This study analyzed cancer incidence data from 15 months at a tertiary cancer center in Chhattisgarh, India. A total of 2296 cancer cases were reported, with more cases in females than males. The most common cancers were oral cancer in males (42.28%) and cervical cancer in females (27.13%). Overall, oral cancer was the most common (25.47%). The study found higher rates of oral, cervical, and breast cancer than national averages, likely due to risk factors like tobacco use, HPV infection, and lack of screening. Addressing preventable risk factors and increasing affordable screening are needed to reduce the cancer burden in Chhattisgarh.

1. Clinics of Oncology
Research Article ISSN: 2640-1037 Volume 4
Jain N1*
, Sharma J2
, Biswal DD3
, Gupta G4
, De D5
, Mazumdar A6
, Ojha S7
, Dubey A8
and Kumar V8
1
Department of Transfusion Medicine & Immunohematology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation,
India
2
Department of Surgical Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
3
Department of Medical Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
4
Department of Radiation Oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
5
Department of Haemato-oncology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
6
Sr. Consultant Pain and Palliative Medicine, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
7
Department of Histopathology, Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
8
Balco Medical Centre, A unit of Vedanta Medical Research Foundation, India
The Growing Burden of Cancer in Chhattisgarh State of Central India: A Tertiary
Cancer Centre Study
*
Corresponding author:
Neelesh Jain,
Consultant, Transfusion Medicine &
Immunohematology, Balco Medical Centre,
A unit of Vedanta Medical Research Foundation,
Sector-36, Atal Nagar, Naya Raipur, Raipur,
Chhattisgarh, India, Tel: 009874592738;
E-mail: drneeleshjain@gmail.com
Received: 02 Mar 2021
Accepted: 22 Mar 2021
Published: 27 Mar 2021
Copyright:
©2021 Jain N, et al. This is an open access article distrib-
uted under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
build upon your work non-commercially.
Citation:
Jain N, The Growing Burden of Cancer in Chhattisgarh
State of Central India: A Tertiary Cancer Centre Study.
Clin Onco. 2021; 4(3): 1-6
Keywords:
Cancer; Incidence; Males; Females; Chhattisgarh
clinicsofoncology.com 1
1. Abstract
All around the world, cancer manifesting in any form is one of
the leading causes for death. In our country approximately 1 mil-
lion cancer cases are detected every year and the annual deaths
due to cancer is around 0.63 million. While lung and oral cancers
are the commonest cancer for men, breast and cervical cancers are
the commonest cancers for women in our country. Our study was
undertaken to find the incidence of cancer burden in Chhattisgarh
state of Central India. A retrospective analysis was done involv-
ing collection of data of 15 months from 1st Jan-2019 till 31st
March 2020. Total reported number of cancer cases during this
period was 2296. Females were more affected with malignancies
than males with female to male ratio of 1:0.88. In our study the
most commonly reported cancer among male patients was found
to be oral cancer (42.28%) followed by lung (5.57%) and stomach
cancer (5.48%). Similarly, in females the cervical cancer (27.13%)
is found to be most common followed by breast (24.34%) and oral
cancer (10.65%). Overall the commonest cancer observed here is
Oral cancer (25.47%).
