Oral Cancers in Mumbai,India: a Fifteen Years Perspective with Respect to Incidence Trend and Cumulative Risk

Objective: We estimated the time trends in the incidence and the risk of developing an oral cancer in Mumbai, ‍Indian population using the data collected by the Bombay Population Based Cancer Registry during the 15 year ‍period from 1986 to 2000. ‍Methods: A total of 9,670 oral cancers (8.2% of all neoplasms) were registered, of which 6577 were in males and ‍3093 in females (10.7% and 5.4% of the respective totals for the two genders) . For evaluation of the trend, we ‍applied a linear regression model based on the logarithm of the observed incidence rates. The annual percentage ‍changes were also computed for the incidence rates to evaluate the time trend. ‍Results: In males, a statistically significant decreasing trend in the overall age-adjusted incidence rates were ‍observed during the period 1986 to 2000, with an yearly decrease of 1.70%. This decrease was significant for men ‍above the age of 40, but for young adult men below the age of 40, there was no significant decrease, the level being ‍stable. In females, the overall decreasing trend in the age-adjusted incidence rates of oral cancers was not significant, ‍but in the age group 40-59, a significant decline was observed. The probability estimates indicated that one out of ‍every 57 men and one out of every 95 women will contract any oral cancer at some time in their whole life and 97% ‍of the chance is after he or she completes the age of 40. ‍Conclusion: The observed decreasing trend in oral cancers in Indian men may be attributed to a decrease in the ‍usage of pan and tobacco. The high prevalence of the usage of smokeless tobacco among young adult men and ‍women may explain the stable trend in oral cancer incidence in this group. These findings help to strengthen the ‍association between tobacco use and oral cancer risk. ‍     

Higher lung cancer rates in young women than young men: Tasmania, 1983 to 1992

In a background of changing lung cancer rates in the past decade, mean incidence and mortality rates for persons aged 25–44 in Tasmania for the decade 1983 through 1992 were examined using Tasmanian Cancer Registry data. The smoking behavior of Tasmanian adults and schoolchildren was also investigated, using data from a social survey conducted by the Australian Bureau of Statistics and from five secondary school smoking surveys. The Tasmanian age-standardized lung cancer incidence rates in 25–44 year olds for the 10-year period were 6.2 per 100,000 females and 3.3 per 100,000 males. Mean rates of incidence were higher for females than for males (P=0.02). The corresponding mortality rates were 4.2 in females and 2.4 in males (P=0.08). The prevalence of smoking by adult Tasmanian women is higher than that for other Australian women (P<0.05), and their duration of smoking is longer (P<0.01). Tasmanian schoolgirls have a higher smoking prevalence than Australian mainland schoolgirls (P=0.01) and higher prevalence than Tasmanian schoolboys (P=0.01). The data suggest that smoking prevalence among teenagers passed that for males only a decade before the observed excess of female incident cases among 25–44 year olds in Tasmania.This project is funded partially by the Tasmanian Department of Community and Health Services in the form of an annual grant for the operation of the Tasmanian Cancer Registry.     

Trends in incidence of head and neck cancers in India

Information relating to cancer incidence trends forms the scientific basis for the planning and organization of prevention, diagnosis and treatment of cancer in a community. An attempt was here made to study the trends in the age adjusted incidence rates for the sites of head and neck cancers in Mumbai, Bangalore, Chennai, Delhi, Bhopal, and Barshi registry's populations. For carrying out trend analysis the gum, the floor of mouth, the mucosa of cheek, the hard and soft palate and the uvula were grouped together and assigned as cancers of mouth. The trend analysis was carried out for all sites together, tongue, mouth, hypopharynx and larynx in males and all sites together and mouth in females. Sites such as lip, hypopharynx and nasopharynx were not considered. In males, for all sites together linear regression showed no increase or decrease in age adjusted rates overall for Bangalore and Delhi registries, a significant decrease for Mumbai and Delhi registries, but a rising trend for Chennai and Bhopal registries over a period of time. In females, for all sites together no change was observed in age adjusted incidence rates for Mumbai, Chennai, Bhopal, Bangalore and Barshi registries while a decreasing trend was noted for Delhi registries over a period of time. For the specific sites, variation among registries was also apparent. The results point to local differences in sub-site specific risk factors which might be elucidated by analytical epidemiological assessment.     

