Cervix and Breast cancers are the most common cancers among women worldwide and extract a large toll in developing countries. In May 1998, supported by a grant from the NCI (US), the Tata Memorial Hospital, Mumbai, India, started a clusterrandomized, controlled, screening-trial for cervix and breast cancer using trained primary health workers to provide healtheducation, visual-inspection of cervix (with 4% acetic acid-VIA) and clinical breast examination (CBE) in the screening arm, and only health education in the control arm. Four rounds of screening at 2-year intervals will be followed by 8 years of monitoring for incidence and mortality from cervix and breast cancers. The methodology and interim results after three rounds of screening are presented here. Good randomization was achieved between the screening (n 5 75360) and control arms (n 5 76178). In the screening arm we see: High screening participation rates; Low attrition; Good compliance to diagnostic confirmation; Significant downstaging; Excellent treatment completion rate; Improving case fatality ratios. The ever-screened and never-screened participants in the screening arm show significant differences with reference to the variables religion, language, age, education, occupation, income and health-seeking behavior for gynecological and breast-related complaints. During the same period, in the control arm we see excellent participation rate for health education; Low attrition and a good number of symptomatic referrals for both cervix and breast.Of the estimated 470,000 new cases of cervix cancer diagnosed each year worldwide, 80% occur in developing countries and around 27% occur in India from where 126,000 new cases are diagnosed annually and over 71,000 deaths because of cervix cancer are reported each year.1,2 Nearly 70% of cervix cancer patients in India present at stages III and IV.3 Around 20% of women who develop cervix cancer die within the first year of diagnosis and the 5-year relative survival rate is 50%. 4 Breast cancer is the most common cancer among women worldwide and is also the leading cause of cancer deaths in women. Breast cancer is responsible for an estimated 189,000 and 184,000 deaths in developed and developing countries respectively thus accounting for 16% and 12% of all cancer deaths in women. Although the age-standardized incidence of breast cancer is generally lower in developing countries than in developed countries (23.1 vs. 63.2 per 100,000 women), incidence rates are seen to vary widely between and within countries. Breast cancer is already more common than cervix cancer in a number of developing countries.5 Data from developing countries suggests that age-standardized incidence rates of breast cancer are rising rapidly in low-incidence regions such as Africa and Asia. 6 There are no organized screening programmes for cervix and breast cancers in India. Cervix Cytology and Mammography based screening programmes are difficult to organize in India because of issues related to absence of trained manpower, infrastructu...

Background:Cervical cancer is a major cause of cancer mortality in women and more than a quarter of its global burden is contributed by developing countries. In India, in spite of alarmingly high figures, there is no nationwide government-sponsored screening program. This study was conducted to assess the burden of cervical cancer in India and review the performance characteristics of available cervical cancer screening tools, so as to provide evidence-based recommendations for application of most practically suited screening test to be used in resource-poor field settings.Materials and Methods:MEDLINE and Web of Science electronic database were searched from January 1990 to December 2015, using the keywords such as “cervical cancer”, “screening”, “early detection”, “cervical cytology” and “visual inspection”, and their corresponding MeSH terms in combination with Boolean operators “OR, AND.” Two authors independently selected studies that are published in English and conducted in India. A total of 11 studies were found to be relevant and eligible to be included in the present study.Results:In India, cervical cancer contributes to approximately 6–29% of all cancers in women. The age-adjusted incidence rate of cervical cancer varies widely among registries; highest is 23.07/100,000 in Mizoram state and the lowest is 4.91/100,000 in Dibrugarh district. The pooled estimates of sensitivity and specificity of visual inspection with acetic acid (VIA), magnified VIA, visual inspection with Lugol's iodine (VILI), cytology (Pap smear), and human papillomavirus DNA were found to be 67.65% and 84.32%, 65.36% and 85.76%, 78.27% and 87.10%, 62.11% and 93.51%, and 77.81% and 91.54%, respectively.Conclusions:In developing countries because of lack of necessary infrastructure and quality control, high-quality cytology screening may not be feasible for wide-scale implementation. Hence, cervical cancer screening program based on visual screening test such as VIA/VILI should be adopted as an integral part of primary health-care setup in resource-poor countries like India.

