from the cancer. Further work should attempt to identify the proportions of patients in the different phases of care in order to optimise the use of prevalence estimates in health care planning.     

Cancer statistics in China, 2015

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high‐quality data from an additional number of population‐based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population‐based cancer registries (2009‐2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000‐2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age‐standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (?1.4% per year; P < .05) and females (?1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations. CA Cancer J Clin 2016;66:115–132. © 2016 American Cancer Society.     

Quality analysis of population-based information on cancer stage at diagnosis across Europe,with presentation of stage-specific cancer survival estimates: A EUROCARE-5 study

BackgroundCancer registries (CRs) are fundamental for estimating cancer burden, evaluating screening and monitoring health service performance. Stage at diagnosis—an essential information item collected by CRs—has been made available, for the first time, by CRs participating in EUROCARE-5. We analysed the quality of this information and estimated stage-specific survival across Europe for CRs with good data quality.Data and methodsSixty-two CRs sent stage (as TNM, condensed TNM or extent of disease) for 15 cancers diagnosed in 2000–2007. We assessed the quality, partly by comparing stage according to the three systems. We also developed procedures to reconstruct stage (categories: local, regional, metastatic and unknown) using information from all three systems, thus minimising the amount of missing information.ResultsModerate-to-excellent stage concordance was found for practically all 24 CRs, for which it was possible to compare at least two staging systems. However, since stage was often incorrectly assigned, and information on the presence/absence of metastases was often lacking, data on only 7/15 cancers from 34/62 CRs (15 countries) were of sufficient quality for further analysis. Cases diagnosed ≥70 years had more advanced (or lacking) stage– and worse stage-specific survival than those <70 years.ConclusionsMany European CRs collect and record reasonably accurate stage information. Others have difficulties. Both the completeness of primary data and the accuracy of stage coding need to be improved in order for CRs to fulfil their expanding roles in cancer control. We propose our stage reconstruction/checking procedures as a means of fully exploiting the stage information provided by EUROCARE CRs. More advanced (or lacking) stage at diagnosis plus poorer stage-specific survival in the elderly are worrying.     

Changing incidence of thyroid cancer.

The incidence of thyroid cancer was examined temporally and geographically by age and sex from data provided by tumor registries in the United States and abroad. The temporal trends in Connecticut showed an increase in annual incidence after 1945, with an especially sudden increase in incidence in females. The increase occurred predominantly in older males and younger females. The increase in young females was confirmed by cohort analysis. The rates rose with age in both sexes, but recently females have developed a secondary peak in the fourth decade of life. The same phenomenon was observed in other U.S. data but not as clearly in data from ten foreign registries. These observations are consistent with the hypothesis that X-radiation therapy for benign conditions of the head and neck in childhood was a factor in the increased incidence of thyroid cancer in U.S. females, but some other etiologic or modifying factor should be sought to explain the increased incidence in U.S. males.     

Worldwide Variations in Colorectal Cancer

Previous studies have documented significant international variations in colorectal cancer rates. However, these studies were limited because they were based on old data or examined only incidence or mortality data. In this article, the colorectal cancer burden and patterns worldwide are described using the most recently updated cancer incidence and mortality data available from the International Agency for Research on Cancer (IARC). The authors provide 5‐year (1998–2002), age‐standardized colorectal cancer incidence rates for select cancer registries in IARC's Cancer Incidence in Five Continents, and trends in age‐standardized death rates by single calendar year for select countries in the World Health Organization mortality database. In addition, available information regarding worldwide colorectal cancer screening initiatives are presented. The highest colorectal cancer incidence rates in 1998–2002 were observed in registries from North America, Oceania, and Europe, including Eastern European countries. These high rates are most likely the result of increases in risk factors associated with “Westernization,” such as obesity and physical inactivity. In contrast, the lowest colorectal cancer incidence rates were observed from registries in Asia, Africa, and South America. Colorectal cancer mortality rates have declined in many longstanding as well as newly economically developed countries; however, they continue to increase in some low‐resource countries of South America and Eastern Europe. Various screening options for colorectal cancer are available and further international consideration of targeted screening programs and/or recommendations could help alleviate the burden of colorectal cancer worldwide. CA Cancer J Clin 2009;59:366–378. © 2009 American Cancer Society, Inc.     