Trends in cancers of the upper alimentary and respiratory tracts in women in bombay, India

Cancers of the upper alimentary and respiratory tracts are proven to be causally associated with tobacco use and are therefore preventable. These cancers form 50% of all cancers in men and 20% in women in Bombay. This study reports on the trends in women for these cancers (observed in the Bombay Cancer Registry during 1964-81) which were found to be by and large similar to those reported elsewhere for males. A significant decline in age-adjusted rates (AAR) for Cancer of the oropharynx (Average Percentage Change: APC=-3.22, P<0.05) and for Cancer of the larynx (APC=-1.88, P<0.05) were observed. For cancer of the tongue, although the AAR did not show a significant decline, examination of trends in 10 yearly age-groups showed a significant decrease in 25-34 year group (APC=-7.09, P<0.01) indicating that in future years the decline in AAR is likely to attain significance. The decline in predominantly bidi (a popular form of smoking in India) dependent cancers is likely to be a reflection of a significant decline in prevalence of smoking in women with decrease in age. Age-adjusted rates for cancers at other sites in the alimentary and respiratory tracts were generally stable and underscored the need for a tobacco control program in women (along with men) to achieve a non-tobacco culture.     

Changes in cancer incidence attributable to tobacco smoking in Germany, 1999–2008

Tobacco smoking, a major cancer risk factor, is very common in Germany as in many other high‐income countries. Few studies have assessed the burden of tobacco‐associated cancer incidence in the German population. We calculated the proportion of cancers attributable to tobacco smoking to estimate the burden of tobacco‐associated cancer in 1999 and 2008. Smoking prevalence was determined from national surveys of a representative sample of the German population in 1998 and 2008–2011, and data on relative risks were obtained from meta‐analyses. Cancer incidence for the years 1999 and 2008 was estimated by the German Centre for Cancer Registry Data at the Robert Koch Institute. We estimate that 72,208 incident cancer cases were attributable to tobacco smoking in Germany in 2008, an increase of >6,200 cases over 1999 levels. Among the cases in 2008 were 55,057 cases among men (22.8% (95% CI, 21.3–24.1) of all new cases) and 17,151 cases among women (7.9% (95% CI, 7.21–8.68) of all new cases). The highest proportions attributable to smoking were estimated for cancer of the lung, larynx, pharynx and the lower urinary tract. Tobacco smoking is currently responsible for more than one in five cancer cases among men and nearly 1 in 12 among women. Considering the increasing trends in cancer incidence and, until very recently, rising prevalence of smoking among women, it can be expected that the number of tobacco‐attributable cancer cases will rise further.     

Sauna, dust and migration as risk factors in lung cancer among smoking and non-smoking males in Finland

To study possible causes of the high lung cancer incidence among Finnish males, the Finnish Cancer Registry and the Cancer Registry of Norway in 1962 performed a population survey covering smoking habits, occupational and residential history and, in Finland, sauna habits. The cohort of 4,475 Finnish men has now been followed up for incidence of lung cancer in 1964-1979. The relative importance of 3 factors--sauna baths, occupational exposure to dust, and migration to urban areas--was studied in different smoking categories. Among smokers of greater than or equal to 25 g/day, takers of frequent saunas (more than once a week) displayed some excess risk (RR 1.7). In smokers an increased risk was also found among those exposed to dust (RR 1.3), and those who had migrated to urban areas (RR 1.8, when compared to native urban population). Dust exposure and migration factors act synergistically with smoking. Migration was the only factor apart from smoking to show a substantial population-attributable risk, which amounted to 10%.     

