Powerpoint Slides - Centre for Global Health Research

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CANCER MORTALITY
IN INDIA
On behalf of the Million Death Study Collaborators, and in
partnership with
Tata Memorial Hospital (Mumbai, India), St. John’s Research Institute
(Bangalore, India), IARC (Lyon, France) and SEARO (Delhi, India) of WHO
and the Centre for Global Health Research (Toronto, Canada)
LANCET PRESS RELEASE: WEDNESDAY, MARCH 28, 2012
CGHR.ORG/CANCER
Twitter: CGHR_org
[email protected]
Key findings
• About 0.6 Million (M) or 6 Lakh cancer deaths in 2010
• Over 70% of cancer deaths occurred during ages 30-69 years
(200,000 men and 195,000 women)
• At ages 30-69 years, the three commonest fatal cancers
– Men: oral, stomach, and lung
– Women: cervical, breast and stomach
• Tobacco-related cancers are over 40% of male and nearly 20%
of female cancers
• Cancer death rates are similar in rural and urban areas
• Huge variation in cancer death rates across states- partly due
to tobacco, and partly for reasons awaiting further discovery
• Cancer death rates 2-fold higher in the least educated
compared to the most educated adults
• Cervical cancer death rates far less in Muslim women than
among Hindu women
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
What’s new about this
research?
• First large, nationally-representative study
of cancer mortality in India, reflecting both
urban and rural areas
• Previous cancer estimates have relied
mostly on cancer registries in cities, but
70% of Indians live in rural areas
• Provides distribution of cancer deaths by
area, educational level, and religion
CGHR.ORG/CANCER
Twitter: CGHR_org
How was the study done?
• Nationally
representative
sample (Sample
Registration
System)
• 6,671 of these small
areas randomly
chosen from all
parts of India (each
with about 1000
people per area)
CGHR.ORG/CANCER
Twitter: CGHR_org
How was the study done?
800 Registrar General of India field workers interviewed
122 thousand families of people who had died in 20012003
Written reports each coded independently by at least
two physicians to attribute a probable cause of death
(i.e., cancer)
Cancer deaths grouped into broadly similar categories
(i.e., oral, lip and pharynx; lung and trachea, etc.)
CGHR.ORG/CANCER
Twitter: CGHR_org
How was the study done?
Calculated proportion of all cancer deaths by
age, gender, and cancer type within the study
Combined with national 2010 UN totals of
deaths, and 2007-2009 state-specific SRS death
rates
Produced national and state estimates of rates
and number of cancer deaths for 2010
CGHR.ORG/CANCER
Twitter: CGHR_org
Key results
• 7137 of 122 429 study deaths were due to
cancer, meaning about 600,000 cancer deaths
across the whole of India in 2010.
• Some 71% (395,000) of cancer deaths
occurred in people aged 30-69 years (200,100
men and 195,300 women).
•At ages 30-69, cancer deaths are:
 8% of the 2.5 million total male deaths
12% of the 1.6 million total female deaths
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
Leading cancers in men and
women, age 30-69 years
MEN
• Oral 45,800 or 23%
• Stomach 25,200 or 13%
• Lung 22,900 or 11%
WOMEN
• Cervical 33,400 or 17%
• Stomach 27,500 or 14%
• Breast 19,900 or 10%
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
Risk of death from cancer
For middle-aged Indians, the risk of dying before age
70 in the absence of other diseases:
47 of 1000 men will die of cancer
44 of 1000 women will die of cancer
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
Deaths among 1000 30 year
olds before age 70 from cancer,
at 2010 death rates
CGHR.ORG/CANCER
Twitter: CGHR_org
MEN
WOMEN
INDIA
47
44
Rural
46
45
Urban
49
42
Richer
states
Poorer
states
51
46
39
39
Source: Dikshit et al, Lancet 2012
Tobacco cancers in men and
women, age 30-69 years
MEN:
WOMEN:
84,000 or 42% of all cancers
35,700 or 18% of all cancers
Together: over 120,000 tobacco cancers
Twice as many oral cancers as lung
cancers
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
Risk of cancer death*, by
state
Men
Women
Northeast
States
112 of 1000 men
60 of 1000 women
Bihar
25 of 1000 men
29 of 1000 women
will die of cancer
will die of cancer
(highest risk)
(lower risk)
will die of cancer
will die of cancer
*For Indians aged 30, the risk of dying before age 70
from cancer in the absence of other diseases
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
Cancer: MEN aged 30-69 years
CGHR.ORG/CANCER
Twitter: CGHR_org
Cancer: WOMEN aged 30-69 years
CGHR.ORG/CANCER
Twitter: CGHR_org
Cancer (non tobacco/non infection):
BOTH GENDERS aged 30-69 years
CGHR.ORG/CANCER
Twitter: CGHR_org
Age-standardised death rate (per
100,000)
Cancer death rates by
education, men and women
aged 30-69
120
100
Men
80
Women
60
40
20
0
Illiterate
CGHR.ORG/CANCER
Twitter: CGHR_org
Primary
Educational level
Above secondary
Source: Dikshit et al, Lancet 2012
Selected cancer rates by
religion, women 30-69 years
Standardised mortality ratio
(and study deaths)
Type
Cervical
Oral
Breast
CGHR.ORG/CANCER
Twitter: CGHR_org
Hindu
1.06
Muslim
0.68
(340)
(24)
1.01
0.80
(190)
(24)
0.92
1.43
(178)
(32)
Source: Dikshit et al, Lancet 2012
Cervical cancer rates by state,
women 30-69 years
Age-standardised mortality rates per
100,000
Jammu &
Kashmir
Assam
India
2.3
Jammu & Kashmir
CGHR.ORG/CANCER
Twitter: CGHR_org
3.5
Assam
16.0
India
Source: Dikshit et al, Lancet 2012
Implications
• Most cancer deaths in India are avoidable as
they occur at younger ages and present late
after cancer starts
• Most importantly, higher tobacco taxes
reduce cancer
• Strategies to vaccinate, screen, and treat
women with cervical cancer also work.
