Cumulative Risk and Trends in Prostate Cancer Incidence in Mumbai,India

Background: Information relating to cancer incidence trends in a community forms the scientific basis for the ‍planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk ‍and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based ‍Cancer Registry from the year 1986 to 2000. ‍Methods: During the 15 year period, a total of 2864 prostate cancer cases (4.7% of all male cancers and 2.4% of ‍all cancers) were registered by the Bombay Population-based Cancer Registry. 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 evaluation. Cumulative incidence rates percentages were calculated by adding ‍up the age specific incidence rates at single ages and then expressed as a percentage. ‍Results: Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 ‍showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00- ‍49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate ‍cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. ‍Conclusion: The stability in age adjusted-incidence rates indicates that there are no changes in the etiological ‍factors for prostate cancer in Mumbai, India. These findings may be of general interest because changes in diagnostic ‍practices are confounded in the time trends of prostate cancer change in many western countries preventing inferences ‍on the changes in risk. ‍     

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.     

Population-based Survival from Cancers of Breast,Cervix and Ovary in Women in Mumbai,India

Background: Breast, cervix and ovarian cancers contribute more than 45% of the total in women in Mumbai ‍and survival proportions for these neoplasms are very high in most developed populations in the World. The authors ‍here report and discuss the population-based survival for these cancers in Mumbai, India. ‍Methods: Follow-up information on 4865 cancers of breast, cervix and ovary, registered in the Mumbai Population ‍Based Cancer Registry for the period 1992-1994 was obtained by a variety of methods, including matching with ‍death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits and ‍scrutiny of medical records. The survival for each case was determined as the duration between the date of diagnosis ‍and date of death, date of loss to follow-up or the closing date of the study (December 31st, 1999). Cumulative ‍observed and relative survival was calculated by the Hakulinen Method. For comparison of results with other ‍populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative ‍survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test ‍was used in univariate analysis to identify the potentially important prognostic variables. The variables showing ‍statistical significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the ‍independent predictors of survival. ‍Results: The 5-year relative survival rates were 46.2% for breast, 47.7% for the cervix and 25.4% for the ovary. ‍Higher survival was observed for those younger than 35 years for all these three sites. For each, survival declined ‍with advancing age. Single patients who remained unmarried had better survival. For all sites Muslims had a better ‍and Christians a lower survival as compared to Hindus. Education did not appear to be of significance. Survival ‍decreased rapidly with advancing clinical extent of disease for all sites. With localized cancer, 5-year rates ranged ‍from 54.7% to 69.3%, for regional spread 20.4% to 41.6% and distant metastasis not a single site recorded more ‍than 5%. On multivariate analysis, age and extent of disease emerged as independent predictors of survival for all ‍the sites. ‍Conclusion: All the sites included in the study demonstrated moderate survival rates with significant variation. ‍Comparison with other populations revealed lower survival rates as compared to developed countries, particularly ‍for breast and ovary. In Indian populations survival proportions did not show much variation for these cancers. ‍Early detection and treatment are clearly important factors to reduce the mortality from these cancers. ‍     

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.     

Population-based Survival from Cancers Having a Poor Prognosis in Mumbai (Bombay), India