Correlation of Cancer Incidence with Diet,Smoking and Socio-Economic Position Across 22 Districts of Tehran in 2008

Background: Variation in cancer incidence in geographical locations is due to different lifestyles and riskfactors. Diet and socio-economic position (SEP) have been identified as important for the etiology of cancer butpatterns are changing and inconsistent. The aim of this study was to investigate correlations of the incidence ofcommon cancers with food groups, total energy, smoking, and SEP. Materials and Methods: In an ecologicalstudy, disaggregated cancer data through the National Cancer Registry in Iran (2008) and dietary intake,smoking habits and SEP obtained through a population based survey within the Urban Health Equity Assessment(Urban-HEART) project were correlated across 22 districts of Tehran. Results: Consumption of fruit, meatand dairy products adjusted for energy were positively correlated with bladder, colorectal, prostate and breastand total cancers in men and women, while these cancers were adversely correlated with bread and fat intake.Also prostate, breast, colorectal, bladder and ovarian cancers had a positive correlation with SEP; there was nocorrelation between SEP and skin cancer in both genders and stomach cancer in men. Conclusions: The incidenceof cancer was higher in some regions of Tehran which appeared to be mainly determined by SEP rather thandietary intake. Further individual data are required to investigate reasons of cancer clustering.     

Decreasing Trend in the Incidence of Stomach Cancer in Mumbai,India, during 1988 to 1999

The time trend in incidence of stomach cancer in males and females in Mumbai, India during 1988 to 1999 was ‍estimated using data collected by the Bombay Population-based Cancer Registry. During the 12-year period, a total ‍of 3657 stomach cancer cases (3.9% of all cancers) were registered by the Bombay Population-based Cancer Registry ‍of which 2467 (5.1% of all male cancers) were in males and 1184 (2.6% of all female cancers) in females. For evaluation ‍of the trend, we applied a linear regression model based on the logarithm of the observed incidence rates. The annual ‍percentage changes were also computed for the incidence rates for evaluating the time trend. A statistically significant ‍decreasing trend in the overall age-adjusted incidence rates of stomach cancer was observed during the period 1988 ‍to 1999, with an yearly decrease of 4.44% in males and 2.56% in females. This decrease was most striking in males ‍in the age groups 40-59 and 60+, and in females only in the age group 40-59. The probability estimates indicated that ‍one out of every 92 men and one out of every 187 women will contract a stomach cancer at some time in their whole ‍life and 95% of the chance is after his or her 40th birthday. The decreasing trend in the age-adjusted incidence rates ‍of stomach cancer in both the sexes indicates that there is a critical change in the etiology of this cancer. The findings ‍may provide clues relating to various life-style and environmental changes impacting on stomach cancer incidence.     

Epidemiology of head and neck cancers

Head and neck cancers are common in India and account for about 30% of cancers in males and about 13% in females. In males, oral cavity and pharynx are the commonly affected site, followed by larynx. In females, oral cavity is the preponderant site. Reliable data on incidence rates from several cancer registries in India is compared with selected data from the United States and France. A wide variety of tobacco habits prevalent in the country are primarily responsible for the occurrence of these cancers. Among them, bidi smoking, tobacco chewing, and cigarette smoking, in that order, account for a large majority of these cancers. In addition, alcohol and some aspects of the Indian diet have been suspected to contribute to this number of head and neck cancers. The government of India has accorded a high priority to prevention of tobacco-related cancers by the turn of the century in its National Cancer Control Programme.     

Adolescent smoking and trends in lung cancer incidence among young adults in Norway 1954–1998

OBJECTIVE: To describe the national trends in lung cancer incidence among young adults and the relationship to adolescent smoking. METHODS: Between 1954 and 1998, a total of 1108 non-carcinoid lung cancers were reported to the Cancer Registry of Norway in individuals aged 20-44 years. Temporal variations were studied in age and sex specific rates, in age-adjusted rates, and by means of age-period-cohort modelling. The association between cancer incidence and smoking prevalence was evaluated. RESULTS: The lung cancer incidence rate among women aged 40-44 in Norway continued to increase into the most recent time interval (1994-1998) whereas the rate among men aged 40-44 was essentially constant after 1970. Consequently, lung cancer incidence rates converged among male and female young adults. Lung cancer incidence rates at age 40-44 were highly correlated with smoking prevalence at age 15-19 in males ( r = 0.88) and females ( r = 0.82) within the same birth cohort. CONCLUSIONS: The lung cancer incidence rate in young Norwegian women now equals that of men. The risk at age 40-44 was closely associated with teenage smoking, indicating that duration and age of onset are important.     

