|Year : 2014 | Volume
| Issue : 2 | Page : 78-82
An exploration of incidence and mortality due to tobacco-related cancers in capital of Gujarat state
Parimal J Jivarajani, Vishruti B Pandya, Santosh D Rohida, Himanshu V Patel, Jayesh B Solanki
Department of Community Oncology and Medical Records, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
|Date of Web Publication||7-Jan-2015|
Dr. Parimal J Jivarajani
Department of Community Oncology and Medical Records, Gujarat Cancer and Research Institute, Shri M. P. Shah Cancer Hospital, New Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat
Source of Support: None, Conflict of Interest: None
Context: This is a retrospective study done using data of population-based cancer registry (PBCR) Gandhi Nagar district for the years 2009-2011.
Aims: The aim was to describe the impact of tobacco-related cancers (TRCs) on incidence and mortality due to cancer and its gender wise distribution.
Subjects and Methods: Cancer incidence and mortality data for 3 years viz. 2009, 2010 and 2011 was used. A total of 980 TRC incidences and 350 deaths was registered.
Statistical Analysis Used: All results were derived using appropriate statistical software and appropriate statistical tests.
Results: Totally, 980 cases were included. Of them, 787 (80.31%) were males, and 193 (19.69%) were females showing higher male preponderance. Most common TRC in males and females was oral cavity 25.41% and 24.35%, respectively. There were 350 deaths due to TRC. Of them, 279 (79.71%) were males, and 71 (20.29%) were females showing higher male preponderance. Male: female ratio was 4.08:1 for incidence and 3.93:1 for mortality. Major proportion of the incidence and deaths were in the age group of 35-64 years. Most common TRC deaths in males were due to tongue (23.30%) and in females due to esophagus (25.35%).
Conclusions: The high prevalence of TRC observed shows a serious concern about occurrence of disease and risk factors related to these cancers. Tobacco is a major risk factor for cancer, and it is significantly high in males than in females. Therefore, this study reveals an urgent need for tobacco control and other preventive measures like cancer awareness programs at community level.
Keywords: Incidence, mortality, population-based cancer registry, tobacco-related cancers
|How to cite this article:|
Jivarajani PJ, Pandya VB, Rohida SD, Patel HV, Solanki JB. An exploration of incidence and mortality due to tobacco-related cancers in capital of Gujarat state. Indian J Health Sci Biomed Res 2014;7:78-82
|How to cite this URL:|
Jivarajani PJ, Pandya VB, Rohida SD, Patel HV, Solanki JB. An exploration of incidence and mortality due to tobacco-related cancers in capital of Gujarat state. Indian J Health Sci Biomed Res [serial online] 2014 [cited 2019 May 24];7:78-82. Available from: http://www.ijournalhs.org/text.asp?2014/7/2/78/148803
| Introduction|| |
Among various addictions, tobacco was the most popular and highest recorded addiction in India as well as in the world.  The oral and nasal use of tobacco, either in leaf form for chewing or powder as snuff, is as old as its use for smoking in pipes, cigars, and cigarettes in first half of the twentieth century. Tobacco use kills near six million people worldwide each year. This global tobacco consumption epidemic kills more people than HIV/AIDS and tuberculosis.  The health effects of tobacco include cancers, cardiovascular disease, respiratory disease, and adverse reproductive outcomes.  Chewing and snuffing tobacco products will never stop, unless there is continued public health action to control their use.  Although women commonly use smokeless tobacco, the rising trend in smoking among women is causing grave concern for the tobacco-related disease. 
According to World Health Organization (WHO) estimates, globally, there were 100 million premature death due to tobacco in the 20 th century, and if the current trends of Tobacco use continue, this number is expected to rise to 1 billion in the 21 th century.  India is the second largest consumer of tobacco globally and accounts for approximately one-sixth of the world's tobacco-related deaths. The tobacco problem in India is peculiar as there is consumption of a variety of smokeless and smoking forms of tobacco. Therefore understanding the trends of tobacco consumption and its problem in India, focusing more efforts for what works and investigating the impact of sociocultural diversity and cost-effectiveness of various modalities of tobacco control should be our priority.  According to the National Family Health Survey - 3, conducted in 2005-2006, tobacco use is more prevalent among men, rural population, and illiterates, poor and vulnerable section of the society. 
