The epidemiological and demographic transition in Kerala over the past two or more decades has left the State struggling with the issues of an ageing population and a steep increase in non-communicable diseases such as diabetes, hypertension, cardiovascular diseases and cancer.
Today, the cancer management facilities have grown in Kerala and have extended to the private sector as well. There are 13 hospital-based cancer registries in both the private and public sector as well as the Population-based Cancer Registries (PBCRs) of Thiruvananthapuram, Kollam and Malabar Cancer Centre.
Better cancer care and management facilities and improved awareness of cancer as a treatable disease are seen as key reasons for the surge in patients in hospitals, but that can hardly hide the fact that cancer incidence in the State has gone up significantly in recent years.
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Data from the PBCRs of Thiruvananthapuram, Kollam and Malabar indicate that, at any point in time, at least three lakh people are living with cancer in the State.
In 1982, the most common cancers among women were cervical, breast, oral and thyroid cancers in that order.
However, in the next 30 years, cancer of the uterine cervix declined significantly, while breast cancer incidence, especially among younger women, rose steeply.
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Leading cancer
According to the PBCR Thiruvananthapuram, in 2014, breast cancer was the leading cancer among women, at an incidence rate of 52 per one lakh population, the highest in the country. Among men, lung cancer has come to replace oral cancers as the number one cancer prevalent among men, with an incidence rate of 23.3 per one lakh (2014), followed by oral cancers, colo-rectum and prostate.
Amongst women, after breast cancer, the common cancers are thyroid, cervix uteri, colo-rectum cancers, in that order. Data from the Malabar Cancer Centre PBCR in 2014 show a slightly different pattern, with cancers of the lungs, stomach, prostate, larynx and oral cavity being the common cancers in men, while in women, after breast cancer, the common cancers were that of the ovary, cervix, thyroid and lungs.
World Health Organisation’s cancer strategy document notes that while most of the common cancers are amenable for prevention or early detection and can achieve good outcomes with prompt treatment, in Kerala, over 50% of the patients with common cancers present themselves at hospitals at an advanced stage of the disease.
Five-year survival rates of common cancers are less than 50%, which is indeed a matter of concern and this has underscored the need for a comprehensive strategy involving prevention as well as early detection and management.
Public health neasures
When it comes to prevention, tobacco ban or restrictions are considered to be the single most important public health measure which can potentially reduce the risk of cancers. Tobacco-related cancers accounted for 37% of all cancers in men and 12% in women in 2011. The per capita consumption of alcohol in Kerala is also quite high and alcohol can potentially lead to cancers of the mouth, food pipe and the gastrointestinal tract.
In recent times, much research evidence has also come up suggesting links between cholesterol and fat and cancers. The high prevalence of overweight/obesity amongst the State’s population, low levels of physical activity and the fact that the consumption of meat has been going up while that of fruits and vegetables is quite low are important risk factors that need to be moderated through urgent public health interventions for the State to move forward in its fight against cancer.