Demographic Shift in Cancer Risk Factors
We know that Cancer is an Enigmatic disease known since ancient times! It has baffled mankind since ages and equally perplexed the Researchers, Scientists, Oncologists and even the Policy makers and Politicians equally. Cancer is going to bemuse us in the near future as well unless we reorient ourselves to the heterogeneous nature of this disease and its emerging and unexplored risk factors. There is a steep rise in the cancer cases globally and it is projected to surpass 20 million (more than 2 Crore cases) by 2030 which will be 69% jump from the global cancer cases that occurred in 2008 (Globocon-WHO).The majority of this rise is going to affect the less developed countries. Our Country India is not lagging anymore to share this rising Cancer burden. The reported cancer incidence in India for the year 2023-24 is estimated to be 19 to 20 lakhs, whereas real incidence is 1.5 to 3 times higher than the reported cases.
The number of Indians suffering from cancer is projected to increase to nearly 30 lakhs annually by 2030 (Globocon & ICMR). With more cases, the deaths from cancer are also projected to increase. This rise is going to impact our overstretched health care resources. Sensing this non stoppable rise, the GOI in the union budget 2025 presented by the Union Finance Minister on 1st February 2025 earmarked a separate fund to establish the Cancer Care facilities in nearly 200 districts by year 2025-26 which will be a big boost to cancer care services especially in the far off and rural areas. Our own UT of J&K is not far behind and the trends in cancer cases run parallel to the trends elsewhere in the country because of multiple factors. As reported earlier, over 51,000 new cancer cases have been registered in J&K over the four years (2019-2022). And more than 34000 have died from cancer during the same period.!! (Greater Kashmir,23rd January 2023).This data is slightly older and the new trends definitely must be reflecting the rise in cancer cases annually.
Why is there a steep rise in Cancer Cases?
The reasons are many some known and some unknown! One of the important risk factor is population explosion with parallel rise in the life expectancy. Cancer mostly involves elderly, the rise is obvious. The current national average life expectancy in India is 69.4 years and in J&K it is 74 years. The world population has surpassed 8 billion in 2022 and India has left behind China as the most populous nation in the mid 2023. The population of J&K has also increased at the rate of 23-29% in last 5 decades with current population expected at 1.5 crore compared to 35 lakhs in 1961 (Census of India).
What are the known and important Risk Factors for Cancer for decades?
Traditionally the common risk factors for Cancer are divided into Modifiable and Non modifiable. The Non-modifiable risk factors are the ones which usually cannot be altered to decrease the risk of cancer. They are the age, sex,r ace, ethinicity, family history and genetic predisposition.Together they are implicated to increase the risk of cancer in less than 20% cases. The most important risk factors are the modifiable or sporadic risk factors.They are associated in more than 80% of cancers.They are the factors which if we intervene, the risk of cancer can be reduced drastically and we can prevent upto 30-50% of cancers.The common ones are the Smoking in any form, Alcohol consumption, Infections, Sedentary life style, Unhealthy diet, Obesity etc. Smoking in any form and alcohol consumption are implicated in 30-50% of cancers. Infections in around 15-20% especially Hepatitis B & C, HPV, H.Pylori, HIV etc. The sedentary life style and unhealthy diet can also increase the risk of cancer in 30-35% cases.The other less common traditional risk fctors are certain occupations, exposure to some chemicals and drugs.
Is there a demographic shift in traditional risk factors?
If we look at the cancer patterns earlier in J&K, the Kangri cancer and Cancer of foodpipe (esophagus) and stomach were more common.
Kangri Cancer
Kangri, a traditional fire pot used to warm individual by keeping inside the Pheran (a tradional Cloak). Its use was the main risk factor for causing Kangri cancer, a type of skin Cancer especially on the inner thighs and lower belly. With the advent of modern heating gadgets and appliances and less harsh winters the use of Kangri has reduced drastically. Kangri cancer is neglible in our society at present. Kangri is now no more the Lawrances’ Laila to a Kashmiri! (What Laila is to Majnoo so is the Kangri to a Kashmiri-The Valley of Kashmir by Sir Walter Lawrance).
Cancer Stomach and Esophagus (food pipe)
A decade and a half back these two were the most prevalent cancers in Kashmir both men and women.The reasons implicated with some research evidence were the use of dried vegetables (Hokh Syun) and the plenty of salted tea (Noon Chai) and the wazwaan and spicy food habits. However over the decades the use of Hokh Syun is near nil in most families because of round the year availability of fresh vegetables and the better economic conditions of most families.The habit of taking plenty of Noon Chai (Salted tea) especially in the morning hours and evenings during the harsh winters has decreased as the intensity of winter has faded. Concurrently the food habits have changed and mostly people take lipton tea or other means of break-fsast. Hokh Syun, Hokh Gada,Vade and Noon Chai has become the thing of past. With this the incidence of cancer esophagus and stomach has been surpassed by other cancers.
