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Cghr 1347810

CANCER MORTALITY IN INDIA

On behalf of the Million Death Study Collaborators, and in partnership with

Tata Memorial Hospital (Mumbai, India), St. John’s Research Institute (Bangalore, India), IARC (Lyon, France) and SEARO (Delhi, India) of WHO and the Centre for Global Health Research (Toronto, Canada)

LANCET PRESS RELEASE: WEDNESDAY, MARCH 28, 2012

Prabhat.jha@utoronto.ca


Key findings
Key findings

About 0.6 Million (M) or 6 Lakh cancer deaths in 2010

Over 70% of cancer deaths occurred during ages 30-69 years (200,000 men and 195,000 women)

At ages 30-69 years, the three commonest fatal cancers

Men: oral, stomach, and lung

Women: cervical, breast and stomach

Tobacco-related cancers are over 40% of male and nearly 20% of female cancers

Cancer death rates are similar in rural and urban areas

Huge variation in cancer death rates across states- partly due to tobacco, and partly for reasons awaiting further discovery

Cancer death rates 2-fold higher in the least educated compared to the most educated adults

Cervical cancer death rates far less in Muslim women than among Hindu women

Source: Dikshit et al, Lancet 2012


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What’s new about this research?

  • First large, nationally-representative study of cancer mortality in India, reflecting both urban and rural areas

  • Previous cancer estimates have relied mostly on cancer registries in cities, but 70% of Indians live in rural areas

  • Provides distribution of cancer deaths by area, educational level, and religion


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How was the study done?

  • Nationally representative sample (Sample Registration System)

  • 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)


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How was the study done?

800 Registrar General of India field workers interviewed 122 thousand families of people who had died in 2001-2003

Written reports each coded independently by at least two physicians to attribute a probable cause of death (i.e., cancer)

Cancer deaths grouped into broadly similar categories (i.e., oral, lip and pharynx; lung and trachea, etc.)


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How was the study done?

Calculated proportion of all cancer deaths by age, gender, and cancer type within the study

Combined with national 2010 UN totals of deaths, and 2007-2009 state-specific SRS death rates

Produced national and state estimates of rates and number of cancer deaths for 2010


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Key results

  • 7137 of 122 429 study deaths were due to cancer, meaning about 600,000 cancer deaths across the whole of India in 2010.

  • Some 71% (395,000) of cancer deaths occurred in people aged 30-69 years (200,100 men and 195,300 women).

  • At ages 30-69, cancer deaths are:

  • 8% of the 2.5 million total male deaths

  • 12% of the 1.6 million total female deaths

Source: Dikshit et al, Lancet 2012


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Leading cancers in men and women, age 30-69 years

  • MEN

  • Oral 45,800 or 23%

  • Stomach 25,200 or 13%

  • Lung 22,900 or 11%

  • WOMEN

  • Cervical 33,400 or 17%

  • Stomach 27,500 or 14%

  • Breast 19,900 or 10%

Source: Dikshit et al, Lancet 2012


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Risk of death from cancer

For middle-aged Indians, the risk of dying before age 70 in the absence of other diseases:

47 of 1000 men will die of cancer

44 of 1000 women will die of cancer

Source: Dikshit et al, Lancet 2012


Deaths among 1000 30 year olds before age 70 from cancer at 2010 death rates
Deaths among 1000 30 year olds before age 70 from cancer, at 2010 death rates

Source: Dikshit et al, Lancet 2012


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Tobacco cancers in men and women, age 30-69 years 2010 death rates

MEN: 84,000 or 42% of all cancers

WOMEN: 35,700 or 18% of all cancers

Together: over 120,000 tobacco cancers

Twice as many oral cancers as lung cancers

Source: Dikshit et al, Lancet 2012


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Risk of cancer death*, by state 2010 death rates

*For Indians aged 30, the risk of dying before age 70 from cancer in the absence of other diseases

Source: Dikshit et al, Lancet 2012


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Cancer: 2010 death ratesMEN aged 30-69 years


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Cancer: 2010 death ratesWOMEN aged 30-69 years


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Cancer 2010 death rates(non tobacco/non infection):BOTH GENDERS aged 30-69 years


Cancer death rates by education men and women aged 30 69
Cancer death rates by education, men and women aged 30-69 2010 death rates

Source: Dikshit et al, Lancet 2012


Selected cancer rates by religion women 30 69 years
Selected cancer rates by religion, women 30-69 years 2010 death rates

Source: Dikshit et al, Lancet 2012


Cervical cancer rates by state women 30 69 years
Cervical cancer rates by state, women 30-69 years 2010 death rates

Source: Dikshit et al, Lancet 2012


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Implications 2010 death rates

  • Most cancer deaths in India are avoidable as they occur at younger ages and present late after cancer starts

  • Most importantly, higher tobacco taxes reduce cancer

  • Strategies to vaccinate, screen, and treat women with cervical cancer also work.

