According to the Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research (NCDIR) cancer profile of India’s northeast region released in 2021, Nagaland had the highest incidence of nasopharyngeal cancer, a relatively rare cancer in other regions of India, and was approximately 21 and 34 times that of Delhi in men and women, respectively.
According to the report, males had the highest proportion of nasopharyngeal cancer (14.3%), followed by stomach cancer (12.6%) and esophageal cancer (10.6%). In females, the cervix-uteri was found to be the most common cancer site (16.4%), followed by the breast (12.2%) and the stomach (11.3%).
The ICMR-NCDIR report also found that the prevalence of current tobacco use in Nagaland is 43.3%, with the smokeless form (39%) being more prevalent than the smoked form (13.2%).
Tobacco use-related cancer sites account for nearly one-third (39.3%) of male cancers and 11.5% of female cancers. The oesophagus (10.6%) and lung (3.7%), respectively, are the most common sites in both men and women, according to the report.
Meanwhile, Shanker, Neha et al., reported some of the key site-specific cancers that contributed to the high cancer burden in the NE region in their paper titled “Cancer scenario in North-East India & need for an appropriate research agenda,” which was published in Indian Journal of Medical Research (2021).
They discovered a link between smoked meat consumption and Nasopharyngeal carcinoma. Several studies, particularly in North-East India, found Epstein-Barr virus (EBV) infection to be associated with nasopharyngeal carcinoma. A study in Manipur found that other risk factors included living in poorly ventilated houses, eating nitrosamine-containing foods, and not eating enough fruits.
According to the study, smoked and smokeless tobacco use was also higher in this region than in the rest of the country, both of which were risk factors in the development of head and neck cancers. The study also discovered that betel nut chewing is a major risk factor for esophageal cancer.
The unusual dietary habits of the locals in this region, such as the consumption of fermented pork fat, smoked dried salted meat and fish, and the use of soda (alkali) as a food additive, have been linked to a high incidence of stomach cancer.
Meanwhile, tobacco smoking has been identified as the primary risk factor for lung cancer. The International Agency for Research on Cancer (IARC) also found a link between second-hand smoke exposure and lung cancer risk. Apart from direct cigarette smoke exposure, inhalation of second-hand smoke was found to be common in the NE region.
The significant interaction between heavy smoking and heavy drinking was discovered to cause liver cancer in North-East India. Persistent HPV-16 and HPV-18 infection has been identified as an important risk factor in the aetiology of cervical cancer.
The ICMR-NCDIR made several key observations, including the fact that cancer is one of the top five leading causes of death in Nagaland, and that the risk of developing stomach cancer is highest in both genders. It was also noted that less than a quarter of the population had health insurance and that the state lacked tertiary cancer care facilities, with only 6 cancer treatment facilities and 1 radiotherapy facility for a population of over 19 lakh.
As a result, it was found that a comprehensive and coherent approach to planning and implementing programs targeting specific regionally prevalent cancers was critical.
“If emphasized, inclusion of community in planning and development of programs and services will have long-term benefits by enhancing acceptability of socio-behavioral interventions such as tobacco cessation, dietary modifications and lifestyle changes,” Shanker, Neha., et al. concluded.