Cancer survival in Africa, Asia, the Caribbean and Central America. Introduction

The dearth of reliable survival statistics from developing countries was very evident until the mid-1990s. This prompted the International Agency for Research on Cancer (IARC) to undertake a project that facilitated hands-on-training and thereby transfer of knowledge and technology on cancer survival analysis to a majority of researchers from the participating population-based cancer registries, which culminated in the publication of the first volume of the IARC scientific publication on Cancer Survival in Developing Countries in 1998. The present study is the second in the series with wider geographical coverage and is based on data from 27 registries in 14 countries in Africa, Asia, the Caribbean and Central America. The calendar period of registration of incident cases for the present study ranges between 1990 and 2001. Data on 564 606 cases of 1-56 cancer sites from different registries are reported. Data from eleven registries were utilized for eliciting survival trend and seventeen registries for reporting survival by clinical extent of disease. Besides chapters on every registry and general chapters on methodology, database and overview, the availability of online comparative statistics on cancer survival data by participating registries or cancer site in the form of tables or graphs is an added feature (available online at http://survcan.iarc.fr).     

Trend analysis of cancer incidence in Japan using data from selected population-based cancer registries

Population-based cancer registries are operated by over 80% of prefectures in Japan. However, only a limited proportion of the registries can provide long-term incidence data. Here, we aimed to establish a method for monitoring cancer incidence trends in Japan using data from selected prefectures. Based on the availability of long-term (≥ 20 years) high-quality data, we collected incidence data from five prefectures (Miyagi, Yamagata, Fukui, Osaka, and Nagasaki), which included an annual average of 54,539 primary cancer cases diagnosed between 1985 and 2004. Cancer mortality data for 1995-2004 were obtained from the vital statistics. Representativeness and homogeneity of the trends were examined by funnel plot analysis of log-linear regression coefficients calculated for the most recent 10 years of data (1995-2004) of age-standardized rates (ASR). The ASR of incidence for five prefectures in total (5-pref total) showed a significant decrease, with an annual percent change (APC) of -1.0 (95% confidence interval [CI] -1.4: -0.6) for males and -0.4 (95% CI -0.8: -0.1) for females. Excluding data from Osaka (4-pref total) reversed the decreasing trend; the corresponding APC was +0.4 (95% CI -0.2: +1.0) for males and +0.7 (95% CI +0.5: +0.9) for females. The APCs for the ASR of mortality for the 4-pref total (males, -1.5; females, -1.3) were more representative of nationwide data (males, -1.4 [95% CI -1.7: -1.2]; females, -1.1 [95% CI -1.4: -0.9]) than those for the 5-pref total (males, -1.7; females, -1.4). We conclude that using data from Miyagi, Yamagata, Fukui, and Nagasaki prefectures, with continuous monitoring of the representativeness of the data, is a provisionally relevant way to evaluate cancer incidence trends in Japan.     

Obtaining data on comorbid diabetes among patients in a U.S. population-based tumor registry

Comorbid diabetes mellitus has been shown to be associated with outcomes among cancer patients, but population-based data have been limited to elderly patients through linkages between the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program database and Medicare databases. Reporting of comorbidity to the population-based Connecticut SEER registry is not required, but the extent of voluntary reporting of comorbid diabetes was assessed in this preliminary study. Of 15,145 Connecticut residents diagnosed at age 20+ years with invasive cancer in 2006, who were ascertained from 33 registry sources, 8688 (57.4%) from 21 sources were included in the analysis of comorbid diabetes. The prevalence of comorbid diabetes was 12.5%, and was lowest for patients with prostate cancer (8.5%) and highest for with liver-pancreas cancer (25.9%), consistent with the literature. Diabetes prevalence was substantial (9.5%) within the non-elderly subgroup aged 20-64 years at cancer diagnosis who comprised 45% of the 8688 patients. These results indicate an opportunity for future large-scale studies of the impact of diabetes on outcomes among all newly diagnosed cancer patients (both non-elderly and elderly) in the Connecticut SEER registry and other US central cancer registries.     

Prevalence of Tobacco Use and Tobacco-dependent Cancers in Males in the Rural Cancer Registry Population at Barshi,India

Background: In the Rural Cancer Registry at Barshi (western Maharashtra, India), it has been found thatthe incidence of cancer is relatively low. Aim: To explain the low incidence of tobacco related cancers in maleson the basis of prevalence of their tobacco habits. Setting and Design: Simple random sample of villages fromBarshi Rural Cancer Registry. Material and Methods: A tobacco survey was carried out in 5,319 adult males.Site specific incidence data for Barshi and Mumbai Cancer Registries were available from published reports inthe National Cancer Registry Programme. Published report of prevalence of tobacco habits in Mumbai maleswas available. Results: The tobacco survey showed that the prevalence of smoking compared to Mumbai waslow (9.9% vs 23.6%) and the incidence of smoking dependent cancers viz., cancers of oropharynx, larynx andlung were significantly low (P<0.05). However, although the proportion of tobacco chewers is higher in Barshicompared to Mumbai, the incidence rates for cancer of hypopharynx and oral cancer which are predominantlychewing dependent did not show higher rate than in Mumbai. Conclusions: The low incidence of smokingdependent cancers in males can be explained by the low prevalence of smoking habit but further studies areneeded to explain the observed incidence of predominantly chewing dependent cancers.