Even though there was sufficient evidence to establish a causal association between cigarette smoking and cancer of the nasal cavities and nasal sinuses, esophagus (adenocarcinoma), stomach, liver, kidney (renal cell carcinoma), uterine cervix, and myeloid leukemia too.  Sites of cancer that have been associated with the use of tobacco (tobacco-related cancer [TRC]) includes lip, tongue, mouth, pharynx (including oropharynx and hypopharynx), esophagus, larynx, lung, and urinary bladder till date. 
The tobacco-related cancer incidence and mortality is higher among males than in females in this study. It is derived with the help of the population-based cancer registry (PBCR) - Gandhi Nagar district data for the year 2009-2011. ,,
| Subjects and Methods|| |
Gujarat Cancer and Research Institute (GCRI), is running PBCR Gandhi Nagar district with the help of Commissionorate of Health, Medical Services and Medical Education, Gandhi Nagar. It is working as per the standards and norms prescribed by the National Cancer Registry Program of the Indian Council of Medical Research.
The GCRI is the main source of registry. Trained field investigators fill the core performa by active registration in GCRI. They also visit various sources of registration in coverage area namely all government hospitals, private hospitals, nursing homes and diagnostic labs, and death registration units besides GCRI. They actively pursue and collect information on cancer cases and deaths reported. As a result of data collection from different hospitals, one and the same patient is sometimes found to be registered at two or more hospitals. Care was taken to see that multiple entries for the same patients were not made in records. On the other hand, in some instances, complete medical information could be obtained only by combining the data obtained from two or more hospitals of the same patient. ,,
Reported malignant neoplasms were classified and coded as per WHO manual of International Classification of Disease-10 (ICD-10).  International Classification of Diseases for Oncology (ICD-O-III) had been used for coding of microscopically verified reports of pathology.  Only invasive cancers were reported in cancer registry database. The anatomical sites included in TRCs were lip, tongue, oral cavity, tonsil, oropharynx, hypopharynx, pharynx, esophagus, larynx, lung, and bladder. 
During the 3 years period from 2009 to 2011, a total of 2,360 cancer incident cancer cases and 736 cancer deaths was registered. Of them, 980 (41.53%) were TRC cases, and 350 (47.55%) were TRC mortality. Of 980, 787 (80.31%) were males, and 193 (19.69%) were females. Of 350, 279 (79.72%) were males and 71 (20.28%) were females. Thus, male: Female ratio for incidence was 4.08:1 and for mortality 3.93:1.
All results were derived using appropriate statistical software and appropriate statistical tests. Chi-square test at 95% confidence was performed to access the association of gender with age groups in incidence and mortality for tobacco-related sites. An odds ratio >1 implies that the tobacco exposed male group was more likely to experience the event than the female group.
| Results|| |
A total of 980 new TRC cases was reported during the study period. Oral cavity was the most common site in males (25.41%) followed by tongue (23%), lung (14.61%), esophagus (10.93%), hypopharynx (7.37%), larynx (10.61%), tonsil (4.57%), pharynx (3.81%), bladder (1.78%), oropharynx (1.14%), and lip (0.76%). Similarly, again oral cavity was the most common site (24.35%) in females followed by tongue (21.76%), esophagus (17.62%), hypopharynx (15.03%), lung (10.36%), larynx (3.63%), bladder (3.11%), pharynx (1.55%), tonsil and oropharynx (1.04%), and lip (0.52%). Overall male: Female ratio for TRC was 4.08:Lindicating highly significant male preponderance (P < 0.000) The odds ratio of 5.508, indicating men had higher risk of cancer due to use of tobacco as compared to women [Table 1].
