Analysis of the Mortality Trends of 23 Major Cancers in the Indian Population Between 2000 and 2019: A Joinpoint Regression Analysis

Our plain-English summary of Analysis of the Mortality Trends of 23 Major Cancers in the Indian Population Between 2000 and 2019: A Joinpoint Regression Analysis, by A. Shaji, P. Keechilat, V. Dk, et al (JCO Global Oncology, 2023).

The study

• Authors: A. Shaji, P. Keechilat, V. Dk, C. Sauvaget
• Journal: JCO Global Oncology
• Published: 2023;9:e2200405
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Cancer mortality trends have not been documented across the population of India. We, therefore, analyzed the overall and individual cancer mortality trends for 23 major cancers between 2000 and 2019 on the basis of Global Health Observatory (GHO) database.

Materials And Methods: This study examined cancer mortality trends for 23 major cancer sites on the basis of 12.85 million cancer deaths obtained from the GHO of the WHO between 2000 and 2019. A joinpoint regression model was used to analyze the long-term trends of cancer mortality. Annual percentage change (APC) and average APC were estimated for various cancer sites.

Results: Between 2000 and 2019, 12.85 million deaths occurred in India from 23 major cancers. The most common lethal cancers were mouth and oropharyngeal (15.6%), stomach (10.6%), lung (9.6%), breast (9%), and colorectal (8%) cancers. The mortality trend decreased by 0.19% annually among men and increased nonsignificantly by 0.25% among women; an increase of 0.02% was observed among combined sexes. Increasing mortality trends were seen among cancers of the lung, breast, colorectum, lymphoma, multiple myeloma, gallbladder, pancreas, kidney, and mesothelioma between 2000 and 2019. The highest annual increase in mortality was observed in pancreatic cancer among both sexes: 2.7%, 2.1% among men, and 3.7% in women. The cancers of the stomach, esophagus, leukemia, larynx, and melanoma showed a declining cancer mortality trend irrespective of sex.

Conclusion: A multifaceted strategy is required to tackle the rising cancer mortality rates in India; the best long-term strategy could be implementing awareness on cancer symptoms among the population as well as cancer prevention policies with improved health infrastructure and specifically dedicated human resources.

In plain English

This study described trends in cancer deaths across India from 2000 to 2019. The authors did not study asbestos or any other exposure. Mesothelioma was one of the 23 cancer types analyzed. They used estimated death counts from the World Health Organization's Global Health Observatory (12.85 million cancer deaths) and applied joinpoint regression to age-standardized death rates. For all 23 cancers together, the yearly change was a statistically significant decrease of 0.19% among men. Among women it was an increase of 0.25%, and for both sexes combined an increase of 0.02%; neither increase was statistically significant. Mouth and oropharynx cancer caused the most deaths (15.6%). Mesothelioma accounted for 32,959 estimated deaths (0.3%): 21,132 in men and 11,827 in women. Mesothelioma death rates rose 2.2% per year among men (95% CI 2 to 2.5) and fell 0.4% per year among women (95% CI -0.7 to -0.1). For both sexes combined they rose 1.3% per year (95% CI 1.1 to 1.6). The authors noted that the data are estimates and that only 19% of deaths in India are medically certified. They concluded that a multifaceted strategy is needed to tackle rising cancer mortality in India.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Trend analysis (joinpoint regression) of national estimated cancer mortality data
• Who was studied: The Indian population, 2000 to 2019. There were 12.85 million estimated cancer deaths from 23 major cancers (12,851,568: 6,675,279 men and 6,176,289 women), taken from the WHO Global Health Observatory.
• Exposure: No exposure was studied. The article does not mention asbestos or any cause of mesothelioma. It reports only death trends by cancer site and sex.
• Main results:
  • For all 23 cancers combined over 2000 to 2019, age-standardized mortality changed by -0.19% per year among men, which was statistically significant. It changed by +0.25% per year among women and +0.02% per year for both sexes combined; neither of these was statistically significant.
  • The leading causes of cancer death were mouth and oropharynx (15.6%), stomach (10.6%), lung (9.6%), breast (9%) and colorectum (8%).
  • Mesothelioma accounted for 32,959 estimated deaths (0.3% of the total): 21,132 men and 11,827 women, a male-to-female ratio of 1.8.
  • Over 2000 to 2019, mesothelioma mortality changed by 2.2% per year among men (95% CI 2 to 2.5), -0.4% per year among women (95% CI -0.7 to -0.1) and 1.3% per year for both sexes combined (95% CI 1.1 to 1.6). All three changes were marked as significant.
  • For mesothelioma in 2000 to 2009, the yearly change was 1.3% among men (0.7 to 1.8), -0.4% among women (-0.7 to -0.1) and 0.6% combined (-0.2 to 1.3, not significant). In 2010 to 2019 it was 2.0% among men (1.4 to 2.6), -0.4% among women (-0.7 to -0.1) and 1.6% combined (1.4 to 1.9).
  • Pancreatic cancer had the highest yearly increase: 2.7% for combined sexes and 2.1% for men. The text gives 3.7% for women, but Table 2 gives 3.4% (95% CI 3 to 3.7).
  • Stomach, esophagus, leukemia, larynx and melanoma deaths showed declining trends in both sexes.
• The authors' conclusion: The authors concluded that a multifaceted strategy is required to tackle rising cancer mortality in India. This could include awareness of cancer symptoms, prevention policies, and improved health infrastructure with dedicated staff. They also concluded that high-quality cancer surveillance and mortality recording systems are needed.
• Limitations the authors state:
  • India has no nationwide cancer registration system, and cause-of-death certificates are incomplete and imprecise. Only 19% of deaths are medically certified.
  • The mortality data are GHO estimates, not registry counts.
  • Estimates from statistical models often differ from estimates based on cancer registry data.

Topics

Medical terms in this study, explained in our Lexicon: Myeloma, Mesothelioma.

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