Background: Oesophagus, stomach, pancreas and lung cancers contribute more than 35% of the total cancer ‍incidence in Mumbai and survival rates for these cancers are very poor in most populations in the world. The ‍authors here report and discuss the population-based survival from these cancers in Mumbai, India. ‍Methods: Follow-up information on 5717 cancers patients having a low prognosis, registered in the Mumbai ‍Population-Based Cancer Registry for the period 1987-1991, was obtained by a variety of methods, including matching ‍with death certificates from the Mumbai vital statistics registration system, postal/telephone enquiries, home visits ‍and scrutiny of medical records. The survival for each case was determined as the duration between the date of ‍diagnosis and date of death, loss to follow-up or the closing date of the study at the end of 1996. Cumulative observed ‍and relative survival rates were calculated by the Hakulinen Method. For comparison of results with other populations, ‍age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to ‍the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used ‍with univariate analysis to identify the potentially important prognostic variables. The variables showing statistical ‍significance in univariate analysis were introduced stepwise into a Cox Regression model to identify the independent ‍predictors of survival. ‍Results: The 5-year relative survival rates were 11.8% for oesophagus, 10.1% for the stomach, 4.1% for the ‍pancreas, and 7.0% for lung. Females had higher survival rates than males, except with lung cancer. Lower survival ‍was observed for those younger than 35 years for all 4 sites. For each site, survival declined with advancing age. ‍Single patients who remained unmarried had better survival, except with pancreatic cancer. For all sites Muslims ‍had a better survival and Christians had a lower survival as compared to Hindus. Education did not show any ‍pattern for any site. Survival decreased rapidly with advancing clinical extent of disease for all sites. Survival for ‍localized cancer ranged from12.5% to 31.3%, for regional spread 1.3% to 3.4% and with distant metastasis not a ‍single site recorded more than 1%. On multivariate analysis, extent of disease emerged as an independent predictor ‍of survival with all the sites. Also, age for oesophagus, stomach and lung, religion for oesophagus and stomach, and ‍education for stomach and lung, emerged as independent predictors of survival. ‍Conclusion: All the sites included in the study demonstrated very low survival rates with significant variation. ‍Comparison with other populations revealed lower survival rates than for Shanghai-China. In remaining populations, ‍survival proportions did not show much variation for pancreas and lung cancers. For stomach cancer, European ‍countries showed better survival rates. Early detection with treatment is clearly important to reduce the mortality ‍from these cancers. ‍     

Improving Cancer Care in India: Prospects and Challenges

The World Cancer Report, a 351 - page global report issued by International Agency for Research on Cancer ‍(IARC) tells us that cancer rates are set to increase at an alarming rate globally (Stewart and Kleiues 2003). Cancer ‍rates could increase by 50 % to 15 million new cases in the year 2020. This will be mainly due to steadily aging ‍populations in both developed and developing countries and also to current trends in smoking prevalence and the ‍growing adoption of unhealthy lifestyles. The report also reveals that cancer has emerged as a major public health ‍problem in developing countries, matching its effect in industrialized nations. Healthy lifestyles and public health ‍action by governments and health practitioners could stem this trend, and prevent as many as one third of cancers ‍worldwide. ‍In a developing country such as India there has been a steady increase in the Crude Incidence Rate (CIR) of all ‍cancers affecting both men and women over the last 15 years. The increase reported by the cancer registries is nearly ‍12 per cent from 1985 to 2001, representing a 57 per cent rise in India's cancer burden. The total number of new ‍cases, which stood at 5.3 lakhs Care lakh is 100,000 in 1985 has risen to over 8.3 lakhs today. The pattern of cancers ‍has changed over the years, with a disturbing increase in cases that are linked to the use of tobacco. In 2003, there ‍were 3.85 lakhs of cases coming under this category in comparison with 1.94 lakhs cases two decades ago. Lung ‍cancer is now the second most common cancer among men. Earlier, it was in fifth place. Among women in urban ‍areas, cancer of the uterine cervix had the highest incidence 15 years ago, but it has now been overtaken by breast ‍cancer. In rural areas, cervical cancer remains the most common form of the disease (The Hindu 2004).     

An Assessment of Cancer Incidence Patterns in Parsi and Non Parsi Populations,Greater Mumbai

The Mumbai Cancer Registry has been in operation since 1964 and reliable morbidity and mortality data on cancer havebeen obtained for the first time in India, from a precisely outlined population. An attempt has been made to examine thedifferences noticed in the site-specific cancer risk, between two groups of people living in this area-the Parsi and non Parsipopulation of Mumbai.For this study, data has been utilized, collected by Mumbai Cancer Registry for the latest five years. For comparisonbetween Parsi and non Parsi populations, crude and age-adjusted rates have been used.The overall age-adjusted rates for the Parsi’s were found to be lower than those for the non Parsi populations and morenoticeably their site-specific risks seem to differ radically from the non Parsi pattern. Cancers of the buccal cavity, pharynx,larynx, oesophagus and cervix uteri which are frequently seen in the non Parsi population, are less commonly observed inthe Parsi community. On the other hand the Parsi rates are higher at site such as the female breast, endometrium, lymphomasand leukaemias.The observed site-specific contrast are believed to be due to differences present in the habits, customs and economicstatus of the two groups.     

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.     

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.     

