Background: According to Report of National Cancer Registry Programme, 2020 India’s cancer burden during 2020 was 1.39 million. The crude mortality rate varied from as low as 9.7 deaths per 100,000 males to as high as 115.0 per 100,000 males. Among females, it ranged from 6.8 deaths per 100,000 females in Nagaland PBCR to 69.6 per 100,000 females. There are also differences of incidences in HBCR/PBCR and Tertiary Hospitals. The overall aims and objectives are to provide incidence data that is comparable among the cancer registries reported in Mumbai, as well as with cancer registries in other urban cities of India. Results: Breast constituted the most common site (25.0%) followed by cervix (16.4%), mouth (5.3%), thyroid (4.4%), stomach (3.8%), colon (3.7%), ovary (3.3%), gallbladder (3.3%), oesophagus (3.3%), uterus (2.8%) as the top ten common sites of malignancies in females. Mouth (9.0 %), urinary bladder (6.6%), prostate (5.1%), gallbladder (5.0%), stomach (4.9%), tongue (4.8%), oesophagus (4.7%), larynx (4.6%), NHL (4.2%), lung (4.0%) were the top ten common sites of malignancies in males. System wise distribution of cases revealed that genitourinary cancers were most common (20.8%), followed by gastrointestinal tract cancers (17.40%) and breast cancer as the 3rd most common group (12.2%). Conclusion: Present study puts forward the idea of distribution of various cancers reported in this region where institute like TMH is juxtaposed. Emphasis to be given on compilation of figures from HBCRs, PBCRs and tertiary care medical institute pathology department data to obtain comprehensive national database.
Over the last three decades there has been an epidemiological transition of deaths proportion from infectious diseases to non-communicable diseases. The number of deaths due to NCDs have raised from 30-35% to 71% of all deaths in 2016 [1]. It caused 15.2 million premature deaths out of which 4.5 million (29.7%) were due to cancer. Amongst 183 nations in the world, cancer is the first or second leading cause of premature death in more than 130 nations [2]. In 2018, there were an estimated 18.1 million new cases and 9.6 million deaths from cancer [3]. Cancer is responsible for one in six deaths globally. The numbers of new cases and deaths continue to rise because of increasing life expectancy and epidemiological and demographic transitions [4].
According to the project done by IARC, GLOBOCAN estimates that the cancer burden of India will nearly double in the next 20 years. [5] According to Report of National Cancer Registry Programme, 2020 India’s cancer burden during 2020 was 1.39 million. According to the report the cases are estimated to increase to 1.57 million in 2025. Age-adjusted incidence rates are varying from 219.8 cases per 1,00,000 females and 39.5 cases per 1,00,000 males reported from 28 Population Based Cancer Registries (PBCRs) and 58 Hospital Based Cancer Registries (HBCRs). The crude mortality rate varied from as low as 9.7 deaths per 100,000 males to as high as 115.0 per 100,000 males. Among females, it ranged from 6.8 deaths per 100,000 females in Nagaland PBCR to 69.6 per 100,000 females. [6].
Such varied distribution of cancer incidence and mortality rates is very common in India. The determinants of the variation are multiple, like genetic, environmental, dietary and social factors.Most developing countries also continue to be disproportionately affected by cancers related to infectious agents, such as cervix, liver, and stomach cancers. As the variation is present in the cancer incidence it is very conspicuous in sites of cancer as well.
In addition to behavioral pattern, habits, customs, its necessary to identify the difference if any in sites and patterns and incidence rates and environmental background of cancer amongst various community living in geographical areas having varying patterns of climate and physical environments by identifying dietary habits, social customs and such other factors.
Mumbai is the country’s most populous city and the capital of the Indian state Maharashtra. In Mumbai, Tata Memorial Center is HBCR, which contributes to National Cancer Registry Programme [7]. The data from cancer registries helped in highlighting the magnitude and common sites of cancer in India, and was useful in planning the National Cancer Control Programme [8].
The main emphasis of this study is on cancer incidence and pattern of cancer according to site of cancer in patients of different age groups, gender, and geographic area. The overall aims and objectives are to provide incidence data that is comparable among the cancer registries reported in Mumbai, as well as with cancer registries in other urban cities of India. This study attempts to give clues to the burden and pattern of cancers in tertiary care hospital, which presents a base for studies in cancer aetiology and control. Although, the geographic area and population covered by this study is small, compared to the vastness of the Mumbai city and its huge population, the data gives a fair idea of cancer problem in Mumbai city [9].
The study spans over four years (2010-2014) and is based on retrospective analysis of more than 22,000 histopathology and almost 40,000 cytological reports. Data was collected from major tertiary care hospital and academic institutes’ pathology department in Mumbai. Only cases which had microscopic verification of diagnosis, either by cytology (n = 39748 cases) or histopathology (n = 22708 cases), were included. Overall site, frequency, year, age and sex pattern were recorded. Classification of various malignant tumors was done according to the International Classification of Disease coding system derived by WHO (10th revision) using code number 140-208 [10]. Data was collected and classified in Microsoft Excel 365.