2. Introduction
India, with a population of more than 1·3 billion, and growing,
while is epidemiologically interesting but poses a huge challenge
for health-care planners. The population demographics, health pol-
icies, health-data recording, access to health care, and affordability
have all improved substantially during the period between 1990
and 2016, as reported by the India State-Level Disease Burden
Initiative Cancer Collaborators in their Global Burden of Disease
paper in The Lancet Oncology. [1]
According to estimates from the World Health Organization
(WHO), Cancer ranks as first and second leading cause of death
before age 70 years in 91 of 172 countries, and it ranks third or
fourth in an additional 22 Countries. [2] It is the leading cause of
death globally after cardiovascular diseases. Patients with cancer

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Volume 4 Issue 3 -2021 Research Article
generally have poor prognosis in low-income and middle income
countries, including India, relatively because of lack of cancer
awareness, delayed diagnosis, inequitable access to affordable
curative services compared with patients in high-income coun-
tries. India spread across 28 states and 8 union territories, with
geographical variations, diversified development, population ge-
netics, environments and lifestyles, leading to a heterogeneous
distribution of disease burden and health loss. There have been
attempts to describe national-level patterns of cancer prevalence
and epidemiology in different parts of India and areas of impor-
tance for cancer control. But a systematic and comprehensive un-
derstanding of the magnitude and time trends of different types
of cancers across India is not readily available which is of utmost
importance for cancer control, to commensurate with the need of
delivery of health care. [3-4]
The National Cancer Registry Program in India was established
in 1981 to generate data on the magnitude and patterns of cancer
through population-based registries. The number of registries have
grown since then and other population-based registries have also
been started in recent years. [5] However, many densely populated
states have no cancer registries yet. Most registries in India are
in urban areas, leading to difficulties in assessing cancer burden
trends in all parts of the country. The India State-Level Disease
Burden Initiative is a collaboration with the Global Burden of Dis-
eases, Injuries, and Risk Factors Study (GBD) to produce subna-
tional disease burden estimates for India. This initiative recently
reported the variable health transition across the states of India
from 1990 to 2016 based on analysis done as part of GBD 2016.
[6]
The epidemiology of cancer involves a study of the cancer etiology
to infer the possible trends. Such epidemiological data based stud-
ies assist in formulating the national cancer control program based
strategies. Although there are few studies highlighting trends in
cancer burden across our country, there is paucity of knowledge
base in the state of Chhattisgarh. Hence the present study was un-
dertaken as a novel attempt to assess the incidence of cancer in a
tertiary care cancer center of Chhattisgarh.
3. Material and Methods
This retrospective observational study was carried out on patients
treated in our institute at Nava Raipur, Chhattisgarh, from 1st Jan-
2019 till 31st March 2020.
3.1. Study Design: Retrospective open label observational study
3.2. Study Location: This was a tertiary cancer centre based study
located at Nava Raipur, Chhattisgarh.
3.3. Study Duration: 1st Jan-2019 till 31st March 2020 (15
Months)
3.4. Subjects & Selection Method: The study population was
drawn from patients who registered in our institute from 1st Jan-
2019 till 31st March 2020.
Procedure Methodology Patient data of last 15 months stored in
the Hospital Management Information System (HMIS) was ana-
lyzed to study the incidence of various cancers along with the de-
mographic details of the patients encountered.
4. Results
A total of 2296 patients were registered at the BMC during the 15
months’ period (from 1/1/2019 to 31/3/2020) from across the Ch-
hattisgarh state. The distribution of types of cancer is depicted in
table-1. Females were more affected with malignancies than males
with female to male ratio of 1:0.88. (Figure 1) Majority of the pa-
tients of both sexes (male and female) registered at BMC were
belongs to the age group of 41-60 years i.e. 1193 (51.9%). Second
most common age group among males and females were 61 to
70 years i.e. 391(17%). Amongst pediatric patients the commonest
age group registered was 11-20 years i.e. 43 (1.8%) Figure 2 & 3.
Most commonly reported cancer among male patients was found
to be oral cancer followed by lung and stomach cancer. The top
five most common cancer reported among male patients were oral
cavity, lung, stomach, colorectal and esophageal cancer. (Figure
2) Most commonly reported cancer among female patients was
cervical cancer followed by breast and oral cancer. Top five most
commonly reported cancer among female patients were cervical,
breast, oral cavity, ovary, and uterine cancer (Figure 3). We noted
3 cases of male breast cancer i.e. 1% amongst total breast cancer.
