Chapter 12: Cancer survival in Barshi, India, 1993-2000
Jayant K, Nene BM, Dinshaw KA, Badwe RA, Panse NS, Thorat RV
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The registry contributed data on survival from cancer of the cervix registered in 1988–1992 for the first volume of the IARC publication on Cancer Survival in Developing Countries[4]. Data on survival from 15 cancer sites or types registered during 1993–2000 are reported in this second volume.
The closing date of follow-up was 31st December 2003. The median follow-up (in months) ranged between 1.6 for liver cancer to 49.2 for cancer of non-melanoma skin. Complete follow-up at five years from the incidence date ranged between 96–100%. The losses to follow-up are very minimal and have occurred at varying intervals of time ranging from <1 year to > 5 years.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is lesser than the corresponding unadjusted for a majority of cancers. The 5-year ASRS (0–74 years of age) is observed to be higher than the corresponding ASRS (all ages) with a few exceptions.
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Abstract
The rural cancer registry of Barshi, Paranda and Bhum, was the first of its kind in India and was established in 1987. Registration of cases is carried out entirely by active methods. Data on survival from 15 cancer sites or types registered during 1993–2000 are reported in this study. Follow-up was carried out predominantly by active methods, with median follow-up time ranging between 2–49 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 73–98%; death certificates only (DCOs) comprised 0–2%; 98–100% of total registered cases were included for survival analysis. Complete follow-up at five years ranged between 96–100% for different cancers. The 5-year age-standardized relative survival rates for selected cancers were non-melanoma skin (86%), penis (63%), breast (61%), cervix (32%), mouth (23%), hypopharynx (11%) and oesophagus (4%). The 5-year relative survival by age group did not display any particular pattern. Five-year relative survival trend between 1988–1992 and 1993–2000 showed a marked decrease for cancers of the tongue, hypopharynx, stomach, rectum, larynx, lung and penis; but a notable increase for breast and non-Hodgkin lymphoma.Rural cancer registry: Barshi, Paranda and Bhum
The Rural Cancer Registry of Barshi, Paranda and Bhum, is the first of its kind in India. It was established in 1987 at the Nargis Dutt Memorial Cancer Hospital, Barshi, in Maharashtra state. Data from the registry were published in the IARC publication Cancer Incidence in Five Continents in Vol VII[1]. Cancer registration is entirely done by active methods. It is different from the registration practices of urban registries in that it relies heavily on interaction with the village community, health camps and other interventions apart from data collection from different medical institutions catering to the population[1], [2]. The registry covers an area of 3713 km2 and caters to a predominantly rural population of about 0.5 million in 2001 with a sex ratio of 926 females to 1000 males. The average annual age-standardized incidence rate is 44 per 100 000 among males and 52 per 100 000 among females with a lifetime cumulative risk of one in 16 of developing cancer for both sexes in the period 1999–2001[3]. The top ranking cancers among males are hypopharynx followed by penis and oesophagus. Among females, the order is cervix, breast and oral cavity.| Map. Map showing location of Barshi, India Click here to open map (PDF format) |
Data quality indices
The proportion of cases with histological confirmation of cancer diagnosis in this series is 87%, varying between 98% for myeloid leukaemia/cancer of the penis and 73% for cancer of the stomach. The proportion of cases registered as death certificates only (DCOs) is <1%, ranging between 0% for most cancers and 2% in liver/lung cancers. There are no cases without any follow-up. The exclusion of cases from the survival analysis ranged between none for most cancers and 2% for cancers of oesophagus, liver and lung. Thus, 98–100% of the total cases registered are included in the estimation of the survival probability. | Table 1. Data quality indices - Proportion (%) of histologically verified and death certificate only cases, number and proportion of included and excluded cases by site, Barshi, India, 1993-2000 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Outcome of follow-up
Follow-up has been carried out predominantly by active methods. These included abstraction of cancer mortality information from hospitals and village death records. The abstracted data are first matched with the incident cancer database. The follow-up information for the unmatched incident cases is then obtained through postal enquiries and house visits.The closing date of follow-up was 31st December 2003. The median follow-up (in months) ranged between 1.6 for liver cancer to 49.2 for cancer of non-melanoma skin. Complete follow-up at five years from the incidence date ranged between 96–100%. The losses to follow-up are very minimal and have occurred at varying intervals of time ranging from <1 year to > 5 years.
