Karela Fry

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The million death study

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The Bill and Melinda Gates Foundation have funded a collaboration of doctors from some of the leading hospitals in India and public health organizations around the world who studied one million deaths around the country. These cases were selected to be representative of mortality patterns in India. It turns out that cancer is the cause of 6% of mortalities. The report in Lancet goes on to report:

71% [of] cancer deaths occurred in people aged 30—69 years (200 100 men and 195 300 women). At 30—69 years, the three most common fatal cancers were oral (including lip and pharynx), stomach, and lung (including trachea and larynx) in men, and cervical, stomach, and breast in women. Tobacco-related cancers represented 42·0% of male and 18·3% of female cancer deaths and there were twice as many deaths from oral cancers as lung cancers. Age-standardised cancer mortality rates per 100 000 were similar in rural (men 95·6 and women 96·6) and urban areas (men 102·4 and women 91·2), but varied greatly between the states, and were two times higher in the least educated than in the most educated adults (men, illiterate 106·6 vs most educated 45·7; women, illiterate 106·7 vs most educated 43·4). Cervical cancer was far less common in Muslim than in Hindu women (age-standardised mortality ratio 0·68 vs 1·06).

Their conclusions are very simple:

Prevention of tobacco-related and cervical cancers and earlier detection of treatable cancers would reduce cancer deaths in India, particularly in the rural areas that are underserved by cancer services. The substantial variation in cancer rates in India suggests other risk factors or causative agents that remain to be discovered.

In a follow up new item, Reuters reports:

“The males have been smoking for a very long time, even longer than the Chinese and the patterns of diseases that come from prolonged smoking can occur in a population even at a younger ages,” [the corresponding author, Prabhat] Jha told Reuters in a telephone interview.

According to The Tobacco Atlas, 26.2 percent of males in India use tobacco, either smoking or chewing it, or both. For females, 3.6 percent use tobacco and most of them chew it.

“Cancer death rates were two-fold higher in the least educated than the most educated, and (the differences) were similar between urban and rural areas. We used to think that cancer is a luxury of the rich, it is a suffering of the poor,” Jha said.

Possible explanations were that tobacco use was higher among the less educated and that richer Indians tended to seek treatment earlier.

The authors called for better health services and vaccines that can protect people against certain cancers. They predicted that if vaccines against infection by the human papillomavirus (HPV) were available for girls and women in India, deaths from cervical cancer would be reduced from 33,000 to 7,000.

The Hindu followed up on the statistics of regional variation in the incidence of cancer:

A 30-year-old male in northeast had about 11.2 per cent chances of dying from cancer before he turned 70. It was 6 per cent in the case of women. Contrast this with the less than 3 per cent risk for men in Bihar, Jharkhand and Odisha.

Tobacco-related cancer deaths in men in Assam and other northeast States were “greater than the national rates of deaths from all cancers.” “Common and long-term use of tobacco is seen in Assam and other northeastern States,” he explains.

Big variations in cancers not related to tobacco are seen in India. “We have no idea why [this is so]. Further research is required,” he says. “That will be useful for India and the rest of the world.”

In the case of cancers common to both sexes, the variation between States was nearly four times. Northeast States, Kerala, West Bengal and Kashmir recorded “particularly high rates of these specific cancers.”

Men and women in the nine poorer States (Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh) had lower risk than the richer States.

HT reported on the role of awareness:

“In the west, cancer in the internal organs like the stomach is higher. In India, cancer in the external organs like breast is higher. In such cases, early detection helps prevent deaths,” said Dr Rajesh Dikshit, associate professor, epidemiology, Tata Memorial Hospital, one of the main authors of the study.

“It is a shame that anyone dies of cervical cancer in our country because it can be prevented at a stage before it becomes cancerous. Most cervical cancer deaths in rural areas occur because of late detection. Any trained health worker can do a visual inspection for as little as Rs5,” said Manisha Gupte, co-founder of Mahila Sarvangeen Utkarsh Mandal, a non-profit working for women’s rights and development in Pune district.


Written by Arhopala Bazaloides

March 29, 2012 at 4:16 am

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