Figure 1: Sex wise incidence of Cancer

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Volume 4 Issue 3 -2021 Research Article
Figure 2: Age distribution of Cancer burden in males
Figure 3: Age distribution of Cancer burden in females
5. Discussion
This study was conducted to evaluate the variations and factors af-
fecting the epidemiology of cancer in Chhattisgarh state, which is
evident from the above observations. We observed the most com-
mon cancer in males are as follows; Oral cavity, followed by Lung
> Stomach > Colo-rectal> Oesophagus. Similarly, in females the
most common cancer found was Cervical followed by Breast>Oral
cavity> Ovary> Uterine. The three most common cancers among
males and females in this study correlates with the results of pre-
vious study conducted here in Chhattisgarh in 2018. [7] The dif-
ference we found here is the fifth most common cancer in female
is uterine cancer in our current study while it was stomach and
colorectal cancer in the previous study. On comparison of our
findings with the National cancer trend as per GLOBOCAN-2018
data, we inferred that among male patients, the five most common
cancers corroborate with our study (Figure 4). But in female pa-
tients there are major differences in the findings. Like, Breast can-
cer is the most common cancer in India as per GLOBOCAN-2018
report followed by Cervical> Ovary> Oral cavity > Colorectal
while we reported Cervical cancer as the commonest one followed
by Breast>Oral cavity> Ovary> Uterine (Figure-5) [8]. In the cur-
rent study we found maximum number of patients were of Oral
cavity cancer (25.47%). High incidence of oral cancer in India as
well as in Chhattisgarh attributes to a number of etiological factors
including tobacco consumption habit among the patients, either
as smokeless tobacco or smoking and alcohol consumption are
the common causes for oral cancer. Positive family history of oral
cancer, viral infections like HPV, poor oral hygiene are the other
causes for oral cancer. Based on the TNM classification, 48% of
the oral cancer cases presented in the late stages. [9] Estimates
indicate 57% of men and 11% of women between 15- 49 years of
age use some form of tobacco. [10]
Similarly, cervical cancer is the leading type of cancer in Indian
women and the second most common cancer in women world-
wide. Though there are several methods of prevention of cervical
cancer, prevention by vaccination is emerging as the most effec-
tive option, with the availability of vaccines. Sexually transmitted
Human Papilloma Virus (HPV) infection is the most important risk
factor for cervical intraepithelial neoplasia and invasive cervical
cancer. [11]

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Volume 4 Issue 3 -2021 Research Article
Figure 4: GLOBOCAN 2018 Data: new cases in 2018, males, all ages
Figure 5: GLOBOCAN 2018 Data: new cases in 2018, females, all ages
Indian women face a 2.5% cumulative lifetime risk and 1.4% cu-
mulative death risk from cervical cancer. At any given time, about
6.6% of women in the general population are estimated to har-
bor cervical HPV infection. HPV serotypes 16 and 18 account for
nearly 76.7% of cervical cancer in India. Warts have been reported
in 2–25% of sexually transmitted disease clinic attendees in India.
[12]
Apart from HPV there are other cofactors which are necessary
for progression from cervical HPV infection to cancer. Long-term
use of hormonal contraceptives, high parity, and early initiation
of sexual activity, multiple sex partners, tobacco smoking and
co-infection with HIV have been identified as established cofac-
tors; co-infection with Chlamydia trachomatis and herpes simplex
virus type-2, immunosuppression, low socioeconomic status, poor
hygiene and diet low in antioxidants are other probable cofactors.
Genetic and immunological host factors and viral factors such as
variants of type, viral load and viral integration are likely to be im-
portant, but have not been clearly identified. [13] To prevent HPV
infection the Indian Academy of Pediatrics (IAP) recommended
vaccination schedule as 2 doses of either of the two available HPV
vaccines at interval of 6 months for girls aged 9-14 years. For girls
15 years and older, and those with HIV/AIDS, on chemotherapy or
after organ transplant require 3 doses at 0, 1-2 and 6 months. [14]
The Government of India has initiated the National Cancer Con-
trol Program in 1975 to equip tertiary care cancer hospitals and in-
stitutions to implement systematic, equitable, and evidence-based
strategies for prevention, early detection, diagnosis, treatment, and
palliative care using available resources. [15] State cancer insti-
tutes and tertiary care cancer centres have been established under
this program, responsible for improved cancer awareness amongst
population and management at the state level. Despite these at-
tempts, access to critical cancer treatment is low in the country.