• Early detection of cancer dramatically
improves the prospect of cure
• Big differences suggest more research on
why common cancers are rare in parts of
India
CGHR.ORG/CANCER
Twitter: CGHR_org
Source: Dikshit et al, Lancet 2012
www.cghr.org/cancer
• The Lancet Paper and Web appendix
• Press release (English, Hindi, and main
regional languages)
• Video release (English, Hindi, and
main regional languages
• FAQs
• PowerPoint slides
Follow us on Twitter: @CGHR_org
CGHR.ORG/CANCER
Twitter: CGHR_org
Million Death Study Collaborators
Indian Academic Partners (in alphabetical order):
Clinical Epidemiology Resource and Training Centre Trivandarum: KB Leena, KT Shenoy (until 2005)
Department of Community Medicine Gujarat Medical College Ahmedabad: DV Bala, P Seth KN Trivedi
Department of Community Medicine Kolkatta Medical College Kolkatta: SK Roy
Department of Community Medicine Regional Institute of Medical Sciences Imphal: L Usharani
Department of Community Medicine S.C.B. Medical College Cuttack Orissa: Dr. B Mohapatra
Department of Community Medicine SMS Medical College Jaipur: AK Bharadwaj, R Gupta
Epidemiological Research Center Chennai: V Gajalakshmi, CV Kanimozhi
Gandhi Medical College Bhopal: RP Dikshit, S Sorangi
Healis-Seskarhia Institute of Public Health Mumbai: PC Gupta, MS Pednekar, S Sreevidya
Indian Institute of Health & Family Welfare, Hyderabad: P Bhatia
Institute of Health Systems Research Hyderabad: P Mahapatra (until 2004)
St. John’s Research Institute St. John’s Academy of Health Sciences Bangalore: A Kurpad, P Mony, M Vaz, R Jotkar, S Rao-Seshadri, S Shrihari, S Srinivasan
King George Medical College Lucknow: S Awasthi
Najafgarh Rural Health Training Centre Ministry of Health Government of India New Delhi: N Dhingra, J Sudhir, I Rawat (until 2007)
National Institute of Mental Health and Neurosciences Bangalore: G Gururaj (until 2004)
North Eastern Indira Gandhi Institute of Regional Medical Sciences Shillong Meghalaya: FU Ahmed (until 2005), DK Parida
Regional Medical Research Center ICMR Institute Bhubaneshwar: AS Karketta, SK Dar
School of Preventative Oncology Patna: DN Sinha
School of Public Health Post Graduate Institute of Medical Education and Research Chandigarh: N Kaur, R Kumar, JS Thakur
Tata Memorial Hospital Mumbai: RA Badwe, RP Dikshit, K Mohandas
Lead Partners:
Office of the Registrar-General India RK Puram New Delhi India: C Chandramouli (Registrar General of India [RGI]), RC Sethi, B Mishra, S Jain (until 2008), DK Dey
(until 2009), AK Saxena, MS Thapa, N Kumar, JK Banthia and DK Sikri (former RGIs)
Million Death Study Coordinating Centre for Global Health Research (CGHR) Li Ka Shing Knowledge Institute Keenan Research Centre St. Michael’s Hospital Dalla
Lana School of Public Health University of Toronto Canada: DG Bassani, P Jha (Principal Investigator), R Jotkar, R Kamadod, B Pezzack, S Rao-Seshadri,
P Rodriguez, J Sudhir, C Ramasundarahettige, W Suraweera
Affiliated Partners:
Indian Council of Medical Research New Delhi India: VM Katoch (Director General or DG from 2008), NK Ganguly (DG to 2008), L Kant, B Bhattacharya
School of Population Health The University of Queensland Australia: AD Lopez, C Rao
World Health Organisation Geneva and SEARO Office New Delhi: T Boerma, T Evans, A Fric, S Habayeb (former WHO Representative-India), S Khanum, C Mathers,
DN Sinha, N Singh, P Singh (Deputy Regional Director)
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) University of Oxford England: N Bhala, J Boreham, Z Chen, R Collins, R Peto, G Whitlock
CGHR.ORG/CANCER
Twitter: CGHR_org
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