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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 91-96

Incidence of colorectal cancers in India: A review from population-based cancer registries


Division of Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research, Indian Council of Medical Research, Noida, Uttar Pradesh, India

Date of Submission19-Nov-2020
Date of Decision19-Nov-2020
Date of Acceptance06-Jan-2021
Date of Web Publication18-Apr-2021

Correspondence Address:
Dr. Satyanarayana Labani
Division of Epidemiology and Biostatistics, National Institute of Cancer Prevention and Research, Indian Council of Medical Research, I-7, Sector-39, Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_65_20

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  Abstract 


A number of studies on population-based cancer registries (PBCRs) data have been reported from India about various cancers. However, updated status of colorectal cancer is not available in literature. The objective is to provide an overview of age-specific and age-adjusted colorectal cancer incidence reported in 27 PBCRs in India. Secondary data on age-specific and age-adjusted rates of incidence rate, the lifetime risk of the disease was computed using cumulative risk and a number of cases for all ages (0–75 years), were collected from the report of the National Cancer Registry Program 2012-2014 in 27 population-based control registries. The annual incidence rates (AARs) for colon cancer and rectal cancer in men are 5.36 and 5.17/100,000, respectively. The AAR for colon cancer in women is 4.3/100,000. Males were comparably at higher risk than females. The maximum lifetime risk of developing colon cancer ranged from 167 to 500 females and lifetime risk of developing rectum cancer ranged from 100 to 353 in males. The risk of colorectal cancers was high amongst the Northeast population followed by South regions of India. The management of colon and rectal cancer cases and screening could serve to control the disease.

Keywords: Annual incidence rate, colon cancer, population-based cancer registry, rectal cancer


How to cite this article:
Asthana S, Khenchi R, Labani S. Incidence of colorectal cancers in India: A review from population-based cancer registries. Curr Med Res Pract 2021;11:91-6

How to cite this URL:
Asthana S, Khenchi R, Labani S. Incidence of colorectal cancers in India: A review from population-based cancer registries. Curr Med Res Pract [serial online] 2021 [cited 2022 Jul 6];11:91-6. Available from: http://www.cmrpjournal.org/text.asp?2021/11/2/91/314029




  Introduction Top


Colorectal cancers are the common gastrointestinal malignancies in the world. According to the Globocan report 2018, this contributes 9.2% amongst all major cancer incidence worldwide. There were over 1.8 million new cases in the year 2018.[1],[2] It is the third most common cancer in males with 746,000 new cases and second in females with 614,000 new cases. The variations in the incidence are also present across the world. The highest rates are in Australia, New Zealand and the lowest in western Africa and Southcentral Asia. These geographic differences could be attributable to differences in dietary and environmental exposures.[3]

The incidence and mortality rates have decreased in the USA by 1.2 per year amongst males and 0.7 per year amongst females in 12 surveillance epidemiology and end results programmes due to the utilisation of screening and improvements in diet among Americans. In contrast, the incidence of colorectal cancer in our neighbouring countries such as Japan and Thailand is rising and this may be due to the adoption of western life styles. In Asia, colorectal cancer incidence increased from 1983-1987 to 1998-2002 amongst 27 of 51 cancer registries for both females and males, with the largest increases in Japan, Kuwait and Israel as compared to India. The increase was more prominent in males than in females. The USA is the only country when colorectal cancer incidence rates declined in both males and females. Most Asian countries have higher incidence due to the absence of colorectal screening.[4],[5]

Time trend report for 1982-2010 of population-based cancer registry (PBCR) shows that colon and rectum both sites are having a significantly increasing trend in all major cancer registries with annual percentage change (APC) ranged from 0.9% to 5.8% for colon and 2.7% to 9.8% for the rectum.[6] This leads to the heavy burden of these two cancers in India. The isolated studies on the incidence of colorectal cancer apart from PBCR data have been done in few parts of the country such as Kashmir, Mumbai and few parts in India and it reports a significant increase in trends in southern and northeastern parts in India but the literature lacks a wide picture of the incidence of colorectal cancer from the whole country.[7],[8],[9] Although various studies on PBCRs data from India reported about various cancers, however, colorectal cancer is not reported separately with updated data. This study attempts to summarise the national and regional incidences data and risk of the development of colorectal cancer using 2012-2014 recent report from the National Cancer Registry Program (NCRP), with the hopes of emphasising a neglected chunk of colorectal cancer burden, that is amenable to screening and efficient primary prevention. This may provide insight into the burden of disease in the Indian community.


