In the second of this 4-part series, Dr. Manigreeva Krishnatreya of Dr. Bhubaneswar Borooah Cancer Institute in Guwahati, Assam discusses the significance of cancer registration in India and how it has helped in identifying major cancer types in the North East of India and how this information is driving public health and research initiatives for better prevention and control.
Please tell us a little bit about current trends in cancer registration in India?
In India, cancer registration covers less than 10% of its population. Cancer registry reports from some of the larger states like Uttar Pradesh, Bihar, and Andhra Pradesh are yet to appear on the National Cancer Registry Program (NCRP) of India. However, the recent initiatives by National Center for Disease Informatics and Research under Indian Council of Medical Research have included these states under its flagship program –NCRP. In India, some of the cancers like breast and lung in women, and colon cancers in men are showing rising trends. Also, due to urbanization and increase in life expectancy, the incidence of cancers of prostate and stomach is showing an upward trend.
When did cancer registration start in the North East and do we have enough cancer registries in all the Northeastern states?
Cancer registration in NE India started in the year 2006 with six population-based cancer registries (PBCR). Now, there are 11 PBCRs reporting cancer data. In North-East India, all the states except Assam are completely covered by cancer registration. Presently, in Assam, there are three reporting population-based cancer registries, namely in Kamrup, Cachar, and Dibrugarh Districts.
Are these registries usually a directive of the central government or can information be collected at the state level?
All the registries of North East India are operational under funding support from Indian Council of Medical Research, Ministry of Health and Family Welfare of Government of India. However, data collection is under the directive and jurisdiction under local governing bodies and the state governments.
How do you check for the quality of data that is collected?
The data quality check is carried out by experts at the National Center for Disease Informatics and Research at Bengaluru. Furthermore, the International Agency for Research on Cancer publishes a report from selected PBCRs of North East India after thorough quality checking and adequate coverage in Cancer Incidence in five Continents report (CIV).
Do you feel that participation in registries should be mandatory, as seen in Finland/Denmark?
Ideally, yes. However, there are ethical issues in making mandatory reporting of cancer cases to cancer registry similar to developed countries like Finland or Denmark. Unlike communicable diseases, such as plague for instance, where public health reporting is mandatory for two reasons: One, is to limit its spread and second, to provide for adequate provisions for its treatment. However, in the case of cancer, we do not have ample government-run centers and sufficient funds to manage the mandatorily reported cancer cases, which makes implementing mandatory reporting of cancer challenging.
What are the main challenges in implementing and executing a nation-wide cancer registry in India?
One of the biggest challenges of cancer registry in the country is active data collection of cancer patient’s data from various sources like hospitals, laboratories, diagnostics centers, private and government clinics, and also from birth and death registration office. Active data collection is an arduous and challenging task in both larger cities and geographically isolated regions like the Northeastern part of the country.
Can you tell us how cancer registration has helped the North East of India in battling cancer?
Cancer registration in North East India has immensely helped in identifying the major cancer types of the region and consequent importance of public health efforts for its prevention and control. Earlier to the start of PBCRs in North East India, oncologists and public health planners believed that the Gangetic belt is the “hot spot” for gall bladder cancer (GBC). Now, Kamrup District in Assam, reports the second-highest incidence of GBC in the world. Similarly, cancers of the esophagus as a whole in the NE India, cancers of the lung in women of Manipur, stomach cancers in Mizoram, and hepatocellular carcinoma or liver cancer in Arunachal Pradesh is drawing considerable attention of researchers and public health planners in the country.
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