No, India’s rate of cancer incidence isn’t among the lowest in the world

No, India’s rate of cancer incidence isn’t among the lowest in the world

A few days ago, the Institute of Health Metrics and Evaluation (IHME), a US-based research institute, published a report on the global prevalence of cancer. The report found a large disparity between the incidence rates of cancer among developed and developing countries.

The countries with the highest rates of cancer were Australia and New Zealand, with 743.8 and 542.8 new cases of cancer per 100,000 people in 2016. They were followed by the US, with 532.9 cases. Over 17.2 million cases of cancer were reported worldwide in 2016.

More notably, the IHME’s analysis indicated that India ranked tenth among the countries with the lowest rate of cancer incidence in the world - with only 106.6 new cancer cases in 2016 for 100,000 members of its population. India was outranked by its regional neighbours - Bhutan, Nepal and Sri Lanka - all of which boasted of lower cancer rates.

These findings beg the question. For a country with such a large population, how are India’s rates of cancer so low? Is it an issue of genetics? Or is there something intrinsic to the Indian diet like turmeric that makes us less prone to cancer?

It’s an issue of data reporting

Interestingly, the list of countries with the lowest rate of cancer was topped by Syria, which had only 85 cases per 100,000 members of its population. Well, when you’re faced with the threat of being bombed on a regular basis, going to the doctor or reporting your cancer diagnosis seems like less of an urgency, doesn’t it?

The fact that Syria tops the list could indicate why India even made the top 10 to begin with. The reporting of cancer cases in India leaves a lot to be desired. While we have a national cancer registry, its most recent data seems to be from 2014.

Further still, according to Dr Ajay Sharma, a New Delhi-based oncologist, record-keeping in hospitals, especially in smaller towns, is not upto the mark. “Data isn’t collated properly and as a result, a lot of India’s cancer cases aren’t reported,” Sharma says.

Dr Sarika Gupta, a women’s cancer specialist at Apollo Hospital in New Delhi, also disagreed with the IHME’s assessment of India. “We have the third-highest rate of female cancer cases in the world after China and the US,” Gupta says. She also added that the symptoms in more than half of India’s cancer patients go undetected due to a shortage of adequate screening technology in rural or underdeveloped areas, or worse, a lack of awareness about the disease itself.

According to a report by Ernst and Young in 2015, there were only 2,700 mammograms, a breast cancer screening device, in India at the time - a fraction of the total number in the US. More surprisingly, there were only 120 PET-CT scanners, most of which were in Tier-1 cities.

A larger problem

In addition to causing the under-reporting of cases, the lack of awareness about the disease translates into higher death rates. According to a study published in Lancet, a medical journal, in 2014, around 70% of India’s cancer cases lead to death due to lack of medical resources as well as the fact that most people don’t seek medical treatment until the late-stage symptoms start manifesting themselves.

The EY report found that while the cancer incidence rate in India was estimated to be at 94 cases per 100,000 people, the actual rate was somewhere between 150-200 cases due to the deficiencies in data collection and screening.

It isn’t far-fetched to think that the reporting and detection problems experienced in India could also be seen in other developing countries. Hence, it feels incorrect to assume people in richer, developed countries are more prone to contracting cancer. They just have more avenues to detect it and these countries have the systems in place to report and collect this data.