  Materials and Methods Top


This study utilised data from published reports of 27 Indian PBCRs, compiled under NCRP by the Indian Council of Medical Research.[10] The number of incident cases, age-adjusted rates (AARs) and cumulative risk (0–74 years) pertaining to colorectal cancer, along with the International Classification of Diseases-10 (ICD-10) codes, were extracted. The following sites were considered as follows: Colon (C18) and Rectum (C19-20) were clubbed in tables.

Based on the geographical location, 27 registries were divided into six regions and presented for the years 2012-2014 as follows:

(1) North region: Delhi, Patiala; (2) South region: Bengaluru, Chennai, Kollam and Thiruvananthapuram; (3) North-East region: Cachar district, Dibrugarh district, Kamrup urban dist., Manipur state, Mizoram state, Sikkim state, Meghalaya, Tripura state, Nagaland, Naharlagun and Pasighat; (4) West region: Mumbai, Ahmedabad urban, Aurangabad, Nagpur, Pune, Barshi rural, Barshi expanded and Wardha district; (5) Central region: Bhopal; (6) East region: Kolkata.

The number of incident cases of colon and rectum cancer by 5 years' age group amongst males and females was summarised. Another epidemiological measure to understand colon and rectal cancer load was computed. One out of the total number of persons who is likely to develop cancer in a lifetime up to 74 years of age was calculated as 100/CR.

Cumulative risk(s) computed by NCRP were based on the following formulae:

Cumulative risk = 100× (1 − exp [ −Cumulative rate/100])

Where, Cumulative rate = (5× Σ [ASpR] × 100)/100,000 and ASpR is age-specific incidence rate.

One in several persons likely to develop colon and rectum cancer was calculated by 100/Cumulative risk.

Data on indicators namely number of cases, incident rates, AARs and number of persons develop cancer were extracted and summarised for both the sexes in each of the 27 registries and presented region wise in the form of ranges.


  Results Top


Colon cancer

The AARs for Colon cancer amongst males and females in 0–75 years of age are presented region-wise (North, South, Northeast, East, Central and West regions) in [Table 1] and [Table 2].
Table 1: The age-specific incidence rates, age-adjusted rates and one in number of persons likely to develop colon and rectal cancer in males (27 population-based cancer registries) for 2012-2014

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Table 2: The age-specific incidence rates, age-adjusted rates and one in number of persons likely to develop colon and rectal cancer in females (27 population-based cancer registries) for 2012-2014

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The incidence rate was quite lower in Chennai and higher in Thiruvananthapuram particularly in the South region amongst females. Whereas the incidence rate of colon cancer was on the peak at 60–65 years of age group in Meghalaya with a negligible incidence rate in earlier age groups for females. The risk of development of colon cancer in the lifetime was maximum (1 in 167) in the Northeast region for both males and females [Table 1] and [Table 2]. The South region has the highest number of cases of colon cancer (1325 cases) for both males and females. Overall the risk of developing colon (as one in several persons likely to develop cancer) ranged from 1 in 167-1 in 500 for females to 1 in 167-1 in 250 for males [Table 1] and [Table 2]. The incidence of Colon cancer was observed to be higher in males than in females. The highest AAR in males for Colon cancer was recorded in the Northeast region (5.36) followed by the South region (4.15). Similarly, the highest AAR in female for Colon cancer was recorded in the Northeast (4.34) followed by the South region (3.08). The Relative Proportion of Colon cancer is 4.07% amongst all Cancers in the East region in Males and 2.55% amongst all Cancers in the Northeast region in females [Table 1] and [Table 2].

Rectum cancer

The incident rate of rectum cancer was quite higher in Chennai amongst the South region for males. Whereas the risk of development of rectal cancer in the lifetime for males was higher (1 in 100) in the North region and for females (1 in 200) in Southern region and the Northeastern region [Table 1] and [Table 2]. Whereas the risk of developing rectal cancer (as one in several persons likely to develop cancer range from 1 in 200-1 in 500 for females to 1 in 100-1 in 353 for males [Table 1] and [Table 2]. The South region has the highest number of cases of rectal cancer (1515 cases) for both and female [Table 1] and [Table 2]. The incidence of rectal cancer was observed to be higher in males than in females. The highest AAR in men for rectal cancer was recorded in the Northeast region (7.3) followed by the South region and West region (5.17). Similarly, the highest AAR in female for rectal cancer was recorded in the Northeast (4.22) followed by the South region (3.65). The relative proportion of rectal cancer was 5.14% among all Cancers in the Northeast region in males and 3.69% amongst all cancers in the South region in females. Both the incidence and the risk of developing colorectal cancer were almost four times higher in males as compared to females across all the regions [Table 1] and [Table 2].