Lifetime Risk and Trends in Lung Cancer Incidence in Greater Mumbai

Objective: To estimate the probability of developing lung cancer in the entire life span of the people ofGreater Mumbai and variation according to age and sex. Information on cancer incidence trends in a communityforms the scientific basis for planning and organising prevention, diagnosis and treatment. During the last 24year period, a total of 11,458 lung cancer cases were registered (9,052 male and 2,406 female) by the BombayCancer Registry. Lung cancer accounts for 9.4% of all male cancers and 2.7% of those in females (6.2% of allcancers) in Greater Mumbai. The probability of developing cancer in the entire life span of the people of GreaterMumbai was estimated. Methods: A method based on the cumulative risk of cancer was used to estimate theprobabilities using lung cancer data collected by the population-based Bombay Cancer Registry from the years1982 to 2005. For evaluation of trends, a linear regression model based on the logarithm of the observed incidencerates was applied. The annual percentage change was also computed for the evaluation. The cumulative incidencerate percentage was calculated by adding up the age-specific incidence rates at single ages and then expressed asa percentage. Results: The results show that age-adjusted incidence rates of lung cancer during the period 1982to 2005 showed a statistically significant decreasing trend in males and a statistically significant increasingtrend among females. When these trends were examined across different age-groups (0-39, 40-64 and 65 orolder), the rates showed a statistically significant decreasing trend from 0-64 years in males and a statisticallysignificant increasing trend in females aged 65 years and older. The rates proved stable across the other agegroups.The probability estimates indicate that one out of every 74 men and one out of every 242 women willcontract lung cancer at some time in their whole life in the absence of other causes of death, assuming that thecurrent trends prevail over the time period. Most of them will acquire the disease after the age of 40 years, afterwhich risk increases with time. Conclusions: The variation in age-adjusted incidence rate across different agegroupsin both sexes clearly indicate that there has been a change in the etiology of lung cancer in GreaterMumbai over time. The most important reason for this would be decrease in smoking prevalence among males.The other reasons for this have to be explored through risk assessment studies, but these findings may be ofgeneral interest because changes in diagnostic practices are confounders in time trends of lung cancer in manydeveloped countries, preventing inferences on changes in risk factors.     

Smoking habits and risk of cancers other than lung cancer: 28 years' follow-up of 26,000 Norwegian men and women

The impact of tobacco smoking on lung cancer risk has been investigated thoroughly since the 1950s, but other types of cancer also have been associated with smoking. In the present study, the aim was to explore the variation in risk connected with cigarette, cigar, and pipe smoking of suspected smoking-associated cancers other than lung cancer. Data were obtained from a survey of a random sample of the Norwegian population. A self-administered mailed questionnaire, which included questions about smoking habits, was completed by 26,000 men and women in 1965 (response rate: 76 percent). The cohort was followed from 1966 through 1993, including registration of all incident cancer cases. A dose-response relationship of cigarette smoking to the risk of urinary bladder cancer and cancers of the upper digestive and respiratory tract was observed. For the latter forms of cancer, a dose-response relationship of pipe smoking also was observed. In cancer of the pancreas, a stronger association between cigarette smoking and cancer risk was observed when the analysis was confined to histologically confirmed cases only. Current cigarette smokers at baseline had a significantly higher risk of cervical cancer than those who never smoked cigarettes. In cancers of the stomach, colon, rectum, breast, corpus uteri, ovary, and prostate, and in leukemia, no association between smoking and cancer risk was observed.Authors are with the Cancer Registry of Norway, Oslo, Norway. Address correspondence to Mr Engeland, The Cancer Registry of Norway, Institute for Epidemiological Cancer Research, Montebello, N-0310 Oslo, Norway. This work was supported by grant no. 95080/001 from the Norwegian Cancer Society and Contract PH-64-499 from the US National Cancer Institute.     

