The presentation begins with a brief history of how cancer epidemiology evolved, and what is the status at present. After describing the burden of the disease of cancer globally and in India, the presentation includes a brief description of Cancer causes and prevention including screening activities. It also talks about the national Cancer Registry Program, NPCDCS and NCCP.

1. Cancer Epidemiology
Sourav Goswami
Moderator: Dr Chetna
Maliye
05.10.17

2. History
Cancer is NOT a new disease
Hippocrates
Bernardino
Ramazzini
Henry Butlin

3. Framework
What is Cancer epidemiology ?
History of Cancer
Burden of disease
Causes of cancer
Prevention of Cancer
National program for Cancer

4. What is Cancer Epidemiology?
Concerns what happens in population
Who?
When?
Where?
Why?
How can we prevent it?

5. Burden of the disease- WORLD
Cancer is one of the leading causes of morbidity and mortality
worldwide, with approximately 14 million new cases in 2012.
The number of new cases is expected to rise by about 70%
over the next 2 decades.
Cancer is the second leading cause of death globally, and was
responsible for 8.8 million deaths in 2015. Globally,
nearly 1 in 6 deaths is due to cancer.
Approximately 70% of deaths from cancer occur in low- and
middle-income countries.
The overall age standardized cancer incidence rate is almost
25% higher in men than in women, with rates of 205 and
165 per 100,000, respectively

6. Burden of the disease-INDIA
The International Agency for Research on Cancer
GLOBOCAN project has predicted that India’s cancer
burden will nearly double in the next 20 years,
from slightly over a million new cases in 2012 to more
than 1·7 million by 2035.
These projections indicate that the absolute number of
cancer deaths will also rise from about 680 000 to 1·2
million in the same period

7. Estimated cancer incidence, 2012 (GLOBOCAN)

8. Estimated cancer mortality, 2012 (GLOBOCAN)

9. Estimated age standardized incidence and mortality
rates, 2012 (GLOBOCAN)- WORLD
Males
Females

10. Estimated age standardized incidence and mortality
rates, 2012 (GLOBOCAN)- INDIA
Males
Females

11. Regional variations in the age-adjusted incidence
rates of cancer in men and women in different
regions of India

12. Estimated projected incidence and mortality
burden of all cancers in Indian men and women to
2035

13. Burden of cancer deaths in Indians by educational status
in individuals aged 30–69 years7

14. What causes Cancer ?

15. How do we decide what
causes Cancer?
If an association is observed, the first question asked
must always be ...
“Is it real?”

16. Exposure & outcome
Does alcohol intake increases the risk of Lung Ca?
ALCOHOL (EXPOSURE) Lung Ca (OUTCOME)
Does Hep B vaccine protect against Liver Ca?
Hep B vaccine (EXPOSURE) Liver Ca (OUTCOME)

17. Confounding
Does alcohol intake increases the risk of Lung Ca?
Alcohol (EXPOSURE) Lung Ca (OUTCOME)
Smoking
(CONFOUNDER)

18. Cancer control
Normal
Epithelium
Invasive Cancer
Carcinoma
In situ
Dysplasia

19. Cancer Control
Primary Prevention
 Control of tobacco & alcohol
consumption
 Personal hygiene
 Radiation
 Occupational exposures
 Immunization
 Foods, drugs & cosmetics
 Air pollution
 Precancerous lesions
 Legislation
 Cancer education
Secondary Prevention
 Cancer registration
 Hospital based registries
 Population-based
registries
 Early detection of cases
 Treatment
 *** Palliative care
ONE THIRD of all cancers are PREVENTABLE !

20. Cancer screening
“ Search for unrecognized malignancy by means
of rapidly applied tests”
Why is cancer screening possible?
Methods of screening:
 Mass screening by comprehensive cancer detection
examination
 Mass screening at single sites
Selective screening

21. Examples of Screening
Screening for cancer Cervix
Pap smear
Visual inspection based screening tests such as
visual inspection with 5 per cent acetic acid {VIA}
VIA with magnification {VIAM} and
visual inspection post application of Lugol's iodine (VILI)
Screening for Breast cancer
breast self-examination (BSE) by the patient
palpation by a physician
thermography, and
 mammography

22. Government initiatives to fight
Cancer
 National Cancer Registry
Program
 National programs
NCCP
NPCDCS

23. National Cancer Registry Program
(NCRP)
NCRP was commenced by the Indian Council of Medical
Research (ICMR) with a network of cancer registries across
the country in December 1981.
The main objectives of this Programme were:
1. To generate reliable data on the magnitude and patterns of cancer
2. Undertake epidemiological studies based on results of registry data
3. Help in designing, planning, monitoring and evaluation of cancer
control activities under the National Cancer Control Programme
(NCCP)
4. Develop training programmes in cancer registration and
epidemiology.