Social Inequalities in Cancer with Special Reference to South Asian Countries

There are major differences in cancer burden across socioeconomic classes, as is evident from the data for cancer ‍incidence and mortality from Greater Mumbai, India. Changes over time are also evident and recently there has ‍been a clear shift to increasing breast cancer particularly in well-educated women, who conversely are at much ‍lower risk of cervical cancer. With infection-related and tobacco-related cancers, programs of prevention and early ‍detection will yield desirable results only if it is associated with a program directed towards elimination of poverty, ‍illiteracy and restoring social inequality. Similarly education must play a role in combatting diet-related neoplasia ‍but here the target population may differ, requiring a specific awareness of psychological profiles.     

Cancer in Women in Mumbai,India

The challenge of population based cancer registration in developing countries is enormous. In India, the firstPopulation Based Cancer Registry named “Bombay Cancer Registry” was established by the Indian Cancer Societyin Mumbai (formerly Bombay) in 1963, covering the population of the Mumbai Agglomeration. Up to now thisregistry has collected epidemiological information on more than 200,000 cancer incidence cases and 100,000 cancerdeaths. At present this registry covers an area of 603.00 sq.kms having a population of 12 million. Here, an attempthas been made to analyse and interpret cancer incidence and mortality data for women, registered in Mumbaiduring 1993-97.     

Cancer of the Oral Cavity - Trends in Karachi South (1995-2002)

The objective was to study the time trends in site-specific oral cancer incidence and to determine the age-and ‍socio-economic profile over time in Karachi South. Oral cancer ranks second in this population, in both genders. ‍The incidence is the highest reported worldwide. Incident oral cancer cases received at the Karachi Cancer Registry ‍during 1st January 1995 to 30th June 2004 were reviewed. To ensure maximally complete data, cases registered ‍between 1st January 1995 and 31st December 2002 were considered for the present study. Cases of lymphoma, leukemia ‍and melanoma were not included. Trends were studied by grouping cases into two periods, 1995-1997 and 1998- ‍2002. ‍A total of 2253 cases of oral cancer were registered in Karachi South for the 8 year study period accounting for ‍8.8% of all cancer cases. Overall, the most common site was the mucosa cheek (55.9%), followed by the tongue ‍(28.4%), palate (6.8%), gum (4.4%), lip (3.1%) and floor of the mouth (1.4%). About 30% of cases occurred in ‍patients 40 years and younger and 23% occurred in patients 65 years and older. Sub-categories of oral cancer ‍showed variation in trends, but an earlier onset of disease in period two was evident for all categories. The incidence ‍of lip cancer in men decreased, the rates remained level in females. An increased incidence was observed for tongue, ‍but a more dramatic increase in the cheek was evident in both sexes, despite no improvement during the past decade ‍in detection of early, localized lesions. A strong socio-economic factor with a poorer, low literacy profile of oral ‍cancer was apparent in the entire study period. The evidence that the largest increase in incidence has occurred in ‍this population may unfavorably affect the mortality rates. ‍Oral cancer trends are an interplay of prevalent risk factors, the level of prevalence, preventive education and ‍intervention. Cost effective and efficient cancer control focused around the target populations would be beneficial ‍for Pakistan. Educational campaigns should include information on oral hygiene, awareness of risk factors and ‍symptoms and the importance of seeking early professional help when any of these are recognized. Audio-visual ‍media involvement is imperative in view of the literacy status of the target population. Capacity building is required ‍by the Government to increase the availability and accessibility of professionals. Population screening would reduce ‍the incidence of oral cancer, but requires careful planning, and extensive financial resources. Mobilization of general ‍practitioners, health visitors, volunteer organizations and medical students for early detection of oral cancer is the ‍essential need of today. ‍     

