Cancer awareness, diagnosis and treatment needs in Mizoram, India: evidence from 18 years trends (2003-2020)

Abstract

Background: Despite being the second least populated state, Mizoram exhibits the highest incidence rate of cancer in India. Its inhabitants, constituting an endogamous and isolated population, have embraced their own distinct culture, way of life and dietary preferences, setting them apart from the rest of mainland India. In 2003, the Mizoram Population Based Cancer Registry (PBCR) was established under the auspices of the National Centre for Disease Informatics and Research (NCDIR), a division of the Indian Council of Medical Research (ICMR), in collaboration with the Department of Health & Family Welfare of the Government of Mizoram, India.

Methods: Cancer incidence and mortality data were extracted from the Mizoram PBCR spanning the years 2003-2020. The Age Standardized Incidence Rate (ASIR) and Age Standardized Mortality Rate (ASMR) were computed per 100,000 individuals, utilizing Segi's World Standard Population as the benchmark. The trajectory of these changes was analysed employing the Joinpoint Regression Analysis Program, Version 4.9.1.0.13, to unveil the Annual Percent Change (APC) with a 95% Confidence Interval and a Significance test (p < 0.05) using Monte Carlo Permutation. The resulting graphical visualizations were generated using Flourish Studio.15.

Findings: The overall ASIR for all cancer sites among men was 197.2 per 100,000, while for women, it was 164.9 per 100,000. Among men, the most prevalent cancer site was the Stomach (ASIR = 41.4), followed by Head & Neck, Lung, Oesophagus, Colorectal, Liver, Urinary, Non-Hodgkin's Lymphoma and Prostate cancers. Conversely, among women, Lung cancer exhibited the highest incidence (ASIR = 26.7), succeeded by Cervical, Breast, Stomach, Head & Neck, Colorectal, Oesophagus, Liver and Ovarian cancers. Stomach cancer emerged as the leading cause of death among men (ASMR = 22.6) and among women, Lung cancer held the highest ASMR (15.9). Joinpoint regression analysis revealed a rising trend in incidence and mortality over time for overall cancer sites. Among the primary cancer sites contributing to incidence and mortality, an increase in APC was observable for all, except Stomach cancer, in both men and women. The diagnostic approach, except for cases of cancer with unknown primary sites, involved a microscopic method.

Interpretation: This cross-sectional study examines PBCR reports spanning from 2003 to 2020, shedding light on a consistent uptick in cancer incidence and mortality trends in Mizoram. Stomach cancer emerges as the most prevalent and primary cause of cancer-related deaths among men, while Lung cancer takes a parallel role in women. The elevated cancer incidence and the growing trend among younger generations might stem from the static lifestyle and dietary patterns prevalent within the endogamous tribal population, potentially contributing to a genetic predisposition. The escalation in mortality rates could be attributed to a dearth of specialized diagnostic facilities and skilled human resources, treatment strategies guided by genomic research and transportation challenges. This underscores the urgent requirement for comprehensive scientific exploration across diverse facets. The implementation of easily accessible diagnostic facilities in proximity and genetic testing for pharmacogenomics to enhance prognoses would also aid in mitigating the burden and advancing the healthcare system's effectiveness.

Funding: Population Based Cancer Registry (PBCR) was supported by National Centre for Disease Informatics and Research (NCDIR) of the Indian Council of Medical Research (ICMR), India.

Keywords: Cancer incidence & mortality; Endogamous; Health care systems; Mizoram; Northeast India.

Fig. 1

Trend in Age Standardized Incidence and Mortality Rates (2003–2020). Trend in incidence and mortality in men, women and both genders (overall) for a span of 2003–2020 for all cancer sites. Age Standardized Rates for incidence and mortality were calculated per 100,000 population using Segi's World Standard Population.

Fig. 2

Overall ASIRs (2003–2020) for all sites in men. Overall Age Standardized Incidence Rates (ASIRs) were calculated for each cancer site from 2003 to 2020 to illustrate the lowest to highest rate in men.

Fig. 3

Overall ASIRs (2003–2020) for all sites in women. Overall Age Standardized Incidence Rates (ASIRs) were calculated for each cancer site from 2003 to 2020 to illustrate the lowest to highest rate in women.

Fig. 4

Overall ASMRs (2003–2020) for all sites in men. Overall Age Standardized Mortality Rates (ASMRs) were calculated for each cancer site from 2003 to 2020 to illustrate the lowest to highest rate in men.

Fig. 5

Overall ASMRs (2003–2020) for all sites in women. Overall Age Standardized Mortality Rates (ASMRs) were calculated for each cancer site from 2003 to 2020 to illustrate the lowest to highest rate in women.

Fig. 6

Trend in ASIR for leading sites in men (2003–2020). Trends in Age Standardized Incidence Rates (ASIRs) for leading sites in men from 2003 to 2020.

Fig. 7

Trend in ASIR for leading sites in women (2003–2020). Trends in Age Standardized Incidence Rates (ASIRs) for leading sites in women from 2003 to 2020.

Fig. 8

Trend in ASMR for leading sites in men (2003–2020). Trends in Age Standardized Mortality Rates (ASMRs) for leading sites in men from 2003 to 2020.

Fig. 9

Trend in ASMR for leading sites in women (2003–2020). Trends in Age Standardized Mortality Rates (ASMRs) for leading sites in women from 2003 to 2020.