Oral, pharyngeal and esophageal cancers are 3 of the 5 most common cancer sites in Indian men. To assess the effect of different patterns of smoking, chewing and alcohol drinking in the development of the above 3 neoplasms and to determine the interaction among these habits, we conducted a case-control study in Chennai and Trivandrum, South India. The cases included 1,563 oral, 636 pharyngeal and 566 esophageal male cancer patients who were compared with 1,711 male disease controls from the 2 centers as well as 1,927 male healthy hospital visitors from Chennai. We observed a significant dose-response relationship for duration and amount of consumption of the 3 habits with the development of the 3 neoplasms. Tobacco chewing emerged as the strongest risk factor for oral cancer, with the highest odds ratio (OR) for chewing products containing tobacco of 5.05 [95% confidence internal (CI) 4.26 -5.97]. The strongest risk factor for pharyngeal and esophageal cancers was tobacco smoking, with ORs of 4.00 (95% CI 3.07-5.22) and 2.83 (95% CI 2.18 -3.66) in current smokers, respectively. An independent increase in risk was observed for each habit in the absence of the other 2. For example, the OR of oral cancers for alcohol drinking in never smokers and never chewers was 2.56 (95% CI 1.42-4.64) and that of esophageal cancers was 3.41 (95% CI 1.46 -7.99). Furthermore, significant decreases in risks for all 3 cancer sites were observed in subjects who quit smoking even among those who had quit smoking 2-4 years before the interview.

SummaryBackgroundPrevious efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available.MethodsWe used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India.Findings8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016.InterpretationThe substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focu...

Reports of increasing rates for kidney cancers in several count prompted this analysis of global incidence trends for total kidney cancers and by subsite. International incidence data for 5-year periods 1973-1977, 1978-1982, 1983-1987 and 1988-1992 were obtained from volumes IV to VII of Cancer Incidence in Five Continents published by the International Agency for Research on Cancer. The USA data for the same 5-year periods were obtained from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. Percentage changes in incidence rates were computed using the relative difference between the time periods 1973-1977 and 1988-1992, and annual percentage changes in incidence rates were computed using log linear regression. In 1988-1992, kidney cancer incidence rates (age-adjusted to the world-standard population) were highest in France (16.1/100,000 man-years and 7.3/100,000 woman-years) and lowest in India (2.0 and 0.9, respectively). Between 1973-1977 and 1988-1992, incidence rates rose among men and women in all regions and ethnic groups, with a few exceptions, mostly in Scandinavian countries. The largest percentage increase for men was in Japan (171%) and for women in Italy (107%). Rates for renal pelvis cancer were less than 1/100,000 person-years in almost all regions in both sexes, and the temporal trends were inconsistent. Incidence trends for renal parenchyma cancer tracked those for total kidney cancers, and appeared to result from increases in the prevalence of risk factors and in use of diagnostic imaging procedures.

Variations in environmental exposures such as tobacco use, diet and infection, as well as better health care access and knowledge may explain some of the observed incidence differences.

Estrogen receptor (ER) status is an important biomarker in defining subtypes of breast cancer differing in antihormonal therapy response, risk factors and prognosis. However, little is known about association of ER status with various risk factors in the developing world. Our case-control study done in Kerala, India looked at the associations of ER status and risk factors of breast cancer. From 2002 to 2005, 1,208 cases and controls were selected at the Regional Cancer Center (RCC), Trivandrum, Kerala, India. Information was collected using a standardized questionnaire, and 3-way analyses compared ER1/ER2 cases, ER1 cases/controls and ER2 cases/controls using unconditional logistic regression to calculate odds ratios and 95% confidence intervals. The proportion of ER2 cases was higher (64.1%) than ER1 cases. Muslim women were more likely to have ER2 breast cancer compared to Hindus (OR 5 1.48, 95% CI 5 1.09, 2.02), an effect limited to premenopausal group (OR 5 1.87, 95% CI 5 1.26, 2.77). Women with higher socioeconomic status were more likely to have ER1 breast cancer (OR 5 1.48, 95% CI 5 1.11, 1.98). Increasing BMI increased likelihood of ER2 breast cancer in premenopausal women (p for trend < 0.001). Increasing age of marriage was positively associated with both ER1 and ER2 breast cancer. Increased breastfeeding and physical activity were in general protective for both ER1 and ER2 breast cancer. The findings of our study are significant in further understanding the relationship of ER status and risk factors of breast cancer in the context of the Indian subcontinent. ' UICCKey words: estrogen receptor; breast cancer; India Estrogen receptor (ER) status of breast tumors has been instrumental in defining an important subtype of breast cancer with differences observed in risk factors, treatment and prognosis. [1][2][3][4][5][6][7] Numerous studies in the past have looked at differences in etiology and risk factors pertaining to presence or absence of ER-alpha. Most of these studies were conducted in Western populations as early as 1980s. [1][2][3][4][5] Around the same time, it was also discovered that ER1 tumors that lacked progesterone receptor (PR) expression were less responsive to endocrine therapy compared to tumors that expressed PR. 8 This led to studies in the past decade that looked at the link of various risk factors of breast cancer and combined ER/PR information to better explain the underlying differences between the various subtypes of breast cancer. 9-13 Chen and Colditz 14 have emphasized the importance of taking into account the ER/PR status information of breast tumors both for effective treatment as well as risk prediction for instituting prophylactic measures. Although there might be numerous ways to subtype breast cancer, the classification into ER1 and ER2 cancer remains a key divider. 14 However, information related to ER status is lacking for populations in developing countries. In fact, in most developing countries, determination of hormone receptor status is not a part of standard pro...

