With the deadly cancer disease emerging as a major health threat globally, Kashmir is witnessing an upsurge in the number of cases in the past few years with lung and breast cancers topping the list.
According to official data available at the lone Regional Cancer Centre, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, the number of registered patients has shown an “alarming” surge during the past few years, especially in the last three years. As per the official data, over 22,002 persons have died due to cancer during the period of 2018 to 2021 across Jammu and Kashmir. The figures available with the Union Health Ministry, further reveal that in 2018, 6824 cancer patients were reported to have died, in 2019 the number of deaths rose to 7003 and in 2020 the fatalities surged to 7189, thus showing an upward trend. A top ministry official said that a committee was also constituted with some members from the Union Territory of Jammu and Kashmir to carry out a baseline survey on why there was an alarming increase in the number of cancer cases across Jammu and Kashmir. “There has been a constant increase in the number of mortalities due to cancers in J&K which is quite alarming,” the ministry official said. As per Union Health Ministry’s figures, Jammu Kashmir has reported an estimated 39041 cancer cases, of which 12675 were recorded in 2019, 13012 in 2020 and 13354 in 2021.
Another official from Sher-i-Kashmir Institute of Medical Sciences (SKIMS), said that the last five to seven years has seen alarmingly worrying figures with regard to the rise of cancers in Jammu and Kashmir, especially in Kashmir region. Divulging details on the number of deaths and rise of cancer prevalence cases, the official said that since January 2014 there were 12,091 patients who were detected with cancer in various state hospitals, while as in 2013, 6,300 patients were detected with the killer disease. In 2016 till now, 4800 cancer patients were registered at SKIMS with the number increasing at an alarming pace.
The official data at Regional Cancer Centre, SKIMS revealed that the number of registered patients has jumped from 2097 in 2007 to 4800 in 2016 to 1100 cases of cancer in the first quarter of ensuing year which is expected to go much higher.
The Centre witnesses a heavy rush with nearly 70,000 older cases that doctors call follow-ups, visiting it for various kinds of therapies. The data available with the SKIMS Centre reveals that cancer patients registered for 2007 were 2,097, in 2008 the number was 2,465, and in 2009, it was 2,968. However; the patient influx recorded a sharp decline in 2010 at 2,623 only but in 2011 it went up again to 3,057. Even as cancer cases in far flung areas go unreported, the 2010 decline has been attributed to the unrest in the valley that year.
The medicos at the Department of Radiation Oncology, SKIMS, Soura, told Greater Kashmir that the cancer cases in Kashmir region have witnessed a surge with the prevalence of lung cancer in menfolk as the most common disease while women are fast falling prey to breast cancers. Figures reveal that against last year’s total patient load of 4800, SKIMS Soura received 1110 cancer cases in the first three months (Jan 1 to March 31) of 2022, highest in recent times.
Head, Department Radiation Oncology, SKIMS, Dr. Fir Afroz, told Greater Kashmir that several initiatives are underway for upscaling the oncology services at the tertiary institute. She informed that Lung cancer was found prominent among men while breast cancer was seen on the rise among women. “Smoking continues to be one of the primary reasons of cancer among males, besides genetics, obesity, age are among the factors responsible for the cancer cases,” she said.
“We have a high inflow of such patients who come forward to get themselves treated. People have overcome their fear of getting treated which is a good sign,” Dr. Afroz said, adding that “early detection of the disease helps provide timely treatment, which ultimately can help save the precious life.”
The rise in the number of cancer cases could be attributed to a larger number of aging population, unhealthy lifestyles, and use of various forms of tobacco and related products, unhealthy diet and in most cases, the non-availability of better diagnostic facilities.
Pertinently, cancer is a multi-dimensional disease and the risk factors inter alia include ageing population, sedentary lifestyle, use of tobacco products, unhealthy diet and air pollution.
‘Top Ten Cancers’
According to experts, the top 10 cancers afflicting the Valley are Lung cancer, Esophagus (cancer of food pipe), Stomach, Colon (large intestine cancers), Breast, Brain, Non-Hodgkin’s Lymphoma, GastroEsophageal, Junction cancer (cancer between the stomach and food pipe), Ovary and Skin cancers.