 | Table 2. Number and proportion of cases with complete / incomplete follow-up and median follow-up (in months) by site, Barshi, India, 1993-2000 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Survival statistics
All ages and both sexes together
Non-melanoma skin cancer had the highest 5-year relative survival (83%), while none survived that period with liver cancer. The highest survival among head and neck cancers was observed in oral cavity (24%) followed by hypopharynx (11%) and tongue (10%). For the gastrointestinal tract cancers, the order is rectum (13%), stomach (6%) and oesophagus (5%). The survival figure for non-Hodgkin lymphoma is 25% and myeloid leukaemia is 15%.The 5-year age-standardized relative survival (ASRS) probability for all ages together is lesser than the corresponding unadjusted for a majority of cancers. The 5-year ASRS (0–74 years of age) is observed to be higher than the corresponding ASRS (all ages) with a few exceptions.
 | Table 3. Comparison of 1-, 3- and 5-year absolute and relative survival and 5-year age-standardized relative survival (ASRS) by site, Barshi, India, 1993-2000 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
 | Figure 1a. Top ten cancers (ranked by survival), Barshi, India, 1993-2000 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Sex
 | Table 4a. Site-wise number of cases, 5-year absolute and relative survival by sex, Barshi, India, 1993-2000 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Male
The 5-year relative survival was the highest for non-melanoma skin cancer (81%) followed by penis (59%). Survival from cancers of the hypopharynx and larynx was noticeably higher among males than females. | Figure 1b. Top five cancers (ranked by survival), Male, Barshi, India, 1993-2000 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Female
The top-ranking cancers in terms of 5-year relative survival were as follows non-melanoma skin (89%), breast (55%), cervix (35%) and non-Hodgkin lymphoma (33%). Survival was markedly higher among females than males for cancers of the tongue, oesophagus and stomach, and non-Hodgkin lymphoma. | Figure 1c. Top five cancers (ranked by survival), Female, Barshi, India, 1993-2000 Click here to open figure (PDF format) Click here to open graph for all the cancer sites |
Age group
The 5-year relative survival by age group does not display any particular pattern. This may be due to scanty number of cases in many age groups for most cancers. | Table 4b. Site-wise number of cases, 5-year absolute and relative survival by age group, Barshi, India, 1993-2000 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Survival trend
The data on trends in survival are available for 15 cancer sites covering 13 years in two time periods between 1988–1992[4] and 1993–2000. The completeness of follow-up at 5 years from incidence date was between 98–100% in both periods. The absolute difference in 5-year relative survival between 1988–1992 and 1993–2000 showed a marked decrease for cancers of tongue, hypopharynx, stomach, rectum, larynx, lung and penis. A notable increase in 5-year relative survival was seen in female breast cancer and non-Hodgkin lymphoma. In the rest, there has been little change. | Table 5. Comparison of 5-year absolute and relative survival of cases diagnosed between 1988-1992 and 1993-2000, Barshi, India Click here to open table (PDF format) Click here to open comparative statistics by registry |
Acknowledgements
The authors are thankful to the registry staff, Dr. A.M. Budukh, Dr.F.Y. Khan, Mr. S.R. Mathapati, Mr. N.V. Kesare, Mr. N.P. Gaikwad, Mr. D.R. Pise, Mr. T.S. Dudhankar and Mr. B.D. Honmane, for their diligent work.References
- Parkin DM, Whelan SL, Ferlay J and Storm H. Cancer Incidence in Five Continents, Vol I to VIII: IARC Cancerbase No. 7. IARCPress, Lyon, 2005.
(link to CI5) - Jayant K, Rao RS, Nene BM and Dale PS. Population-based Rural Cancer Registry. Annual Report 1987–1988. Tata Memorial Centre, Bombay, 1989.
- National Cancer Registry Programme. Consolidated report of population-based cancer registries: 1999–2001. Indian Council of Medical Research, New Delhi, 2004.
- Jayant K, Nene BM, Dinshaw KA and Budukh AM. Survival from cervical cancer in Barshi registry, rural India. In: Cancer Survival in Developing Countries (eds) R Sankaranarayanan, RJ Black and DM Parkin. IARC Scientific Publications No. 145. IARCPress, Lyon, 1998, pp 69–77.
(link to Cancer Survival, volume 1)