24. Population-based cancer
registries (total 29) seek to
collect data on all new cases
of cancer occurring in a well
defined population. Usually,
the population is that which
is resident in a particular
geographical region
Hospital-based cancer
registries (total 09) maintain
data on all patients diagnosed
and/or treated for cancer at a
particular facility. The focus of
the hospital-based cancer
registry is on clinical care and
hospital administration

25. NCCP
 1975-76- NCCP was launched with priorities given for equipping the
premier cancer hospitals. Central assistance at the rate of Rs.2.50 lakhs
was given to each institution for purchase of cobalt machines.
 1984-85- The strategy was revised and stress was laid on primary
prevention and early detection of cancer cases.
 1990-91- District Cancer Control Program was started in selected
districts (near the medical college hospitals).
 2000-01- Modified District Cancer Control program initiated.
 2004 - Evaluation of NCCP was done by National Institute of Health &
Family Welfare, New Delhi.
 2005 - The programme was further revised after evaluation.
 RCC – new/strenthening; Oncology wing; Decentralised NGO scheme

26. NPCDCS

27. NPCDCS
Service Package for Cancer
Sub center
Health promotion for behavior change and counseling.
‘Population based/ Opportunistic’ Screening of common NCDs
including cancer.
Awareness generation of early warning signals of common cancer
& other risk factors of NCD (Cancer)
 PHC + CHC/RH = Subcentre +
‘Population based/ Opportunistic’ Screening of 3 common
cancers (oral, breast, and cervical by VIA).
Identification of early warning signals of common cancer.
DH= PHC/CHC +
Follow up chemotherapy in cancer cases, Rehabilitation and
physiotherapy services.

28. NPCDCS
Service Package for Cancer
Medical College
Mentoring of District Hospitals, Early diagnosis and
management of Cancer
Training of health personnel, Operational Research.
 Tertiary Cancer Centre
Mentoring of District Hospital and outreach activities,
Comprehensive cancer care including prevention, early
detection, diagnosis, treatment, palliative care and
rehabilitation.
Training of health personnel &
Operational Research

29. The distribution of the population (2011) and cancer mortality
(2010) in five zones of India compared with the corresponding
proportions of radiotherapy centres, oncology departments,
and
postgraduate oncology training positions

30. Training facilities and yearly intake for formal
training of oncology staff in India, by
postgraduate course
# Source: MCI
No of MBBS seats: 49918/year

31. Burden of the disease-INDIA
The International Agency for Research on Cancer
GLOBOCAN project has predicted that India’s cancer
burden will nearly double in the next 20 years,
from slightly over a million new cases in 2012 to more
than 1·7 million by 2035.
These projections indicate that the absolute number of
cancer deaths will also rise from about 680 000 to 1·2
million in the same period

32. Are we doing things right???

33. Conclusion
The burden of cancer in India is intimately linked to the
country’s major socioeconomic inequalities in access to
health care and other areas.
Rebalancing of the distribution of power, social goods,
and resources33 will be a crucial determinant of how
India will address its cancer burden in the long term.
Even greater losses of welfare are associated with
longstanding weaknesses in the country’s public health
system and its capacity to deliver preventive services

34. Conclusion contd…
At the root of the solutions to India’s cancer burden is the
need for political commitment and action. Measures such as
a fully committed eff ort to reduce, and, in the long term,
eliminate, use of tobacco products through the vigorous
implementation of the Framework Convention on Tobacco
Control, would in time substantially decrease the incidence
of, and consequently the mortality caused by,

35. Reference
1. Isabel dos Santos Silva. Cancer Epidemiology: Principles and methods.
International Agency for Research on Cancer. WHO. Lyon
2. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0,Cancer
Incidence and Mortality Worldwide: IARC Cancer Base No.11.Lyon, France:
International Agency for Research on Cancer, 2013.
3. Forman D, Bray F, Brewster DH. In: Gombe Mbalawa C, Kohler B, Piñeros M,
Steliarova-Foucher E, Swaminathan R, Ferlay J.Cancer incidence in five
continents, Vol X (electronic version) Lyon: International Agency for Research
on Cancer.
4. Indian Council of Medical Research. National Cancer Registry Program.
http://www.ncrpindia.org/
5. Park K. Park’s Textbook of Preventive and Social medicine. 23rd Ed. Jabalpur:
M/s Banarasidas Bhanot; 2015. Chapter 2,Concept of Health and Disease; p.
400-06.
6. Ministry of Health and family Welfare. GOI. National Programme For Prevention
and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke(NPCDCS).
7. Mallath, Mohandas K et al. The growing burden of cancer in India:

36. Thank you !!!