Cancer in Women in Kerala - a Transition from a Less-developed State

An epidemiologic assessment of the problem of cancer in women in Kerala based on 3 Population Cancer Registry ‍data and a Hospital Based data is presented. Kerala’s Socio-economic and demography presents an intermediate ‍development from a less developed to a better-developed state. As yet, the women follow a tradition-based life style. ‍Cancer incidence rate in Kerala was only 80% of urban rates than seen in Urban Metropolis in India. The pattern of ‍site distribution has shown that GI, Breast & Cervix cancers are the predominant cancers. Oral cavity cancers also ‍show a high frequency. Thyroid cancer has a higher incidence rate in Kerala compared to other areas. Lung cancer ‍among women has higher incidence rate in Karunagappally women. A high prevalence of tobacco use is reported ‍among the men in the above area. Breast cancer incidence rate in the rural areas was only 60% of the rate seen in ‍Urban Trivandrum. Unlike in other rural and urban areas of India Cervix cancer has a low incidence rate in Kerala ‍women. This may be due to better education and also due to the changes in marital and other life style practices. ‍Only 15% of cancer patients attend for medical assistance in localized stage of disease. The need for public education ‍is highlighted and focusing on tobacco use control, self-examination and screening.     

2014年上海市恶性肿瘤发病和死亡特征分析

背景与目的：恶性肿瘤已成为严重威胁上海市居民健康的重大公共卫生问题。该研究旨在描述和分析2014年上海市恶性肿瘤发病与死亡情况。方法：根据上海市恶性肿瘤病例报告登记系统收集的恶性肿瘤发病资料,按地区、性别分层,分别计算恶性肿瘤发病与死亡粗率、标化率、前10位恶性肿瘤发病与死亡顺位和构成等,应用Joinpoint统计软件分析2002—2014年上海市恶性肿瘤发病和死亡趋势,估算总体和分阶段的年度变化百分比（annual percentage change,APC）。采用Segi’s世界标准人口年龄构成计算标化率。结果：2014年上海市共报告恶性肿瘤新发病例68 541例,死亡病例37 242例。病理学诊断比例为79.49%,只有死亡医学证明书比例为0.04%,死亡发病比为0.54。上海市恶性肿瘤粗发病率为477.79/10万,标化发病率为223.57/10万,男性标化发病率低于女性,市区低于郊区。恶性肿瘤发病在40岁以后快速上升,在80~84岁年龄组达到高峰。全市发病前10位恶性肿瘤依次为肺癌、结直肠癌、甲状腺癌、胃癌、乳腺癌、肝癌、前列腺癌、胰腺癌、脑和中枢神经系统肿瘤以及膀胱癌,前10位恶性肿瘤占全部恶性肿瘤发病的75.89%。全市恶性肿瘤粗死亡率为259.61/10万,标化死亡率为95.73/10万,男性标化死亡率高于女性,市区和郊区基本持平。死亡率在45岁以后快速上升,在≥85岁年龄组达到高峰。死亡前10位恶性肿瘤依次为肺癌、结直肠癌、胃癌、肝癌、胰腺癌、乳腺癌、食管癌、胆囊癌、前列腺癌以及脑和中枢神经系统肿瘤,前10位恶性肿瘤占全部恶性肿瘤死亡的78.12%。2002—2014年,上海市女性所有部位的恶性肿瘤标化发病率呈明显上升趋势（APC为2.17%,P<0.001）,男性标化发病率则较为稳定。男性和女性所有部位的恶性肿瘤标化死亡率均呈明显下降趋势（APC分别为-0.82%和-0.76%,P<0.05）。结论：肺癌、消化系统恶性肿瘤、甲状腺癌和女性乳腺癌是威胁上海市居民健康的主要恶性肿瘤,仍是肿瘤防治工作的重点。同时,2002—2014年女性恶性肿瘤发病率有上升趋势,男性和女性恶性肿瘤死亡率均持续下降。     