  Discussion Top


This study provided a comprehensive overview of the pattern of colorectal cancer incidence from PBCRs in India for the years 2012-2014. It is observed that the incidence of colorectal cancer was highest in the Northeast and South region followed by North and Central regions. The incidence of colorectal cancer was found to be maximum amongst more than 50 years' age group in both sexes in the Northeast, South and West regions. The incidence of colorectal cancer was higher in males than in females. The risk of developing colorectal cancer in the lifetime was maximum in the Northeast and South regions. The incidence of colorectal cancer was also found amongst younger age groups (20–35 years of age group) in the North and Central regions as compared to other regions. Earlier studies have assigned the association of colorectal cancer in the younger age group with hereditary syndromes and gene susceptibility.[11],[12],[13],[14]

South and Northeast regions had the maximum number of cases and incidence for both cancers. The reason for the higher incidence in these regions might have contributed due to dietary factors such as consumption of beef, pungent spices and red meat.[15],[16],[17] Various studies have shown that reduction in colorectal cancer cases is linked to the consumption of fruits and vegetables which contains fibres, antioxidants and various vitamins and minerals that have anticancer properties.[18],[19],[20],[21],[22]

Gender differences were observed for the incidence and risk of developing cancer for both colon and rectum sites. Both the incidence and risk of developing colon and rectum cancer in males were almost two times higher as compared to females across all the regions. The gender-related differences may be due to a higher intake of red and processed meat, alcohol intake and high prevalence of smoking amongst males.[23],[24],[25]

The incidence of colorectal cancer was also found amongst younger age groups (20–35 years of age group) in the North and Central regions as compared to other regions. Earlier studies have assigned the association of colorectal cancer in the younger age group with hereditary syndromes and gene susceptibility.[21],[22],[23],[24]

Colon cancer is the third most commonly diagnosed cancer in the USA, whereas, in India, Colon cancer ranks 8th and rectal cancer 9th amongst males. The incidence rate of colon cancer in the USA were comparably greater than in India for both males and females.[26],[27] Although the incidence of CRC is lower in India as compared to other western countries, whereas, the mortality is high due to this cancer as compared to other countries. Colorectal cancer is the 4th most common cause of death due to cancer.[14] Increasing trends of this cancer in major registries also makes it a serious alert cancer as the burden due to this is likely to increase enormously.

It is observed that rectal cancer is higher than colon cancer in population-based registries in India. Incidence of colorectal is rising on the basis of population-based studies. The incidence rate of colorectal cancer in India (4.3 and 3.4/100,000) is comparably lower than the other Asian countries such as Qatar (10.5), Kuwait (11.8) and Malaysia (19.6). It has been believed that a predominately vegetarian diet with high fibre and low meat intake is responsible for low colorectal incidence in India.[28],[29]

Colorectal cancer is a largely preventable disease through minimising the adverse and unhealthy factors such as physical inactivity, obesity, overweight, excessive meat intake, smoking and alcoholic beverage consumption. Many studies have been stated that abdominal pain, loss of weight, rectal bleeding and change in bowel habits are the most commonly reported signs and symptoms.[1],[16],[17] Many times, symptoms initially may not even be identifiable and often go undiagnosed. These symptoms, especially if appearing in conjunction with such cases should be addressed with a more focused approach to rule out the possibilities of under diagnosis should opt for the screening of colorectal cancer for being diagnoses and treatment as soon as possible. In India, a significant increase in the incidence of both colon and rectum has been reported for both males and females over the last two decades. Amongst both males and females, cancers of colon and rectum sites have reported the significant increase in incidence rates from 1982 to 2010.[6] Similarly, on comparison of the earlier 3-year report of population-based registries of 2009-11.[30] We also found high values of AAR in Thiruvananthapuram, Bengaluru, Nagaland and Mizoram for 2012–2014.


  Conclusion Top


The regions with higher incidence/risk, namely the Northeast and South regions need more attention. The incidence of colorectal cancer is two times higher in males than in females. The incidence of rectal cancer is higher as compared to colon cancer. The reporting magnitude of colorectal cancer and its update is important for public health professionals and policymakers. Besides, there is a dire need to increase the number of PBCRs across the regions to allow assessment of the magnitude in these areas.

Acknowledgements

We would like to acknowledge NCDIR, Bengaluru, for compiling Indian cancer registry data under NCRP which we utilised in our communication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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