For example, lesser availability of radiotherapy machines, delays
in treatment and geographic inequity in the distribution of such re-
sources. [16] With the launch of the National Program for Control
of Cancer, Diabetes, CVD and Stroke in 2010 in India, the cancer
control efforts are now part of this umbrella program for non-com-
municable diseases. [17]

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Table 1: Distribution of cases according to the site of cancer
Sr No Cancer Type Total Female Male
1 Lip, oral cavity 585 130 455
2 Cervix uteri 331 331 0
3 Breast 300 297 3
4 Ovary 110 110 0
5 Stomach 79 20 59
6 Lung 79 19 60
7 Rectum 78 33 45
8 Oesophagus 76 30 46
9 Colon 56 23 33
10 Soft Tissue Sarcoma 54 22 32
11 Corpus uteri 51 51 0
12 Thyroid 47 26 21
13 Larynx 46 5 41
14 Leukaemia 45 9 36
15 Brain, nervous system 40 16 24
16 Prostate 34 0 34
17 Oropharynx 33 12 21
18 Pancreas 32 16 16
19 Gall Bladder 31 15 16
20 Bladder 24 2 22
21 Non Hodgkins Lymphoma 16 2 14
22 Testis 15 0 15
23 Kidney 14 5 9
24 Nasopharynx 14 3 11
25 Unknown primary 13 6 7
26 Liver 12 3 9
27 Salivary glands 11 3 8
28 Skin Cancer 10 2 8
29 Vulva 9 9 0
30 Hodgkin lymphoma 9 4 5
31 Osteosarcoma 9 3 6
32 Multiple myeloma 8 2 6
33 Penis 8 0 8
34 Anus 7 2 5
35 Vagina 5 5 0
36 Small Intestine 3 2 1
37 Bone Tumor 1 1 0
38 Kaposi sarcoma 1 1 0
TOTAL 2296 1220 1076
The national program aims to tackle cancer by addressing prevent-
able common risk factors through community-level, cost-effective
screening for high-burden cancers, which include clinical breast
examination for breast cancer, visual inspection for cervical cancer
and visual examination for oral cancers. [18] However, there are
many challenges with these efforts, including difficulties acquir-
ing trained human resources, follow-up of positive tests, timely
diagnosis, and well-tracked referral pathways. [19] Additionally,
there are limited population-level screening modalities available
for some of the cancers responsible for the highest cancer burden
in India, such as stomach and lung cancers. Ideally, national and
state-level efforts should coordinate to facilitate the development
of a prevention-to-palliation system of upward referral for ear-
ly confirmatory diagnosis and prompt treatment of cancers, and
downward referral for adequate follow-up, including palliative
care and pain relief.
6. Conclusion
It’s a tertiary cancer centre based study, in which we have identified
the oral cavity cancer is the commonest cancer in male and the cer-
vical cancer in female here at Chhattisgarh state of Central India.
Our findings are more or less similar to the National cancer data
as per GLOBOCAN 2018 report apart from breast cancer which
is the commonest cancer in Indian females while our study report-
ed cervical cancer as the most common cancer among females in
Chhattisgarh. Looking at the Nationwide Cancer burden, it’s ris-
ing very fast and most of the common cancers amongst males and
females are avoidable through the vigorous implementation of the
framework convention on tobacco control, screening and vaccina-
tion programs to prevent infection-related cancers, such as cervical
cancer (human papillomavirus). Public health initiatives directed
at improving nutrition, health education and prevention of obesi-
ty would help in controlling the lifestyle-associated cancers. The
continuing improvement of cancer outcomes will require changed
priorities and more emphasis on improvement of cancer research
in India.