This data is derived from cancers in patients attending the hospital OPD. The tertiary care center in Mumbai caters to patients from the other peripheral hospitals in Mumbai; for the various urban health centres, rural, secondary, primary health centres situated in Mumbai and Thane districts and for immigrant population outside Mumbai, Thane, rest of Maharashtra and other states.
Overall Demographics
Out of approximately 62,456 histopathology and cytology records, which were studied during the selected four years 2010 to 2014 a total of 3333 cancer cases, were recorded. There were 52.2% (1738) males and 47.8% (1595) females, male to female ratio being 1.08:1. The frequency of cancer increased as the age increased. The highest numbers of cases were found between age groups of 60-64 years followed by 50-54 years of age in males. Similarly, in females’ highest numbers of cases were found in 50-54 years, 40-44 years and 60-64 years of age in decreasing order of frequency.
Site Wise Distribution
Site wise distribution of cancers in the overall study group revealed that breast constituted the most common site (25.0%) followed by cervix (16.4%), mouth (5.3%), thyroid (4.4%), stomach (3.8%), colon (3.7%), ovary (3.3%), gallbladder (3.3%), oesophagus (3.3%), uterus (2.8%) as the top ten common sites of malignancies in females. Mouth (9.0 %), urinary bladder (6.6%), prostate (5.1%), gallbladder (5.0%), stomach (4.9%), tongue (4.8%), oesophagus (4.7%), larynx (4.6%), NHL (4.2%), lung (4.0%) were the top ten common sites of malignancies in males.
System Wise Distribution
Genitourinary cancers were most common (20.8%), followed by gastrointestinal tract cancers (17.40%) and breast cancer as the 3rd most common group (12.2%).
Genitourinary System Malignancies
The most noteworthy feature of present study is that cancers of genitourinary system (20.8% of all malignancies) were most common single group of cancers in both sexes. In males, genitourinary cancers formed 15.6% of all malignancies. Predominantly, urinary bladder (6.6%) and prostate (5.1%) were involved. Cervix uteri 16.4% and ovary 3.3% were the major sites involved formed 5.4% of all cancers.
Gastrointestinal System Malignancies
Digestive Tract: (17.40%) is the second most common system involved. In males, it constituted 34.0% and in females 14.3%. Gallbladder (4.2%) formed the most common site among all gastrointestinal malignancies. It constituted 23.4% of all GI cancers (23.8% in males and 23.1% in females). Oesophagus was the second most common site in males (23.4%) whereas colon (26.2%) was the second most common site in females
Breast: cancers were the third most common malignancy constituting 12.2% of all cancers in both sexes. In females, it formed 25.0% which was top most common malignancy, whereas in males it
Head and Neck Cancers
Head and neck cancers formed 8.70%. The malignancies of the mouth formed 6.9% of all malignancies (9.0% in males and 5.3% in females). Tongue (3.3%) was the second common site in this group (4.8% in males and 1.7% in females).
Table 1: Comparison of Ten Most Common Cancers in Males among Present Study and Other Hbcrs (2008-2012)
| Sites | Present Study | Mumbai | Bangalore | Chennai | Thi’puram | Dibrugarh | Guwahati | Chandigarh | ||||||||
| % | R | % | R | % | R | % | R | % | R | % | R | % | R | % | R | |
| Mouth | 9 | 1 | 12.3 | 1 | 6.5 | 5 | 8.6 | 3 | 8.3 | 2 | 8.9 | 3 | 8 | 3 | 3.6 | 10 |
| U. Bladder | 6.6 | 2 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Prostate | 5.1 | 3 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Gall Bladder | 5 | 4 | 2.3 | 8 | 0.6 | 8 | 1 | 9 | 0.5 | 8 | 2.1 | 6 | 3.8 | 7 | 3.8 | 6 |
| Stomach | 4.9 | 5 | 3.5 | 7 | 5.5 | 1 | 9.2 | 6 | 4.8 | NA | 6.8 | 1 | 6.5 | 2 | 2.3 | NA |
| Tongue | 4.8 | 6 | 7.1 | 3 | 6.7 | 4 | 6.7 | 4 | 6.3 | 3 | 5.7 | 5 | 6.9 | 5 | 7.3 | 3 |
| Oesophagus | 4.7 | 7 | 4.6 | 5 | 7.9 | 2 | 5.7 | 5 | 4.2 | 7 | 13.1 | 2 | 15 | 1 | 6.2 | 4 |
| Larynx | 4.6 | 8 | 3.7 | 6 | 4 | 9 | 3.8 | 7 | 4 | 5 | 3.7 | B | 5.6 | NA | 5.3 | 8 |
| NHL | 4.2 | 9 | 6.1 | 4 | 4.6 | 7 | 4.2 | 8 | 5 | 4 | 2.9 | 9 | 1.9 | NA | 4.3 | 7 |
| Lung | 4 | 10 | 8 | 2 | 7 | 3 | 8.9 | 2 | 14.8 | 1 | 3.6 | 7 | 7.4 | 4 | 9.2 | 1 |
*NA: In the PBCRs mentioned as NA the corresponding cancers were not enlisted in leading 10
Hematolymphoid Malignancies
As a group, hematolymphoid malignancies contributed 6.60% of all malignancies (8.6% in males and 4.3% in females). In this group, Non- Hodgkins Lymphoma (NHL) constituted 3.2% of all cancers and was the most common subtype. Leukemias (2.1%) were the second most common cancer in both sexes of this group Table 1.