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. ‍     

Projection of cancer incidence in five cities and cancer mortality in India

Background: Cancer is second largest non-communicable disease and it has a sizable contribution in the total number of deaths. It is important for the public health professionals to understand the dynamics of cancer incidence for future strategies. Therefore, this paper is attempted with the objective of projecting number of cancer incidence for five cities namely, Bangalore, Chennai, Delhi, Bhopal and Mumbai and to estimate the cancer mortality rate for all India for the year 2008. Materials and Methods: The data were used from the Indian Council of Medical Research's publication of Population-Based Cancer Registry for the year 1999-2000. The population was calculated from the Census reports of 1991 and 2001. Causes-specific mortality report by the Central Bureau of Health Intelligence was used for estimating cancer mortality for all India. The age-specific rate method is utilized to project number of cancer incidence for the cities of Bangalore, Chennai, Delhi, Bhopal and Mumbai and to estimate cancer mortality in 2000 for all India. Results and Conclusion: About 26.6% increase is expected in the registered number of cancer cases in these five cities and 52.68% increase is projected for Delhi which would mean highest number of cases in Delhi among these five cities within a span of eight years. And in Mumbai it is expected to have a marginal decline in the number of cases for the year 2008 (around -3.25%). The age adjusted analysis indicates that Mumbai is experiencing the higher incidence rate among the five cities studied herein. It is estimated about 50% cancer mortality is reported from the age group 55 and above years.     

Methodology to Identify Iranian Immigrants for Epidemiological Studies

Determining ethnic differences in cancer patterns using administrative databases is often a methodological ‍challenge for information on ethnicity or place of birth is commonly lacking. This paper describes the approach we ‍used to identify Iranians residing in British Columbia (BC), Canada and who were registered within the BC Cancer ‍Registry. A listing of common Iranian surnames and given names was generated from two sources: a residential ‍telephone book (with a high density of Iranians) and a provincial breast cancer screening program (which allowed ‍for the selection of women born in Iran). Surnames and given names were reviewed manually and the Iranian ‍names were identified and coded as ‘highly probable’ and ‘probable’ Iranian. A name directory was then created ‍and linked with the BC Cancer Registry to identify Iranian cancer cases. Using this method, 1729 surnames and 737 ‍given names were selected from the telephone book, and 1881 surnames and 757 given names from the screening ‍program. The majority of these names were coded as ‘highly probable’ Iranian (98% and 96% for surnames and ‍given names, respectively). 12% of surnames and 10% of given names were common to both sources. A listing of the ‍most common Iranian surnames and given names is provided. In conclusion, in the absence of other ethnicity data, ‍surnames and given names can be very helpful to identify persons of specific ethnicities when these ethnic groups ‍have distinctive names.     

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.     

Is it Reporting Bias Doubled the Risk of Prostate Cancer in Vasectomised Men in Mumbai,India?

Background: Vasectomy is a common method of family planning in India and worldwide. The objective of the ‍present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing ‍country. A population based case control study was conducted in Mumbai, India, for this purpose. Methods: Included ‍in this study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by ‍Bombay Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general ‍population of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the ‍comparison group. Data on vasectomy and potential confounding factors were obtained by structured face to face ‍interviews. After exclusions, 390 cases and 780 controls were available for final analysis and confounding was controlled ‍by multiple logistic regression. Results: Overall 14.9% of cases and 10.0% of controls had undergone vasectomy. ‍Compared with no vasectomy the OR with ever having undergone vasectomy was 1.9 (95% CI: 1.3-2.9), after ‍controlling for age and other possible confounding factors. The risk for those who had had a vasectomy before the ‍age of 45 years was 2.1 fold (95% CI: 1.2-3.9) and for those who underwent the procedure at a later age was 1.8 fold ‍(95% CI: 1.1-2.9). The linear trend for an increase in risk with a decrease in age at vasectomy was statistically ‍significant (p for trend= 0.01). The risk for those who completed 25 years or more time since undergoing vasectomy ‍was 3.8 fold (95% CI: 1.9-7.6) and for those who completed less than 25 years it was 1.2 fold (95% CI: 0.7-2.1). The ‍linear trend for an increase in risk with an increase in time since vasectomy was highly significant (p for trend = ‍0.001). Conclusion: There are major public health and birth control implications on vasectomy increases the risk for ‍prostate cancer. It is likely, however, that biases identified in this study result in high estimates of risk and the true ‍risk due to vasectomy is substantially less than the estimated one. Due to the several limitations and possibilities for ‍reporting biases in this study, the evidence for the estimates of the higher odds ratio for prostate cancer in vasectomised ‍men may not be a strong one. In view of the importance of vasectomy for fertility control, further studies with good ‍design and conduct (the information on vasectomy need to be collected with better reliability) are required to clarify ‍the issue of vasectomy associations with prostate cancer.     

