Lifestyles choices that affect incidence of cancer in Indian context.

In any geographic region incidence of cancers changes as the lifestyle and socioeconomic status change, the relationship could however be linear or inverse.

Indian economy has been undergoing changes and has seen a rise and stabilization over the last few years. So has the lifestyle, more people now have a sedentary lifestyle as ‘desktop workstations’ and ‘motor mobility’ have become norms instead of walking and cycling. Laptops and mobile gaming have replaced sports and outdoorsy activities. Calorie rich diet and fast-food culture have contributed to obesity. Add to it smoking and alcohol and you have a ready mix for developing lifestyle diseases, cancer being one of them.

Cancers like breast cancer/ colon cancer cancer/ uterine and prostate cancer are more prevalent in people with obesity and sedentary lifestyle more common with people of higher socioeconomic status.

A report by WHO has spelled out that cancer rates globally could rise by 60% over the next 20 years because of the rise of cancer incidence in low and middle-income countries unless cancer care is ramped up in these countries.

Less than 15% of these nations have comprehensive cancer treatment services through their public health systems, even though economies are improved, according to the U.N. agency.

Breast and Cervical cancers, lifestyle affect.

There is a diverging trend in the incidence for breast cancer and cervical cancer in India. India contributes about 122,844 cervical cancer and 144,937 breast cancer cases every year. Breast cancer is on the rise in the urban middle class. This may be partly explained by improvements in the socioeconomic status of women, higher education levels, increasing household incomes, later ages at marriage and at first birth, lower parity, adoption of sedentary lifestyles, dietary patterns typical of industrialized countries, and lower levels of physical activity in successive generations of women, suggested by the WHO report.

However, there is a perceptible decrease in cervical cancers in the urban middle class because of availability of education and vaccination of females against HPV, of which some strains have shown to be causative in cervix cancers. Rural and low socioeconomic class is yet to show any such degree of awareness. Cervical cancer is more in women in lower socioeconomic status. India accounts for nearly one-third of the global cervical cancer deaths. More sexual freedom and increase in multiplicity of sex partners coupled to it a certain degree of lack of personal hygiene leads to its rising incidences.

Tobacco related habits and cancer, the Indian context.

Use of chewed and smoked tobacco is more common in the lower socioeconomic strata in India. Populace with more proclivity to chewed tobacco abuse or smoking bidis have a very high incidence of oral cavity cancers and head and neck cancers.

WHO reports that about 80% of the world's smokers live in low and middle-income countries.

China, India, and Indonesia are the major three countries where tobacco abuse in its smoked or chewed form is prevalent.

The report mentions that In India currently 164 million use smokeless tobacco, 69 million smokers, and 42 million smokers and chewers. More than 90% of patients with oral cancer are of low or lower-middle socio-economic status. Tobacco-related cancers account for 34-69% of all cancers in men, they constitute 10-27% of all cancers in women in most regions in India.

Rising incidence in the younger and the older, better life

Improved lifestyle means, availability of better medical care and hence higher life expectancy which is largely a contributor to rise in overall cancer incidence in India. Aging raises the possibility of an individual to be immunocompromised and often susceptible to cancer.

Paradoxically more and more younger people are now coming with diagnosed cancers than they ever were.

Sedentary lifestyles, smoking, alcohol, late age at marriage and childbirth in women are causing more younger women to have cancer of the breast.

Role of prevention, screening and better healthcare.

Role of screening, early detection and prevention and better availability of healthcare facilities including cancer care is the need of the hour-today as far as India is concerned.

Author : Dr. Pooja Khullar, Consultant – Radiation Oncology, Dharamshila Narayana Superspeciality Hospital, Delhi