|Table 1: TRC incidence according to gender and site PBCR Gandhi Nagar district 2009-2011|
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350 deaths were reported in TRCs during the study period. Major deaths in males were due to tongue cancer (23.30%) and in females it was due to cancer of esophagus (25.35%). Male: Female Mortality ratio was 3.93:1. Again distinctly male preponderance was found to be highly significant (P < 0.000). The computed odds ratio was 4.269, indicating men had a higher risk of cancer death due to use of tobacco as compared to women [Table 2].
|Table 2: TRC mortality according to gender and site PBCR Gandhi Nagar district 2009-2011|
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There was a high male preponderance of TRCs in all age groups. Among both males and females, largest number of TRCs was seen in age group of 35-64 years. With respect to age group of 15-34 years and age group of 65+ years, it was highly significant (P < 0.000) in male truncated age group [Table 3].
|Table 3: Distribution of TRC by broad age groups and gender in PBCR Gandhi Nagar district 2009-2011|
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Similar observations are made in TRC mortality also [Table 4].
|Table 4: Distribution of TRC mortality by broad age groups and gender in PBCR Gandhi Nagar district 2009-2011|
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Age-adjusted incidence rates as well as age-adjusted mortality rates were observed to be higher in males than in females [Figure 1] and [Figure 2].
|Figure 1: Age-specific incidence rates of tobacco-related cancer in Gandhi Nagar district 2009-2011|
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|Figure 2: Age-specific mortality rates of tobacco-related cancer in Gandhi Nagar district 2009-2011|
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| Discussion|| |
The present study highlights that TRCs were 41.53% of total cancer registered and TRC deaths were 47.55% of total cancer deaths in Gandhi Nagar district from January 2009 to December 2011. TRCs incidence in Gandhi Nagar district during 2009-2011 for males was 57.28% and for females it was 19.57%. Various studies show TRC with respect to total malignancies varied from 31.9% to 57% in males and 9.5% to 26.3% in females. ,, TRC deaths in Gandhi Nagar district during 2009-2011 for males was 60.13% and for females it was 26.10%. TRC deaths varied from 42% to 58.42% in males and 18.3% to 22.92% of female cancer deaths. ,, The estimates of the Global Adult Tobacco Survey conducted among persons 15 years of age or older during 2009-2010 indicate that 34.6% of the adults (47.9% males and 20.3% females) are current tobacco users. Fourteen percent of the adults smoke (24.3% males and 2.9% females) and 25.9% use smokeless tobacco (32.9% males and 18.4% females).  According to the Global Youth Tobacco Survey conducted among 24,000 students aged 13-15 years in 2009, 14.6% students were tobacco users.  It shows TRCs in Gandhi Nagar district represents similar pattern as in Ahmedabad urban and rural area and also in all over India.
In terms of gender distribution, male tobacco-related cancers were more common as compared to female tobacco-related cancers. In this study, the sex ratio for tobacco-related cancers was 4.08:1 (male: Female). Oral Cavity was the common site in males as well as in females. The highest male: Female ratio was found in tonsil cancers (18:1). Similarly, male tobacco-related cancer deaths were more common than female tobacco-related cancer deaths. The sex ratio for mortality due to tobacco-related cancers was observed to be 3.93:1 (male: Female). Tongue was the commonest site in males while esophagus was more common in females. The highest male: Female ratio was found in lung cancers (6.22:1).
The study reflects specific patient population residing in Gandhi Nagar district, where TRCs are very common. Public education with reference to tobacco and cancer awareness in the targeted population is required to bring down the risk for TRCs. Public education regarding self-examination of the oral cavity and oral screening is recommended for prevention of TRCs. This would promote early detection of oral premalignant and invasive cancers and prompt and adequate treatment of the lesions.
| Acknowledgments|| |
The authors express their sincere appreciation to the Directorate of Medical Education and Research (DMER) Gandhi Nagar for their support in this study.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]