A retrospective case-control study of 7 I 3 male oral-cancer patients seen at Tata Memorial Hospital, Bombay, during 1980-1 984 was undertaken to assess the association between chewing, smoking and alcohol habits. Male controls were chosen among those persons who attended the hospital during the same period and were diagnosed as free from cancer, benign tumour and infectious disease. Statistical analysis was based on unconditional logistic regression and the confidence interval for RR was calculated using the standard error of the estimates. Established factors such as tobacco chewing and bidi smoking showed a significant association with oral cancer. For the alcohol habit, the relative risk was 1.42 and the doseresponse relationship, in terms of frequency and duration of the habit, was also observed. The illiterate group showed an almost 2-fold significant excess risk compared to the literate group. After adjusting for confounding variables such as age, residence, illiteracy and known factors such as tobacco chewing and bidi smoking, the study has brought out the significance of a non-vegetarian diet as a high-risk factor for oral cancer compared to a vegetarian diet. Further studies are required to identify specific items in the non-vegetarian diet which may be associated with oral cancer.

S_ary A case-control study of 689 breast cancer patients seen at Tata Memorial Hospital during the period 1980-84 was carried out. During the same period 711 females who attended the hospital without a history of benign breast lesions or gynaecological complaints were selected as controls. Patients were interviewed by trained investigators to collect data on reproductive factors, menstrual history, tobacco smoking and chewing habit, dietary practices (vegetarian and non-vegetarian diet) and alcohol consumption. Cases and controls were stratified into four age groups (<35 years, [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] (Bombay, Maharashtra, others). Odds ratios were calculated by univariate methods as well as by stratified analysis. The Mantel and Haenzel (1959) summary chi-squared test was used for testing statistical significance and a test-based estimation procedure was used for calculation of confidence intervals for odds ratios (Kleinbaum et al., 1982). ResultsGeneral features of breast cancer cases and controls are shown in Table I. The average age of cancer patients was 46.2 years, whereas it was 42.8 years for controls. The religious distribution between cases and controls did not differ and hence is not adjusted for in the analysis. Reproductive factors in cases and controls are presented in Table II. Factors such as age at menarche, age at marriage, age at first pregnancy and number of pregnancies appeared to be similar between the cancer cases and controls.The relative risks (RRs) for factors studied are presented in Table III. Cases and controls were stratified by four age groups and three places of residence. In our study, unmarried women had a 2.3 times higher risk of developing breast cancer than married women. The nulliparous women had 2.2 times the risk of parous women (P<0.OO1). Breast feeding,

Introduction Inflammation seems to play a critical role in the development and progression of numerous cancers. Peripheral blood leukocyte count is an easily assessable parameter of systemic inflammatory response. Objective The aim of this study was to investigate whether the pretreatment leukocyte counts can predict the prognosis of patients with oral cavity cancer. Methods Medical records of 471 oral cavity cancer patients diagnosed between January 2007 and December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards analyses were applied to evaluate the associations of leukocyte counts with overall survival. Results The overall five year's survival of the cohort was found to be 49.4%. On univariate analysis, elevated monocyte count (≥500/mm3) and neutrophil-to-lymphocyte ratio (NLR) (>2.38) were associated with poor overall survival (OS) (p = 0.001 and 0.000, respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and NLR levels were significant independent predictors of worse OS (HR = 1.385, 95% CI = 1.049 - 1.829; p < 0.05 and HR = 1.392, 95% CI = 1.045 - 1.855; p < 0.05, respectively). The advanced overall stage and lymph nodal involvement were also independent indicators for poor OS. Conclusions Higher pretreatment monocyte and NLR levels are independent predictors of poor prognosis for patients with oral cavity cancer. Thus, these easily accessed variables can serve as a potent marker to predict the outcomes of oral cancer patients.

Stomach cancer incidence rates are much lower in India than elsewhere, but the stomach remains one of the 10 leading sites of cancer in both sexes in most of the metropolitan registries. This is an unmatched case-control study of stomach cancer carried out at Tata Memorial Hospital (TMH), Mumbai. Our purpose was to identify the association of tobacco and alcohol use, occupational hazards, diet, consumption of beverages like tea and coffee, the living environment, cooking media and literacy with stomach cancer. Our study included 170 stomach cancer cases and 2,184 hospital controls interviewed during the period 1988 -1992. Tobacco chewing, bidi or cigarette smoking and alcohol drinking did not emerge as high risk factors for stomach cancer. Consumption of dry fish at least once a week compared to never or once a every 2 weeks showed a 12-fold excess risk (OR ‫؍‬ 12.4, 95% CI 7.0 -22.1, p < 0.0001) for stomach cancer among the nonvegetarian food items considered. A protective effect of tea consumption (OR ‫؍‬ 0.4, 95% CI 0.2-0.9, p ‫؍‬ 0.03), showing 59% reduction in risk, was identified, which could be of use for possible control and prevention of this cancer.

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