Time Trend in Breast and Cervix Cancer of Women in India, (1990-2003)

The Indian Council of Medical Research (ICMR) started a National Cancer Registry Programme (NCRP)in the year 1982 with the main objective of generating reliable data on the magnitude and pattern of cancer inIndia. There are about 20 Population Based Cancer Registries (PBCR) which are currently functioning underthe network of NCRP. The present paper aims to provide the time trends in the incidence of breast and cervixcancer among females of India. The incidence data collected by Bangalore, Barshi, Bhopal, Chennai, Delhi andMumbai over the period 1990 to 2003 formed the sources of data. In the year 1990, cervix was the leading site ofcancer followed by breast cancer in the registries of Bangalore (23.0% vs. 15.9%), Bhopal (23.2% vs. 21.4%),Chennai (28.9% vs. 17.7%) and Delhi (21.6% vs. 20.3%), while in Mumbai breast was the leading site of cancer(24.1% vs. 16.0%). By the years 2000-3, the scenario had changed and breast had overtaken as the leading siteof cancer in all the registries except in Barshi (16.9% vs. 36.8%). The time trend analysis for these sites suggesteda significant decreasing trend in the case of cervix in Bangalore and Delhi registries, while the registries ofBhopal, Chennai and Mumbai did not show any significant changes. However, in the case of breast cancer, asignificant increasing trend was observed in Bhopal, Chennai and Delhi registries with Bangalore and Mumbairegistries demonstrating no such significant changes. Histopathologic confirmation for both malignancies wasfound to be more than 80% in these registries. It is concluded that in India the cervix cancer rates are decreasingwhile breast cancer is on the increase.     

An epidemiologic study of oral cancer and precancerous conditions among 101,761 villagers in Maharashtra, India

In an extensive epidemiologic house-to-house survey, undertaken to study oral cancer and precancerous conditions, 101,761 villagers were examined in the Poona district in the Maharashtra state in India. Besides detection of 12 oral cancers, prevalences were established for leukoplakia (0.67%), preleukoplakia (0.86%), and submucous fibrosis (0.03%). The sample was also studied for chewing and smoking habits, which were practised by 54.4% of the individuals. Among males the most common habit was chewing tobacco with lime, whereas the dominating habit among females was the use of mishri (burned tobacco). The strongest association found was between bidi smoking and mixed habits and leukoplakia. Only a few cases of leukoplakia were found among mishri users. Except for submucous fibrosis it was found that prevalence does not depend on sex if tobacco habits are taken into account.     

Epidemiology of head and neck cancer in Thailand

Cancer is the most common cause of death in Thailand, with the mortality almost doubled during 1998–2011 (from 48.4 to 95.2 per 100 000). The estimated number of new cancer cases in 2011 was 112 392. Our review provides baseline data on the current epidemiological situation with head and neck (HN) cancer in Thailand based on reports of the National Cancer Registry and findings from local and international publications. Collectively, HN cancer approaches age‐standardized rate (ASR) incidence of 15.7 and 10.7 per 100 000 males and females, respectively, and is ranked among the top five dominant cancers in Thailand. The leading HN malignancies in men are oral (ASR incidence 4.6 per 100 000), nasopharyngeal (ASR 2.8) and laryngeal (ASR 2.7) cancers, while the most common cancers in women are thyroid (ASR 5.1) and oral (ASR 3.2) carcinomas. Some local habits (betel quid chewing, traditional cigarette smoking and alcohol intake) are associated with the high incidence of oral cancer in Northeast Thailand. Despite important prognostic significance, the role of human papillomavirus infection in various HN cancers from Thailand has been scarcely addressed. There is a growing incidence of thyroid cancer over the last two decades. The Thai population overall, compared to worldwide rates of HN malignancies, has a lower incidence of laryngeal and thyroid cancers but higher incidence of nasopharyngeal cancer.