BackgroundThe role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.MethodsThe India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.ResultsAcross the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); Ptrend = 0.008] and hypertension [2.20 (1.47-3.31); Ptrend < 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); Ptrend = 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); Ptrend = 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); Ptrend = 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.ConclusionsCardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.

Breast cancer incidence is low in India compared with highincome countries, but it has increased in recent decades, particularly among urban women. The reasons for this pattern are not known although they are likely related to reproductive and lifestyle factors. Here, we report the results of a large case-control study on the association between breastfeeding and breast cancer risk. The study was conducted in 2 areas in South India during [2002][2003][2004][2005] and included 1,866 cases and 1,873 controls. Detailed information regarding menstruation, reproduction, breastfeeding and physical activity was collected through in-person interview. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression models. Breastfeeding for long duration was common in the study population. Lifetime duration of breastfeeding was inversely associated with breast cancer risk among premenopausal women (p-value of linear trend, 0.02). No such protective effect was observed in postmenopausal women, among whom a protective effect of parity was suggested. A reduction of breast cancer risk with prolonged breastfeeding was shown among premenopausal women. Health campaign focusing on breastfeeding behavior by appropriately educating women would contribute to reduce breast cancer burden. ' UICCKey words: breastfeeding; breast cancer; India Breast cancer is the most common cancer in women worldwide with nearly 1,000,000 new cases each year, representing over 20% of all malignancies. 1 There are striking geographic variations in breast cancer incidence with more than a 10-fold difference between low rates in rural African and Asian populations and high rates in North American and Western European populations.Age-standardized breast cancer incidence rates in India range from 15 to 29 per 100,000 and have been increasing in recent decades, especially among urban women, and India is now the country with the largest estimated number of breast cancer deaths worldwide. 1 The reasons for the low incidence of breast cancer among Indian women and the increasing incidence in recent years are not completely understood, although are likely to be explained by reproductive and lifestyle factors. Only few epidemiological studies have been conducted to determine the risk factors of breast cancer in Indian women. [2][3][4] Although it is well established that prolonged breastfeeding decreases the risk of breast cancer, 5 most of the evidence derives from studies conducted in high-income countries. Data from lowincome countries, where prolonged breastfeeding is prevalent, are needed to better quantify the effect of long-term breastfeeding.The World Health Organization (WHO) 6 conducted a study on breastfeeding in India between 1975 and 1978, and found sociocultural factors such as education, employment and income to be the strongest determinants of the length of breastfeeding; 96% of mothers in the urban areas and 100% in rural areas breastfed their infants. Data from National Family Health Survey-2 show that in ...

A case-control study was conducted at the National Naval Medical Center (Maryland, USA) from 1994 to 1996 to investigate the possible association between dietary factors and colorectal adenomas. Cases (n ‫؍‬ 239) were subjects diagnosed with adenomas (146 new and 93 recurrent) by sigmoidoscopy or colonoscopy. Those with no evidence of adenomas found by sigmoidoscopy were recruited as controls (n ‫؍‬ 228). Dietary variables, assessed by a 100-item food frequency questionnaire, were analyzed by the logistic regression model, which was adjusted for age, gender and total energy intake. Variables of fat intake were further adjusted for red meat intake. Colorectal cancer is the second leading cause of cancer deaths in the United States, accounting for approximately 10% of all cancer deaths. 1 Colorectal adenomas are considered to be potential precancerous lesions 2 and probably share a common etio-pathogenesis with colorectal cancer. 3 Epidemiologic studies have shown a positive association between fat and red meat 4 -6 and an inverse association between dietary fiber, fruit and vegetable intake with the development of colorectal adenomas 7-10 However, the associations with more specific types of fats, fibers, fruits and vegetables are much less clear. Therefore, we investigated the associations between fat and its subtypes, fiber and its subtypes, fruits and vegetables and their subgroups in a sigmoidoscopy-based casecontrol study on colorectal adenomas. MATERIAL AND METHODSThe study was undertaken at the National Navy Medical Center (Bethesda, MD, USA) during 1994 -1996. The details of the study have been published elsewhere. 6,11 Briefly, the cases (n ϭ 239) were subjects with new (n ϭ 146) or recurrent (n ϭ 93) adenomas diagnosed by sigmoidoscopy or colonoscopy and confirmed histologically. The controls (n ϭ 228) were subjects who were found to be free of adenomas on examination by sigmoidoscopy, during the same time period, and were frequency-matched to cases by age (Ϯ 5 years) and gender. The subjects were resident of the study area between the ages of 18 and 74 years and had never been diagnosed with Crohn's disease, ulcerative colitis or cancer (except nonmelanoma of the skin). The study was approved by the institutional review boards of both the National Cancer Institute and the National Naval Medical Center. Written informed consent was obtained from all participants. The participation rates were 84% for the cases and 74% for the controls.A validated self-administered food frequency questionnaire, a modified version of the 100-item health habits and history questionnaire, 12 was used to obtain information on diet for the past 12 months before endoscopy. Frequencies of consumption as well as serving sizes were included in the questionnaire. Values for nutrient intake were computed by using the HHHQ-DIETSYS 13 software. Data analysisInitially, mean intake (g/day) for the nutrient variables between new and recurrent adenoma cases were tested by t-statistic. In the absence of any significant differences, both n...