The burgeoning cancer burden in northeast India is fueled by lifestyle choices and a genetic predisposition, says studies

By Rosy James

With the latest reports from the Indian Council of Medical Research showing that northeast India has the highest incidence of cancer within the country, it looks like a dire prognosis for the region, which comprises 7.5 percent of India’s land area. The region comprises eight states namely, Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura, and accounts for just 3.7 percent of the total population.

However, from this small pool, about 45,000 new cancer patients are diagnosed every year. The average reported cancer incidences (per lakh population) for the region is almost double the national average, which stands at 80-110 new cases; the average for the northeastern region is 150-200 new cases. Of the total cancer cases reported from the northeast in 2012- 2014, 45 percent of cases are female. The highest incidence rates are recorded from Mizoram, Arunachal Pradesh, and Nagaland. At the district level, Aizawl (Mizoram) and Papum Pare (Arunachal Pradesh) reported the highest number of cancer cases. In fact, Mizoram is dubbed ‘The Cancer Capital of India’.

“The Fact That There Are Only Few Care Centres, Coupled With The Difficult Terrain Of The Region, Is The Reason For Low Compliance Of Treatment.”

Dr Amal Chandra
Director, Dr B Borooah Cancer Institute (RCC), Guwahati

The alarming aspect is that in spite of the increase in cancer incidence rates, the awareness level of the population still remains very low and this is aggravating the situation. The major causes of cancer can be attributed to the lifestyle choices of the region. Like the high consumption of tobacco products and fermented beetle nuts, both of which are highly addictive and carcinogenic substances. In fact, northeast India has the highest number of tobacco users in the 15–17 year age bracket. Studies show that for this region, approximately 57 percent of all cancers in men and 28 percent of all cancers in women are directly linked to tobacco consumption.

The dietary habits unique to this region may also be contributing to the cancer burden. Like the consumption of simmering hot tea. A 2009 study at the Tata Memorial Hospital, Mumbai, shows that people who consumed extremely hot beverages were four times more at risk for oesophageal cancer. The high incidence of stomach cancer is linked to certain dietary habits unique to this region. Improperly smoked and preserved meat serves as a good breeding ground for Helicobacter pylori, which is known to cause ulcers that increase the chances of gastrointestinal cancers. The northeastern palate is partial towards certain spices and chilies, especially the homegrown variety of chili called bhut jolokia; this predilection is considered to be another cause for oesophageal cancer.

Obesity and late pregnancy have been linked to increased breast cancer incidence in the region. Low quality of sexual wellness (multiple sex partners and lack of hygiene) has resulted in high instances of Human Papilloma Virus infection, which in turn lead could lead to cervical cancer. The heavy metal contamination in the groundwater contributes to high incidences of gall bladder cancers among people living in and around river basins.

Poor Infrastructure

Unfortunately, there are only about eight centers (three in Assam and one each in Manipur, Tripura, and Meghalaya), which are equipped to provide cancer therapy in the entire northeastern region.
“The fact that there are only a few care centers, coupled with the difficult terrain of the region, is the reason for low compliance of treatment,” says Dr. Amal Chandra Kataki, Director of Dr. B Borooah Cancer Institute (RCC), Guwahati. “Thus, cancer is detected and treated in the late stages, which is the cause of the high rates of mortality due to the disease. The difficulty associated with travel within the terrain causes patients to skip follow-ups and further investigations.”

Certain cancer forms like nasopharyngeal cancer (a rare kind of head and neck cancer) are unique to northeast India. The detection of this cancer is difficult due to its specific location in the body. Research seems to show that this may be due to the different genetic makeup of the people of the region (leaning towards the Mongoloid race). Fixing the cancer crisis of the northeast requires the cumulative effort of the Centre and state governments, hospitals, medical organizations, and NGOs. Some of the initiatives required are:

• An increase in the number of cancer care facilities will help in timely detection and cooperation for follow-ups.
• Developing centers that can facilitate remote consultations over the phone or the Internet, especially in regions where the reach of care is difficult. • Spreading awareness about preventive measures. Education is key to helping people understand the cause and effect of their lifestyle choices.
• Research to understand the environmental factors and genetic predisposition of the natives towards certain types of cancer and what can be done to reduce the risk factors of the same.
• These initiatives will provide a base for the people of northeast India to deal with the rising cancer menace.

The Cancer Problem, In Figures
37,448 cancer cases reported from 2012 to 2014 45% cases among women
Mizoram dubbed ‘The Cancer Capital of India’

Reported cancer incidence per lakh population
National average: 80-110 cases
Northeast India average: 150-200 cases