Cancer Incidence and Mortality Across 43 Cancer Registries in India

Abstract

Importance: Cancer is a significant global health concern, with India ranking second in Asia and third in the world in terms of cancer incidence. Regular monitoring and updates on cancer statistics are vital for assessing the impact and burden of the disease and the effectiveness of cancer control measures.

Objective: To measure the recent patterns and trends in cancer incidence and mortality across 43 geographic regions in India from 2015 to 2019 and to provide estimates for 2024.

Design, setting, and participants: This cross-sectional study used data from 43 population-based cancer registries across India, covering varying periods between January 1, 2015, and December 31, 2019. Population at-risk data were obtained from the Census of India, and findings were assessed by registry area. Data were analyzed from May 1 to December 20, 2024.

Main outcomes and measures: Number of cases, crude rates, and age-adjusted rates (per 100 000 population) for cancer incidence and mortality, estimated average annual percent change (AAPC) from time trends, and estimated cancer cases in India for 2024.

Results: Incidence of 708 223 cases with 206 457 deaths from 43 population-based cancer registries were included. The lifetime risk of developing cancer in India was 11.0%, while Mizoram in the Northeastern region reported lifetime risks of 21.1% in males and 18.9% in females. The district of Aizawl reported the highest age-adjusted incidence rate (AAIR) in both males (256.1; 95% CI, 245.2-267.0) and females (217.2; 95% CI, 207.6-226.7). The most common cancers were oral, lung, and prostate in males and breast, cervical, and ovarian in females. Among metropolitan cities (defined as an urban agglomeration with a population of over 1 million), Delhi had the highest overall cancer AAIR for males (146.7; 95% CI, 145.1-148.3), while Srinagar recorded the highest AAIR for lung cancer (39.5; 95% CI, 35.8-43.2). Oral cancer showed significant increases in 14 population-based cancer registries (PBCRs) among males and 4 PBCRs among females; Ahmedabad Urban had an increase of 4.7% (95% CI, 2.9% to 6.6%) in males and 6.9% (95% CI, 4.1% to 9.7%) in females. The estimated AAPC in AAIR (all sites) showed a significant increase over time in Kamrup Urban in males (3.3%; 95% CI, 2.3%-4.3%) and Thiruvananthapuram Taluk in females (3.4%; 95% CI, 3.1%-3.8%). The estimated cancer incidence for 2024 was 1 562 099 cases; estimated cancer mortality, 874 404 cases.

Conclusions and relevance: This cross-sectional study highlighted significant regional disparities in cancer incidence across India and the increasing cancer burden. The findings provide key insights for policymakers to enhance resource allocation and strengthen cancer control strategies nationwide.

Figure 1.. Comparison of All Cancer Sites’ Age-Adjusted Incidence Rates (AAIRs) of All Population-Based Cancer Registries (PBCRs), 2015 to 2019

Comparison of AAIR across the population was performed based on the World Standard Population (WSP; codes C00-C97 from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Error bars represent 95% CIs. A comparison of AAIR for selected leading sites of cancer across PBCRs is given in eFigure 1 in Supplement 1.

Figure 2.. Trends in Age-Adjusted Incidence Rate (AAIR) for All Sites of Cancer, 2002 to 2019

Trends in AAIRs across the population were performed based on the World Standard Population (WSP), for all cancers combined; population-based cancer registries with more than 10 years of continuous data were included in the analysis, while those with fewer than 10 cases per year were excluded. Details regarding the average annual percent change values and trends in the AAIR for all cancer sites are provided in eTable 3 in Supplement 1. Additionally, trends in the AAIR from 2002 to 2019 for selected cancer sites are depicted in eFigure 2 in Supplement 1.