Chapter 16: Cancer survival in Mumbai (Bombay), India, 1992-1999
Yeole BB, Kurkure AP and Sunny L
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The registry contributed data on survival for the cancers of the female breast and uterine cervix in the first volume of the IARC publication on Cancer Survival in Developing Countries[3]. Data on survival from 28 cancer sites or types registered during 1992–1999 are reported in this second volume.
The closing date of follow-up was 31st December 1999 for cases registered in 1992–1994 and 31st December 2003 for cases registered in 1995–1999. The median follow-up (in months) ranged between <1 for unspecified leukaemia to 50.9 for lip cancer. Complete follow-up information at five years from the incidence date ranged from 92.8% (cancer of the lung) to 81.7% (cancer of the penis). The cases lost to follow-up also displayed a pattern: the proportion of lost to follow-up was generally the highest in the extremities of the classified follow-up intervals (within the first year and five or more years of follow-up) for all cancers. This minimizes the bias of estimation of 5-year survival probability, as a sizeable proportion of cases lost to follow-up after five years would have had a complete follow-up until 5 years from the incidence date.
The 5-year age-standardized relative survival (ASRS) probability for all ages together is generally less than or similar to the corresponding unadjusted one with a few exceptions. Also, the 5-year ASRS (0–74 years of age) is generally higher than the corresponding ASRS (all ages) for most cancers.
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Abstract
The Bombay cancer registry is the second oldest population-based cancer registry in Asia, and the first of its kind in India. It was established in 1963, and registration of cases is done by active methods. Data on survival from 28 cancer sites or types registered during 1992–1999 are reported. Follow-up has been carried out predominantly by active methods, with median follow-up ranging between 1–51 months for different cancers. The proportion of histologically verified diagnosis for various cancers ranged between 41–100%; death certificates only (DCOs) comprised 0–15%; 84–99% of total registered cases were included for survival analysis. Complete follow-up at five years ranged from 85–92% for different cancers. The 5-year age-standardized relative survival rates for common cancers were breast (48%), cervix (44%), lung (11%), oesophagus (14%), oral cavity (35%) and non-Hodgkin lymphoma (34%). The 5-year relative survival by age group portrayed either an inverse relationship or was fluctuating. Cases with a regional spread of disease were the highest for cancers of the tongue, oral cavity, larynx and cervix; survival decreased with the increasing extent of disease for all cancers studied.Mumbai Cancer Registry
The Mumbai Cancer Registry, formerly known as the Bombay Cancer Registry, is the second-oldest Population-Based Cancer Registry in Asia and the first of its kind in India. It was established in 1963 and has been contributing data to the quinquennial IARC publication Cancer Incidence in Five Continents since Vol II[1]. Cancer registration is still done by active methods. Over 150 sources of registration, comprising hospitals in the government and private sectors, nursing homes, pathology laboratories, imaging centres and hospices, are visited for data collection. The registry caters to an entirely urban population of about 12 million with a sex ratio of 815 females to 1000 males. The average annual age-standardized incidence rate is 116 per 100 000 among males and 122 per 100 000 among females with a lifetime cumulative risk of one in 7 of developing cancer for both sexes in the period 1999–2001[2]. The top ranking cancers among males are lung followed by oral cavity and larynx. Among females, the order is breast, cervix and ovary.| Map. Map showing location of Mumbai, India Click here to open map (PDF format) |
Data quality indices
The proportion of cases with histologically verified cancer diagnosis in our series is 78%, varying between 99.9% for lymphoid leukaemia and 41% for the pancreas. The proportion of cases registered as death certificates only (DCOs) is 6.5% ranging between 0.1% in lymphoid leukaemia and 15.2% in pancreas. The exclusion of cases from the survival analysis is the greatest among the cancer of the pancreas (15.8%) and the least among lymphoid leukaemia (0.5%). Thus, 84–99% of the total cases registered among selected cancers are include 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, Mumbai, India, 1992–1994 cases followed through 1999 and 1995–1999 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 mortality information from the hospitals and municipal corporation records. The abstracted data are matched with the incident cancer database. Unmatched incident cases are then subjected to one or more of the following to obtain the vital status information: repeated scrutiny of records in the respective sources of registration, postal/telephone enquiries and house visits.The closing date of follow-up was 31st December 1999 for cases registered in 1992–1994 and 31st December 2003 for cases registered in 1995–1999. The median follow-up (in months) ranged between <1 for unspecified leukaemia to 50.9 for lip cancer. Complete follow-up information at five years from the incidence date ranged from 92.8% (cancer of the lung) to 81.7% (cancer of the penis). The cases lost to follow-up also displayed a pattern: the proportion of lost to follow-up was generally the highest in the extremities of the classified follow-up intervals (within the first year and five or more years of follow-up) for all cancers. This minimizes the bias of estimation of 5-year survival probability, as a sizeable proportion of cases lost to follow-up after five years would have had a complete follow-up until 5 years from the incidence date.
