Insights into cancer patterns, diagnosis, and treatment landscape in Kerala, India

Cancer is a leading public health challenge, with 18.1 million new cases in 2018, projected to increase to 29.5 million by 2040, especially in countries with lower socioeconomic status, including India.[1] In India, cancer ranks as the fifth leading cause of death, with 1.1 million cases and over 0.7 million deaths reported in 2018. These numbers are predicted to reach nearly 2 million cases and 1 million deaths by 2040.[1] Since 1981, the National Cancer Registry Program (NCRP) has been an important source of cancer data, allowing for extensive investigations on India's cancer trends and burden. These registries serve as vital tools for epidemiological studies, policymaking, and resource allocation. India's cancer epidemiology exhibits significant regional variations, highlighted by NCRP, which shows a stark difference in incidence rates across different regions.[2] A recent 10-year retrospective study published in the journal Cancer Research, Statistics, and Treatment by Anilkumar et al.[3] identified the cancer patterns, focusing on incidence rates, demographic details, and type prevalence in North Malabar, Kerala, India. A hospital-based cancer registry comprising information from more than 56,961 cancer patients registered during this period was utilized in the study.[4,5] Key findings include the predominance of lung cancer in males and breast cancer in females, with an upward trend in the five leading cancers for both males and females over the observed period, indicating a growing cancer burden in North Malabar, Kerala. The median age of cancer diagnosis was reported to be 62 years for men and 57 years for women, which is roughly 10 years lower than the Western population. Other studies in India have also reported a similar age of diagnosis. This trend underscores the importance of strengthening cancer surveillance and targeted health-care interventions and planning.[3] The study's findings revealed that lung cancer in men and breast cancer in women are the predominant cancer types, mirroring national trends.[6,7] Particularly, the lung, mouth, stomach, tongue, and larynx are the leading cancer sites among men, whereas, for women, the most common sites are the breast, cervix uteri, ovary, mouth, and lung. However, statistics from Uttar Pradesh's (UP), India population-based cancer registries show a distinct pattern: mouth and tongue cancers are the most prevalent among men, and breast, cervix uteri, and gallbladder cancers are predominant among women.[8] However, the most common malignancies for males are lung and esophageal, while the most common cancers for women are breast and cervical in North-Eastern India.[9] This regional variation emphasizes the diverse cancer epidemiology within India, indicating the need for tailored cancer control and prevention strategies. Another key finding of the study is that with time, the five leading cancers in both males and females showed an upward trend in South India. Similar to this, Goswami et al.[10] noted in their study a consistent rise in oral cavity cancers and lung cancer in males and breast cancer and ovarian cancers in females in Eastern India between 1996 and 2020. A similar trend in breast cancer has been reported in Bhopal, Chennai, and Delhi registries as well,[4-6] whereas a significant decrease in cervical cancer has been noted in Bangalore and Chennai over 25-30 years. This variation could be attributed to generational changes in risk factors.[6] The study's findings also highlighted several significant aspects of cancer treatment, including late-stage diagnosis, different treatment pathways, etc. These elements are critical to comprehending and enhancing cancer care. The fact that 50.9% (19,786) of patients were detected at advanced stages of cancer is significant and is supported by the national and regional levels studies which revealed that delayed or restricted access to early-stage screening and detection programs could seriously compromise patient survival and treatment success.[3,11] These results cumulatively imply that there is a need to develop effective public health interventions aimed at early detection, increased access to comprehensive cancer treatment, and supplemental services to deal with the myriads of issues faced by cancer patients. By addressing the issues mentioned above, patients would be more likely to adhere to the treatment, which will ultimately improve their quality of life and result in better cancer care outcomes. According to Kumar et al.[12] and George,[13] this delay is typically caused by misconceptions about the disease, perceived stigma, fear, and denial of cancer, symptoms mimicking minor ailments, familial responsibilities, etc. The study also reveals that 30.1% of the patients had previously received some cancer-directed treatment before presenting to the health facility. This finding may indicate that patients seek care from multiple sources, possibly due to accessibility concerns, the pluralistic treatment system in India, or dissatisfaction with their initial therapies.[12] A situation like this emphasizes the necessity of a thorough cancer treatment plan. Furthermore, rates of dropout and recommended but unreceived treatments indicate difficulties with treatment adherence, suggesting elements such as cost, adverse effects, or logistical challenges. The research findings vividly reflect the growing figures of cancer in Kerala, India. Nevertheless, these findings should be considered with the known difficulties of hospital-based registries, which are unable to cover the entire scope of cancer patients due to possible nonreporting of cases as many patients are less likely to visit a medical facility for treatment. In addition, it is not possible to determine causality in absolute terms due to the retrospective design. Other limitations could include the variation in diagnostic abilities throughout the research and the neglect of factors influencing socioeconomic and lifestyle choices that influence the selection of cancer detection rates and prevalence. Furthermore, due to the unique population or demographic characteristics or another health-care system, the regional population may pose a challenge to the generalizability of the study findings.[13] To develop comprehensive strategies for cancer prevention, early detection, and treatment, future research should concentrate on comparing the findings with data from across the globe, accounting for variations in risk factors, health-care accessibility, and diagnostic patterns.[13,14] Overall, the study highlights the necessity of region-specific cancer control measures in North Malabar, Kerala, with a focus on early diagnosis, awareness, and health-care accessibility.[3] The study results might be used to guide state-level policy shifts toward high-incidence tumors. Prospective studies should be given prominence in future research to understand local risk factors and outcomes. It is also necessary that population-based registries should be used to gain a wider perspective. Lastly, the effectiveness of cancer intervention programs, which could be customized to their respective demographic and cultural settings, should be evaluated.