The rise in incidence of new Cancers and the real demographic Shift in Risk factors?
Smoking
In the last decade the two most common cancers individually in Men and Women in Kashmir are Lung Cancer and Breast Cancer respectively. It is known that smoking in any form has strong association with Lung Cancer. There is some change in the pattern of smoking over the past few decades. The traditional Hookah or Jajeer is now extinct. Presently it is cigarette smoking. There is a definite rise in smoking especially in the youth. The figures are very alarming. Kashmir is ranked 6th in smoking in country and the spending in a year is estimated at whooping Rs.850 crore annually (Greater Kashmir,6th October 2023).Though there are few legislations from Govt.of J&K to curb this menace but it needs a full public cooperation to make the smoking cessations programme more stringent and successful.
Meat Consumption
Red meat consumption in large quantities is implicated as a risk factor for some cancers especially the Colon and Rectal Cancers (cancer of the large Intestines). There is a steep rise in these cancers in our society especially in the young population. Mutton has replaced the Hukh Syun to a large extent and so the incidence of Colon and Rectal cancers compared to cancer of oesophagus and stomach. There is urgent need for public awareness about the ill effects of excess mutton consumption. The mutton industry of Kashmir has an annual turnaround of Rs.3900 crore which is very huge and reflects the amount of consumption of meat in our society (GK,4th June 2023).
Obesity and sedentary life style
Some 4-8% of cancers are related to obesity and sedentary life style. The common cancers are Breast, Uterine, Prostate, Liver etc. Breast Cancer is the most prevalent cancer in women in our population. We need to educate the youth about cancer causing propensity of obesity and to adopt the healthy food habits and active life style.
Alcohol consumption
Alcohol consumption is attributed to cause cancer of mouth, throat, liver, colon and breast etc. There is rise in the liver cancer, colon cancer and breast cancer in our society. There needs to be general awareness about the ill effects of alcohol consumption.
Pesticides and Herbicides
The back bone of our economy is horticulture and agriculture. Nearly 70-80% of the rural population is directly or indirectly involved in farming be it agriculture or horticulture. There is huge need and use of various chemicals like pesticides, herbicides, fungicides and other spraying chemicals to protect the fruits and crops from various diseases. However the excess use of these chemicals is implicated in the causation of various cancers especially Multiple Myeloma, Non Hodgkins Lymphoma, Brain tumours and some Leukaemia’s. The Horticulture industry’s annual turnaround is more than Rs.800 crore and it reflects the amount of these various chemical sprays used to protect the produce. This area needs a strong focus from the Govt.and SKAUST-K to explore the protective measures and safer pesticides and alternatives means to save the industry and human life as well.
Infections
Around 15-20% cancers are caused by Infections like Liver Cancer, Cervical Cancer, Anal Cancer, Oral Cancer etc. We see some rise in the liver cancers from some areas were Hep.B and Hep.C infections are very prevalent. These cancers are to a large extent preventable if vaccines are used to prevent these infections. These vaccinations programs are now included in the national immunisation programmes like Hep.B and HPV vaccinations to prevent the occurrence of these Cancers.
Food adulteration
There is a strong concern globally about the use of various food adulterants and their propensity to cause cancer. Some association has been seen with the rise in gall bladder cancer. There is definite increase in the incidence of gall bladder cancer in our society. This needs a focus by the food safety department and strong legislations by Govt. to curb this menace.
Air pollution
Nearly 1% of cancers are attributed to Air pollution. Mostly it is related to Lung Cancer. With the growing use of automobiles and industries the level of air pollution is rising and is definitely going to have its impact on cancer incidence.
Micro plastics (Nano Plastics)
Plastic is indispensable in our lives. However over the years its use has increased manifold and it has crept in all spheres of our daily life so much so that we can’t imagine life without plastic. It has many harmful ill effects on our lives directly and indirectly, It can cause various diseases and also causes soil ,water and air pollution. However its excessive and avoidable use has been found to increase the risk of some cancers. We need to avoid using excess of plastics for drinking tea, water, milk and other beverages and avoid taking food wrapped in plasticisers to decrease the risk of Cancer.
Mobile towers and Mobile phones
With the boom of telecommunication and with its huge impact on our lives, there are some concerns if it is increasing the risk of cancer. Though there are some ill health effects like radio frequency sickness etc. However as of now there is no conclusive evidence of its association as risk factor for cancer.
Tailpiece: Traditional Kashmiri foods like Kangar, Nun Chai, Hukh Syun, Hukk Gada, and Vade are no longer the dominant risk factors; today’s health threats stem from red meat, smoking, alcohol, infections, obesity, air pollution, sedentary lifestyles, microplastics, and adulterated foods.
Dr Mir Mohammad Hussain, MD General Medicine, DM Medical Oncology, Post DM Fellowship in Blood & Marrow Transplantation AIIMS New Delhi. Currently works as Assistant Professor Medical Oncology at SKIMS Srinagar.