 | Table 2. Number and proportion of cases with complete / incomplete follow-up and median follow-up (in months) by site, Mumbai, India, 1992–1994 cases followed through 1999 and 1995–1999 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
The 5-year relative survival is the highest for lip cancer (64%) and the lowest for cancer of the tonsil (17%) among the cancers of the head and neck. Cancers of the pancreas, stomach and oesophagus (15%) had the poorest survival, compared to cancer of the anus (39%) among the gastrointestinal tract cancers. Survival from cancers of the urinary system was 42% for urinary bladder and 36% for kidney. Hodgkin lymphoma had a better survival (52%) than non-Hodgkin lymphoma (34%). The best survival figures for leukaemias were lymphoid (16%), followed by myeloid (15%) and unspecified (7%).The 5-year age-standardized relative survival (ASRS) probability for all ages together is generally less than or similar to the corresponding unadjusted one with a few exceptions. Also, the 5-year ASRS (0–74 years of age) is generally higher than the corresponding ASRS (all ages) for most cancers.
 | Table 3. Comparison of 1-, 3- and 5-year absolute and relative survival and 5-year age-standardized relative survival (ASRS) by site, Mumbai, India, 1992–1994 cases followed through 1999 and 1995–1999 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), Mumbai, 1992–1999 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, Mumbai, India, 1992–1994 cases followed through 1999 and 1995–1999 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 lip cancer (60%) followed in order by Hodgkin lymphoma (56%), testis (55%) and penis (52%). Survival from Hodgkin lymphoma was noticeably higher among males (56%) than females (41%). | Figure 1b. Top five caners (ranked by survival), Male, Mumbai, 1992–1999 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 are lip (70%), breast (51%), cervix (46%) and anus (42%). The survival is markedly higher among females than males for cancers of the lip, tongue and tonsil. | Figure 1c. Top five cancers (ranked by survival), Female, Mumbai, 1992–1999 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 portrays an inverse relationship: a decreasing survival with increasing age at diagnosis for cancers of the tongue, nasopharynx, oesophagus, stomach, colon, rectum, larynx, lung, breast, cervix, prostate, bladder and non-Hodgkin lymphoma. In the rest, it fluctuates. | Table 4b. Site-wise number of cases, 5-year absolute and relative survival by age group, Mumbai, India, 1992–1994 cases followed through 1999 and 1995–1999 cases followed-up until 2003 Click here to open table (PDF format) Click here to open comparative statistics by registry |
Extent of disease
A majority of cases of the following cancers have been diagnosed with localized disease: lip (52%), rectum (46%) and colon (39%). In breast cancer, there was no difference in the proportion of cases with localized (40%) and regional (41%) spread of disease. Ovarian cancer is the solitary instance in which most cases were diagnosed with distant metastasis (50%). Cases with a regional spread of disease were the highest among cancers of the tongue, oral cavity, larynx and cervix. The extent of disease was unknown in 4–10%. The 5-year absolute survival by extent of disease followed the expected pattern: highest for localized cases, followed by regional and distant metastasis cases among known categories of extent of disease. | Table 5. Proportion (%) of cases and 5-year absolute survival by extent of disease and site, Mumbai, India, 1992–1999 Click here to open table (PDF format) Click here to open comparative statistics by registry |
 | Figure 2a-2i. Absolute survival (%) from selected cancers by extent of disease: Mumbai, India Click here to open figure (PDF format) |
 | Figure 2a. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the lip Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2b. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the tongue Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2c. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the oral cavity Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2d. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the colon Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2e. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the rectum Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2f. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the larynx Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2g. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the breast Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2h. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the cervix Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
 | Figure 2i. Absolute survival (%) by extent of disease: Mumbai, India: Cancer of the ovary Click here to open figure (PDF format) Click here to open comparative statistics by cancer site |
Survival trend
The 5-year relative survival from cancers of the female breast (51%) and cervix (46%) registered in 1992–1999 has shown a slight decline compared to an earlier series (1982–1986: breast: 55.1%; cervix: 50.7%) reported in the first volume of survival publication[3]. This might be a consequence of the increased availability of complete follow-up information in the present volume (85–87%) compared to 73–75% in the earlier series. | Table 6. Comparison of 5-year absolute and relative survival of cases diagnosed between 1982–1986 and 1992–1999, Mumbai, India Click here to open table (PDF format) Click here to open comparative statistics by registry |
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) - National Cancer Registry Programme. Consolidated report of population-based cancer registries: 1999–2001. Indian Council of Medical Research, New Delhi, 2004.
- Yeole BB, Jussawalla DJ, Sabnis SD and Sunny L. Survival from breast and cervical cancer in Mumbai (Bombay), India. In: Cancer Survival in Developing Countries (eds) R Sankaranarayanan, RJ Black and DM Parkin. International Agency for Research on Cancer, IARC Scientific Publications No. 145, Lyon, 1998.
(link to Cancer Survival, volume 1)