RespiratoryTtract Malignancies
Cancers of respiratory tract constituted 6.10% of all malignancies. Ca lung was the most common site (2.7%) followed by larynx which formed 2.6% among the respiratory tract malignancies. Larynx (4.6%) was the most common site of malignancies followed by lung (4.0%) in males; and vice versa in females (lung (1.3%) was the most common site than larynx (0.3%)).
Childhood Cancers
Childhood cancers (0-14 years) constituted 1.6% of all malignancies. In the order of frequency, NHL (0.3%), cancers of brain (0.33%), leukemias (0.2%), kidney (0.09%), soft tissue cancers (0.06%) were the most common malignancies. NHL constituted 21.4% of childhood cancers in present study. (Table 2)
Table 2 Comparison of Ten Most Common Cancers in Females among Present Study and Other Hbcrs (2008-2012)
| Sites | Present Study | Mumbai | Bangalore | Chennai | Thi’puram | Dibrugarh | Guwahati | Chandigarh | ||||||||
| % | R | % | R | % | R | % | R | % | R | % | R | % | R | % | R | |
| Breast | 25 | 1 | 30 | 1 | 16 | 2 | 22 | 2 | 29 | 1 | 15 | 1 | 14 | 2 | 16 | 2 |
| Cervix Uteri | 16 | 2 | 13 | 2 | 27 | 1 | 26 | 1 | 9.3 | 3 | 12 | 2 | 16 | 1 | 18 | 1 |
| Mouth | 5.3 | 3 | 4.4 | 4 | 10 | 3 | 5.2 | 4 | 4.7 | 5 | 5.1 | 7 | 5.4 | 5 | 0.9 | NA |
| Thyroid | 4.4 | 4 | 3.3 | 7 | 3.4 | 6 | 2.7 | 8 | 11 | 2 | 1 | NA | 1.3 | NA | 0.7 | NA |
| Stomach | 3.8 | 5 | 1.8 | NA | 2.1 | 8 | 3.7 | 5 | 1.5 | NA | 5.8 | 6 | 4.3 | 7 | 0.9 | NA |
| Colon | 3.7 | 6 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Ovary | 3.3 | 7 | 5.1 | 3 | 5.9 | 4 | 5.3 | 3 | 5.1 | 4 | 8.8 | 4 | 4.9 | 6 | 7.9 | 3 |
| Gallbladder, | 3.3 | 8 | 3.9 | 5 | 0.5 | NA | 0.7 | NA | 0.4 | NA | 7.7 | 5 | 12 | 3 | 6.6 | 4 |
| Oesophagus | 3.3 | 9 | 2.8 | 9 | 5.1 | 5 | 3.2 | 6 | 1.6 | NA | 10 | 3 | 10 | 4 | 5.1 | 5 |
| Uterus | 2.8 | 10 | 1.9 | NA | 1.6 | NA | 2 | NA | 3.3 | 7 | 1.4 | NA | 1.5 | NA | 3.8 | 7 |
*NA: In the PBCRs mentioned as NA the corresponding cancers were not enlisted in leading 10
This study showed that cancer of oral cavity was significant in both the sexes and breast and cervix cancer are predominant in females. Tertiary care medical institutes are important stakeholders for cancer registry, tobacco cessation and cancer screening programmes along with HBCRs. Higher proportion of genitourinary cancers among males in present study can be because the city is surrounded by 28 industrial areas. Interventions like workplace hygiene, regular screening at workplace and identification of at-risk occupations is required.
Present study puts forward the idea of distribution of various cancers reported in this region where institute like TMH is juxtaposed. Emphasis to be given on compilation of figures from HBCRs, PBCRs and tertiary care medical institute pathology department data to obtain comprehensive national database. There is a greater need to strengthen the preventive oncology services at all tertiary care medical institutes along with HBCRs to enhance facilities for prevention and early diagnosis of cancer cases.
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