Cancer is among the top five leading causes of death in Manipur, according to a report by the National Cancer Registry Programme (NCRP) of Northeastern Region (NER) of India.
In Manipur, the leading site of cancer was lung (18.9 per cent) which was followed by cancer of the stomach (6.9per cent) and cancer of the nasopharynx (6.2 per cent). Whereas in females, the breast is a leading cancer site (15.4 per cent) followed by lung (14.4 per cent) and cervix uteri (9.5 per cent), as per the report.
“Tobacco-use-related cancer sites were seen as high as a little over 35 per cent among males and close to 20 per cent among females. Across both the genders, cancer of the lung (18.9 per cent in males and 14.4 per cent in females) constituted the leading site followed by oesophagus (5.3 per cent in males and 1.4 per cent in females)”, stated the report.
Number of cancer cases and Age Adjusted Incidence Rate (AAR) per 1,00,000 population, new cancer cases of male are 3702 and female is 4500 and AAR is 62.8 and 71.1 respectively.
The survey was conducted between November, 2019 and December, 2020.
According to the report, the prevalence of current tobacco use (smoked or smokeless) was 52.1 per cent. The prevalence of smokeless tobacco use (46.3 per cent) was higher than smoked tobacco use (15.5 per cent). Nearly half of the (43.3 per cent) of current tobacco users (smoked or smokeless) were daily users. The mean age at initiation of use was 23.9 years. The average duration of tobacco use among past smokers was 18.5 years. Only 12.8 per cent of the smoked tobacco users had made self-attempts to quit smoking, while only 2.3 per cent had been advised to quit tobacco use by doctor/health workers.
Around 31 per cent reported exposure to second-hand tobacco smoke in the past 30 days, either at home, during travel or at the workplace.
As many as 25.2 per cent of the respondents were current users of non-tobacco betel products in the form of pan masala, betel quid or areca nut. The use of arecanut (23.3 per cent) was highest among current users.
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According to the data, 62.7 percent of women use smokeless tobacco like Pan with Zarda, Betel with Tobacco quid, Tuibur, Tobacco Snuff, by mouth and 66.1 percent men.
Only 5.5 per cent of the respondents were aware of cancer screening for the three common cancers: Oral, breast and cervical cancer. Less than 1% had ever undergone screening for these cancers, according to the report. At least 16.3 per cent of the respondents reported having consumed alcohol over the past 12 months and 14.4 per cent reported alcohol use within the past month. The mean number of days on which either fruits or vegetables were consumed was 5.4 days in a week.
According to the WHO criteria, the proportion of those who were obese was 9.8 per cent, while the prevalence of obesity was higher (42.3 per cent) using Asian cut off points. The prevalence of raised blood pressure was 33.2 percent, of which the proportion of newly detected (27.6 per cent) was higher than previously known (5.6 per cent).
The proportion of respondents, whose blood glucose level was over 126 mg/dl, was 6.3 per cent, among whom the proportion of known diabetics was 3.0 per cent. Nearly 42 per cent of the cancer patients had sought health care outside of their state, the majority (64 per cent) were availing of treatment at a government health facility. Over a third (40 per cent) of the cancer patients were self-financing their treatment; 12 per cent were covered by health insurance.
Cancer screening for all three types of cancers (cervical, breast, oral) was available in none of the PHC and CHC, while it was available at 33.3 per cent of the district hospitals.
A few district hospitals had a specialist in position in the following departments: surgery (66.7 per cent), medicine (66.7 per cent) and gynaecology (33.3 per cent). Nearly 60 per cent of the General Duty Medical Officers at the CHC and District hospitals had been trained for the NPCDCS/NHM (NCD related)/State program.
Likewise, the proportion of staff from other cadres who had undergone NCD-related programme management training was low in PHC, CHC and District hospitals. More than a quarter of the district hospitals had day-care facilities for chemotherapy.
It may be mentioned that the survey was conducted with an objective to generate prevalence of key cancer and other NCD related risk factors and estimate health system response in the state of Manipur.
It was also aimed at setting a baseline to monitor and track trends in the prevalence of risk factors associated with cancer and other NCDs in the state of Manipur and to link or correlate risk factors with cancer incidence and burden collected by the PBCR in the Manipur state.
The study recommended improving the infrastructure of PHC, CHC and DH. Emergency services need to be made available regarding ambulance, working telephone, ICU and emergency cardiac care unit. Training for doctors and Para medical staff for NPCDCS/NHM (NCD related) to be increased, the study further recommended.
Awareness of cancer and other NCD regarding the various risk factors in different age groups to be increased by various means, the report stated. Facilities for screening of cancer need to be made available in different health care facilities like in PHC, CHC, DH and private sectors and the IEC materials related to cancer and other NCD need to be increased. Counselling for risk factors, risk behaviour needs to be increased for NCD and there is a need to increase availability and awareness of HPV vaccine, recommended the report.