There are several major causes of cancer in India. Tobacco consumption, through smoking bidis and other products, is the leading cause and is responsible for close to half of all cancer cases among Indian men and one-fifth of cases among women. Other top causes include consumption of alcohol, certain viruses like HPV which cause cervical cancer, consumption of red meat and processed foods, radiation, and certain sexual and reproductive factors. The number of cancer cases is also rising in India due to an aging population and lifestyle changes associated with urbanization.

1. According to the Global Cancer Observatory
(GLOBOCAN) estimates, there were 19.3 million
incident cancer cases worldwide for the year 20201.
India ranked third after China and the United States of
America2. GLOBOCAN predicted that cancer cases in
India would increase to 2.08 million, accounting for a
rise of 57.5 per cent in 2040 from 20202.

2. • According to the Global Cancer Observatory
(GLOBOCAN) estimates, there were 19.3
million incident cancer cases worldwide for
the year 20201 . India ranked third after China
and the United States of America2 .
GLOBOCAN predicted that cancer cases in
India would increase to 2.08 million,
accounting for a rise of 57.5 per cent in 2040
from 20202

3. • IntroductionThe burden of NCDs is still increasing
worldwide despite advances for diagnosis and
treatment.Cancer is currently the cause of 12% of all deaths
worldwide.Overall NCDs are emerging as the leading cause
of death and disability in India accounting for over 42% of
all deaths (Registrar General of India)Cancer registry data
reveals that 48% of cancer in males and 20% in females are
tobacco related and are totally avoidable.75-80% patients
are in advanced stage of disease at the time of first
attendancesource: National commission on health
economics and health(NCMH)Report,2005crude incidence
rate per populationCancer cervix21.3Cancer
Breast17.1Cancer Oral cavity11.8

4. • Caner has become one of the ten leading causes
of death in India.It is estimated that there are
nearly million cancer cases at any given point of
time.8-9 lakh new cases and 4 lakh deaths occur
annually due to cancer.Cancer of oral cavity and
lungs in males and cervix and breast in females
account for 50% of all cancer deaths in IndiaWHO
has estimated that 91% of oral cancers in SEAR
directly attributable to the use of tobacco and
this is the leading cause of oral cavity and lung
cancer in India.By 2050, there will be 17 million
new cases in the developing world .

5. Demographic shift
• Urbanization, industrialization, changes in
lifestyles, population growth and ageing all have
contributed for epidemiological transition in the
country.The absolute number of new cancer
cases is increasing rapidly and increase in the
proportion of elderly persons as a result of
improved life expectancy following control of
communicable diseases.In India, the life
expectancy at birth has steadily risen from 45
years in 1971 to 62 years in 1991, presently 67.3
for males and 69.6 for females indicating a shift in
demographic profile.

6. • Cancer Causes in India Tobbaco Alcohol
Dietary habits Radiation
• Miscellaneous pollutantsInfectionsSexual and
Reproductive factors

7. • Tobacco consumption remains the most important
avoidable cancer risk.Between 25 and 30% of all
cancers in developed countries are tobacco-related.The
principle impact of tobacco smoking is seen in higher
incidence of cancers of the lung, larynx, oesophagus,
pancreas and bladder.Bidi smoking is associated with
cancer of oropharynx as well as larynx.India is the third
largest producer and consumer of tobacco.The
unrefined form of tobacco used in bidis (WHO, 1999)
and the frequency with which a bidi needs to be puffed
per minute may be responsible for its relatively higher
carcinogenic effects as compared to cigarettes

8. • Increased alcohol consumption is causally associated
with cancers at various sites, mainly oral cavity,
pharynx, larynx, and oesophagus and is also
responsible for the incidence of primary liver
cancer.Globally about 9.4% new colorectal cancer cases
are attributed to the consumption of alcohol.It is
thought that ethanol being a co-carcinogen might play
a crucial role in the carcinogenesis .The metabolic
products of ethanol are acetaldehyde and free radicals.
The free radicals are responsible for alcohol assisted
carcinogenesis through their binding to DNA and
proteins, which destroy foliate leading to secondary
hyper proliferation

9. • There is strong evidence that majority of cervical
neoplasia is caused by certain sub types of human
papilloma virus (HPV), a sexually transmitted
infections.Besides cervical cancer, evidence indicates
that sexually transmitted virus is associated with a
variety of other malignancies such as oesophageal
carcinoma, anal cancer, penile cancer and oral
cancer.Other virus–cancer relationships are between
Epstein–Barr virus and nasopharyngeal cancer; chronic
active infection and hepatitis B virus and primary liver
cancer; Helicobacter pylori and stomach cancer; HIV
and Kaposi’s sarcoma and some forms of lymphoma.

10. • The heavy consumption of red meat is the main cause
of several cancers including gastrointestinal tract and
colorectal, breast, oral ca.Most probably, it is due to
the production of heterocyclic amines(most potential
carcinogens) during cooking of red meat.Food kept in
plastic containers turns out to be carcinogenic because
bios-phenol from the plastic containers gets dissolved
and migrates into the food; resulting into the risk of
breast and prostate.High consumption of fruits and
vegetables associated with reduced risk of several
cancers including lung, oral, pancreas, larynx,
oesophagus, bladder, stomach and cervical cancers.

11. • Role of sexual and reproductive factors affecting
the incidence of breast and cervical cancers has
been well documented.Epidemiological data
strongly implicate sexually transmitted agents in
the etiology of cervical cancer.Studies carried out
have been shown that early onset of menarche,
late age at first child birth, nulli-parity and late
natural menopause increase the risk of breast
cancer.Early age at first sexual intercourse and
multiple sexual partners add to the risk of cancer
of the cervix.

12. • n the developed and developing countries, the radiations
are also notorious carcinogens. About 10% cancer
occurrence is due to radiation effect, both ionizing and non-
ionizing.The major sources of radiations are radioactive
compounds, ultraviolet (UV) and pulsed electromagnetic
fields.Exposure leads to thyroid, skin, leukemia, lymphoma,
lung and breast carcinomas.High risk of breast cancer
among girls at puberty is due to chest irradiation of X-rays
(used for diagnostic and therapeutic purposes).The
underground testing of nuclear weapons may be the major
cause of digestive system, liver and kidney cancers, as
radiations have been reported in ground water of the
nuclear weapon testing area

13. There are four principal approaches to cancer control:1.
Prevention2. Early Detection3. Diagnosis and Treatment4.
Palliative CareStrategies for Early Detection of Common
Cancers in India:Screening for Cervix CancerIn many
developed countries a decline in the incidence of and
mortality due to cervix cancer has been observed in the past
30 years due to cytology screening (PAP Smear)Visual
inspection of the cervix after application of 4-5% acetic acid
(VIA) is a simple, inexpensive test that can be provided by
trained health workers.