Rising Burden of Colorectal Cancer in Kashmir

Colorectal cancer (CRC), once considered a disease of the developed West, is rapidly gaining a foothold in India—and alarmingly towns of Jammu and Kashmir. With steadily rising cancer diagnoses and increasing reports from local clinics and hospitals, CRC has emerged as a significant and growing threat to the public health of Kashmir’s over two crore residents.

This emerging crisis is not merely a reflection of global cancer trends but a consequence of profound changes within the region—shifts in diet, lifestyle, awareness, and healthcare access. Together, these factors form a complex mosaic of risk that demands urgent attention.

National and Regional Trends

India ranks fifth globally in CRC-related deaths, with 64,863 new cases and 38,367 deaths reported in 2022 alone. While the age-adjusted incidence rates remain relatively low at 5.7 per 100,000 males and 3.4 per 100,000 females, the upward trajectory—especially in urbanizing regions—is unmistakable.

In Kashmir, the situation is even more concerning. Despite the absence of population-based cancer registries, multiple hospital-based studies and clinical reports confirm a worrying rise in CRC cases among both men and women. Notably, CRC has become the most common cancer among Kashmiri women and the second most prevalent in men. A silent but significant transformation is underway in the region’s disease profile.

Why is Colorectal Cancer Rising in Kashmir?

CRC is a multifactorial disease influenced by genetics, infections, and—most significantly—environmental and lifestyle factors. Kashmir is now facing the brunt of all three.

1. The Changing Kashmiri Diet: From Protection to Risk

Traditionally, the Kashmiri diet was a protective shield against gastrointestinal diseases. It was rich in fiber, green leafy vegetables, whole grains, dairy products, and locally sourced produce. These foods provide calcium, antioxidants, and other micronutrients that reduce inflammation, promote gut health and prevent cancer.

However, in recent years, modernization and urbanization have eroded this healthy pattern. Today, there is a marked shift towards: Increased intake of red and processed meats and sausages. Frequent consumption of fried and packaged foods. Declining intake of fiber-rich pulses, vegetables, and dairy.

Several studies have shown that excess red meat consumption can increase CRC risk by up to 4 times, while processed meats and fried foods can double the risk. Cooking methods—such as grilling and frying—further compound the issue by generating carcinogenic compounds like heterocyclic amines (HCAs) and N-nitroso compounds.

2. Physical Inactivity and Obesity

Urban lifestyles, academic stress, increased screen time, and reduced outdoor activity have contributed to a sharp decline in physical activity, particularly among youth. Obesity, especially abdominal obesity, is strongly associated with CRC due to chronic inflammation and insulin resistance. The rising body mass index (BMI) among Kashmiris is becoming a key driver of this disease. 

3. Tobacco and Alcohol

While cultural norms restrict alcohol use, smoking remains alarmingly common among Kashmiri men. Studies suggest smoking increases CRC risk by up to 8.7 times, making it one of the most potent modifiable risk factors.

4. Genetic and Inflammatory Risks

Patients with inflammatory bowel diseases (IBD) like ulcerative colitis or Crohn’s disease—increasingly diagnosed in Kashmir—have a significantly higher risk of CRC over time. Moreover, genetic syndromes like Lynch Syndrome remain underdiagnosed due to a lack of genetic testing facilities and awareness.

5. Infectious Agents

Chronic gastrointestinal infections from Helicobacter pylori, HPV, and human cytomegalovirus (HCMV) are also implicated in CRC risk, especially in lower-income settings like rural Kashmir.

 The Clinical Picture: Late Diagnosis, Worse Outcomes

CRC is most commonly detected in Kashmir between the ages of 55–65, but nearly 20% of cases now affect individuals under 35—a distressing trend. Symptoms like rectal bleeding, changes in bowel habits, and unexplained weight loss are often ignored or misdiagnosed until the disease reaches an advanced stage.

 Rural and under-resourced areas face systemic barriers to early diagnosis, including poor access to colonoscopy, limited pathology services, and a lack of trained personnel. This contributes to India’s poor 5-year CRC survival rate of just 34–38%, far below the 58–65% seen in countries like the US and UK.

 What Needs to Be Done: A Call to Action

Addressing the CRC crisis in Kashmir requires urgent, coordinated efforts on multiple fronts:

 Raise Awareness: Launch education campaigns in schools, colleges, workplaces, and rural communities to promote understanding of symptoms, risk factors, and the importance of early screening.

Implement Screening Programs: Introduce affordable and accessible screening—such as the fecal immunochemical test (FIT)—into public healthcare schemes like Ayushman Bharat. Even simple stool-based home tests could transform CRC outcomes in the region.

Preserve Protective Diets: Encourage the return to traditional plant-based eating habits. Promote home-cooked meals, seasonal vegetables, whole grains, and dairy consumption while reducing red meat and processed food intake.

Train Healthcare Workers: Enhance training for primary care providers, especially in rural clinics, to identify CRC symptoms early and facilitate timely referrals.

Build Genetic and Surveillance Capacity: Strengthen genetic counseling for high-risk individuals and establish IBD surveillance protocols to catch pre-cancerous changes early.

 Preventable Tragedy

CRC is a largely preventable and treatable cancer—but only when caught early. With Kashmir experiencing a nutrition and lifestyle transition, the stakes have never been higher. A combination of traditional dietary wisdom, modern screening tools, public awareness, and healthcare reform can stem the tide of this growing epidemic.

Let us not wait for the numbers to rise any further. Timely action can save lives—across villages, towns, and the breathtaking landscapes of Kashmir.

 Dr Umer Majeed Khaja is a cancer researcher who earned his Ph.D. in Life Sciences with a focus on colorectal cancer