Trends of Head and Neck Cancers in Urban and Rural India

Background:The sub-site predilection of head and neck squamous cell carcinoma (HNSCC) reflects the risk ‍profile of a community and there are suggestions that these are changing over time. Objective: To determine the ‍change in head and neck cancer in rural and urban populations in India. Methods: Cancer registry data of an urban ‍and a rural population were reviewed over a period of 13 and 11 years, respectively. Age adjusted rates (AAR) and ‍age specific incidence rates were used for data analysis. Results: Oral cancers formed the majority of the head and ‍neck cancers with a predilection for tongue, except in rural males, in whom the pharynx was the predominant subsite. ‍Overall there was a reduction in the incidence of HNSCC, which was more pronounced in urban females and ‍rural males (p< .001). Among the sub-sites, oral cavity cancers showed a decreasing trend in urban females (p< .01) ‍and rural males (p< .01). However, the trend was towards increase of incidence of tongue cancers. Pharyngeal ‍cancer showed reduction in urban females (p< .01), whereas it increased in rural females. The recent increase in ‍incidence of young adults with HNSCC reported in developed countries was not observed. Conclusions: Overall, ‍incidence of HNSCC is reducing. This may be attributed to the decreased prevalence of tobacco use.The increase in ‍incidence of tongue cancer may suggest factors other than tobacco and alcohol in its genesis.     

A Low Fat Diet Rich in Fruits and Vegetables May Reduce the Risk of Developing Prostate Cancer

Background: Diet has been implicated in prostate cancer risk and there is evidence of risk reduction with a ‍healthy diet. The objective of this population-based case control study was to examine whether a low fat diet rich in ‍fruits and vegetables can reduce the risk of developing prostate cancer in Mumbai, India. Methods: Included in this ‍study were microscopically proved cases of prostate cancer diagnosed during 1998 to 2000 and registered by Bombay ‍Population Based Cancer Registry (n=594). The controls were healthy men belonging to the resident general population ‍of Mumbai, India. Two controls for each case matched by age and place of residence were selected as the comparison ‍group. Data on oil/fat consumption, fruits and vegetable consumption and other probable confounding factors were ‍obtained by structured face-to-face interview. After exclusions, 390 cases and 780 controls were available for final ‍analysis and confounding was controlled by multiple logistic regression. Results: 58.7% of the control group consumed ‍more than 3 kg of fruits and vegetables per week compared to 52.1% of the case group. Controlling for age and ‍probable confounding factors, a statistically significant protective effect for prostate cancer was observed for those ‍who consumed fruits and vegetables 2 to 3 kg (OR 0.5, 95%CI 0.3-0.8) and more than 3 kg (OR 0.4, 95% CI 0.3-0.6) ‍per week compared to those who consumed less than 2 kg per week. The linear trend for the protective effect was ‍highly significant with increase in the consumption of fruits and vegetables (p = 0.001). Even though not statistically ‍significant, oil/fat consumption showed an elevated risk (OR 1.7, 95%CI 0.9-3.3) for those who consumed more than ‍2kg of oil/fat per month compared to those who consumed less than 1kg. Conclusion: The findings from this study ‍support the hypothesis that a low fat diet rich in fruits and vegetables may reduce the risk of prostate cancer.     

Cancer Registration in India - Current Scenario and Future Perspectives

Cancer registration, an important component of cancer surveillance, is essential to a uni ed, scienti c and public health approach to cancer prevention and control. India has one of the highest cancer incidence and mortality rates in the world. A good surveillance system in the form of cancer registries is important for planning and evaluating cancer-control activities. Cancer registration in India was initiated in 1964 and expanded since 1982, through initiation of the National Cancer Registry Program (NCRP) by the Indian Council of Medical Research. NCRP currently has twenty-six population based registries and seven hospital based registries. Yet, Indian cancer registries, mostly in urban areas, cover less than 15% of the population. Other potential concerns about some Indian registries include accuracy and detail of information on cancer diagnosis, and timeliness in updating the registry databases. It is also important that necessary data collection related quality assurance measures be undertaken rigorously by the registries to ensure reliable and valid information availability. This paper reviews the current status of cancer registration in India and discusses some of the important pitfalls and issues related to cancer registration. Cancer registration in India should be complemented with a nationwide effort to foster systematic investigations of cancer patterns and trends by states, regions and sub populations and allow a continuous cycle of measurement, communication and action.