References
1. India State-Level Disease Burden Initiative Cancer Collaborators.
The burden of cancers and their variations across the states of In-
dia: the Global Burden of Disease Study 1990–2016. Lancet Oncol.
2018; 19: 1291-308.
2. World Health Organization. Global Health Observatory. Geneva:
World Health Organization; 2018.
3. Sivaram S, Majumdar G, Perin D, et al. Population-based cancer
screening programmes in low-income and middle-income countries:
regional consultation of the International Cancer Screening Network
in India. Lancet Oncol. 2018; 19: e113-22.
4. India State-Level Disease Burden Initiative Collaborators. Nations
within a nation: variations in epidemiological transition across the
states of India, 1990–2016 in the Global Burden of Disease Study.
Lancet. 2017; 390: 2437-60.
5. Indian Council of Medical Research. Three-year report of population
based cancer registries 2012–2014: incidence, distribution, trends in
incidence rates and projections of burden of cancer. Bengaluru: Na-
tional Centre for Disease Informatics and Research, ICMR, 2016.
6. Indian Council of Medical Research, Public Health Foundation of
India, Institute for Health Metrics and Evaluation. India: Health of
the Nation’s States—The Indian State-Level Disease Burden Initia-
tive. New Delhi: ICMR, PHFI and IHME, 2017.
7. Ashish Kumar Sinha et al. Epidemiological Trend of Cancer among
Patients at Regional Cancer Center, Dr. B. R. Ambedkar Memorial
Hospital, Raipur: A Tertiary Care Hospital of Central India; Interna-
tional Journal of Health Sciences & Research. 2018; 8(2).
8. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al.
Global Cancer Observatory: Cancer Today. Lyon, France: Interna-
tional Agency for Research on Cancer. 2018.
9. Mallath MK, Taylor G, Badwe RA, Rath GK, Shanta V, Pramesh
CS, et al. The growing burden of cancer in India: epidemiology and
social context. Lancet Oncol. 2014; 15(6): e205-12.

6. clinicsofoncology.com 6
Volume 4 Issue 3 -2021 Research Article
10. Ken Russell Coelho. Challenges of the Oral Cancer Burden in India;
Journal of Cancer Epidemiology. 2012.
11. Schiffman M, Castle PE, Jeronim J, Rodrigue AC, Wacholde S. Hu-
man papillomavirus and cervical cancer. Lancet. 2007; 370: 890-907.
12. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV
Information Centre). Summary report on HPV and cervical cancer
statistics in India 2007.
13. Castellsague X, Munoz N. Cofactors in human papillomavirus car-
cinogenesis - role of parity, oral contraceptives, and tobacco smok-
ing. J Natl Cancer Inst Monogr. 2003; 31: 20-8.
14. Vashishtha VM, Choudhury P, Kalra A, et al. Indian Academy of
Pediatrics (IAP) recommended immunization schedule for children
aged 0 through 18 years–India, 2014 and updates on immunization.
Indian Pediatr. 2014; 51(10): 785-800.
15. Ministry of Health and Family Welfare, Government of India. Na-
tional cancer control programme. (accessed March, 2020).
16. Grover S, Gudi S, Gandhi AK, et al. Radiation oncology in India:
challenges and opportunities. Semin Radiat Oncol. 2017; 27: 158-
63. Mallath MK, Taylor DG, Badwe RA, et al. The growing burden
of cancer in India: epidemiology and social context. Lancet Oncol.
2014; 15: e205-12.
17. Directorate General of Health Services, Ministry of Health and Fam-
ily Welfare, Government of India. National Programme for Preven-
tion and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke. (accessed on April 2020)
18. Rajaraman P, Anderson BO, Basu P, et al. Recommendations for
screening and early detection of common cancers in India. Lancet
Oncol. 2015; 16: e352-61.
19. Krishnan S, Sivaram S, Anderson BO, et al. Using implementation
science to advance cancer prevention in India. Asian Pac J Cancer
Prev. 2015; 16: 3639-44.