  • Early detection of cancer dramatically improves the prospect of cure

  • Big differences suggest more research on why common cancers are rare in parts of India

Source: Dikshit et al, Lancet 2012


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www.cghr.org/cancer 2010 death rates

  • The Lancet Paper and Web appendix

  • Press release (English, Hindi, and main regional languages)

  • Video release (English, Hindi, and main regional languages

  • FAQs

  • PowerPoint slides

Follow us on Twitter: @CGHR_org


Million death study collaborators
Million Death Study Collaborators 2010 death rates

Indian Academic Partners (in alphabetical order):

Clinical Epidemiology Resource and Training Centre Trivandarum: KB Leena, KT Shenoy (until 2005)

Department of Community Medicine Gujarat Medical College Ahmedabad: DV Bala, P Seth KN Trivedi

Department of Community Medicine Kolkatta Medical College Kolkatta: SK Roy

Department of Community Medicine Regional Institute of Medical Sciences Imphal: L Usharani

Department of Community Medicine S.C.B. Medical College Cuttack Orissa: Dr. B Mohapatra

Department of Community Medicine SMS Medical College Jaipur: AK Bharadwaj, R Gupta

Epidemiological Research Center Chennai: V Gajalakshmi, CV Kanimozhi

Gandhi Medical College Bhopal: RP Dikshit, S Sorangi

Healis-Seskarhia Institute of Public Health Mumbai: PC Gupta, MS Pednekar, S Sreevidya

Indian Institute of Health & Family Welfare, Hyderabad: P Bhatia

Institute of Health Systems Research Hyderabad: P Mahapatra (until 2004)

St. John’s Research Institute St. John’s Academy of Health Sciences Bangalore: A Kurpad, P Mony, M Vaz, R Jotkar, S Rao-Seshadri, S Shrihari, S Srinivasan

King George Medical College Lucknow: S Awasthi

Najafgarh Rural Health Training Centre Ministry of Health Government of India New Delhi: N Dhingra, J Sudhir, I Rawat (until 2007)

National Institute of Mental Health and Neurosciences Bangalore: G Gururaj (until 2004)

North Eastern Indira Gandhi Institute of Regional Medical Sciences Shillong Meghalaya: FU Ahmed (until 2005), DK Parida

Regional Medical Research Center ICMR Institute Bhubaneshwar: AS Karketta, SK Dar

School of Preventative Oncology Patna: DN Sinha

School of Public Health Post Graduate Institute of Medical Education and Research Chandigarh: N Kaur, R Kumar, JS Thakur

Tata Memorial Hospital Mumbai: RA Badwe, RP Dikshit, K Mohandas

Lead Partners:

Office of the Registrar-General India RK Puram New Delhi India: C Chandramouli (Registrar General of India [RGI]), RC Sethi, B Mishra, S Jain (until 2008), DK Dey (until 2009), AK Saxena, MS Thapa, N Kumar, JK Banthia and DK Sikri (former RGIs)

Million Death Study Coordinating Centre for Global Health Research (CGHR) Li Ka Shing Knowledge Institute Keenan Research Centre St. Michael’s Hospital Dalla Lana School of Public Health University of Toronto Canada: DG Bassani, P Jha (Principal Investigator), R Jotkar, R Kamadod, B Pezzack, S Rao-Seshadri, P Rodriguez, J Sudhir, C Ramasundarahettige, W Suraweera

Affiliated Partners:

Indian Council of Medical Research New Delhi India: VM Katoch (Director General or DG from 2008), NK Ganguly (DG to 2008), L Kant, B Bhattacharya

School of Population Health The University of Queensland Australia: AD Lopez, C Rao

World Health Organisation Geneva and SEARO Office New Delhi: T Boerma, T Evans, A Fric, S Habayeb (former WHO Representative-India), S Khanum, C Mathers, DN Sinha, N Singh, P Singh (Deputy Regional Director)

Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) University of Oxford England: N Bhala, J Boreham, Z Chen, R Collins, R Peto, G Whitlock