Leading oncologist and former Director, Regional Cancer Centre, SKIMS, Dr Muhammad Maqbool Lone, told Greater Kashmir, that the situation in Kashmir is becoming alarming every day a with the highest number of lung cancers in the country found in the people of Kashmir.
“Situation is changing as far as the deadly disease cancer is concerned. The diseases are alarmingly on surge. There are patients hailing from every part of Kashmir including the far-flung areas which are diagnosed with such a terminal disease,” Dr Lone said. He said that lung cancer, which for a few years back was not witnessed in that alarming number, has surpassed oesophagus cancers across Kashmir region.
Expressing serious concern, experts said the cancer mortality rate among Kashmiris had increased due to some leading behavioural and dietary risks, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and lack of regular check-up. They said that the changing lifestyle and food habits among the Valleyites had caused a surge in all cancers, especially in oesophagus, colon and breast cancers.
“We receive peculiar types of cases relatively different from those in rest of India because of geographic, socio-economic and religious factors,” Head, Department of Haematology and Department of Oncology, SKIMS, Dr Javid Rasool, told Greater Kashmir. “Tobacco use is the leading cancer risk factor at the global level causing 71 percent of lung cancer deaths. In Kashmir, the situation is very grim with the highest number of lung cancer cases, which is increasing alarmingly.” He said there were several scientific interventions underway which are considered as a milestone in cancer treatment. “We have also started bone marrow transplant and with other initiatives we are trying to decrease the mortality rate and give quality life to the cancer patients.”
According to researchers, cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasm. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, which invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis, a major cause of cancer death.
The experts attributed the rise in cancer cases to intake of spicy food, changing dietary habits and consumption of bulk of contaminated food items available in the market.
“There is massive adulteration in mass consumption of food items which kills people slowly. We have seen an increasing number of patients complaining of food poisoning, gastric troubles and other problems. Any delay in detection of the cancer can prove fatal,” former SKIMS director and noted gastroenterologist, Dr Showkat Ahmad Zargar said. “Lung, stomach, liver, colon and breast cancer cause the most cancer deaths every year in the world. The situation in Kashmir is no different.”
The experts said that early check-ups and adoption of preventive strategies can reduce the risk. Acquisition of knowledge about its causes and intervention to prevent and manage the disease is the need of the hour. Evidence-based strategies for cancer prevention and early detection and management of the disease can go a long way in reducing the incidence of the dreaded disease.
Doctors and doctor bodies in Jammu and Kashmir have vehemently demanded complete ban on import, manufacturing, transportation and sale of all forms of tobacco. “These things can make this disease more fatal in Kashmir. Whenever a patient develops any symptom, he should immediately report to the hospital,” senior Consultant Anesthesia, Dr Masood Rashid. “100% ban should be ensured in public places,” he said.
J&K is emerging as the smoking capital of north India and cigarette smoking is almost double the nationwide prevalence of 5.7 per cent J&K has 12 per cent cigarette smokers, 3.8 per cent bidi smokers and 8 per cent smokeless (chewable) tobacco users. Tobacco is a risk for heart attacks, strokes, COPD, cancers, hypertension and peripheral vascular disease,” he said.
According to a study conducted at SKIMS smoking related cancers like lung cancers have high incidence in the valley. International agency for research on cancers concluded in 2014, that involuntary smoking is carcinogenic to humans.
However, according to experts, a massive awareness campaign is needed for early detection of symptoms (for cancer types such as cervical, breast colorectal and oral) to get them diagnosed and treated early before the disease enters an advanced stage. They alleged early diagnosis programs were particularly relevant in low-resource settings where the majority of patients were diagnosed very late.
“Screening and cancer detection camps are seldom organized in far off areas. Research is the worst hit; doctors don’t get time while the authorities never emphasize its need and, in the process, quality patient-care gets affected,” said a senior professor of Oncology at SKIMS, wishing anonymity. He accused the directorate of Health Services of virtually doing nothing to create awareness about cancer among the people or to provide for some preliminary diagnostic facilities at various healthcare institutions. Surveys have shown that breast cancer has upstaged cervical cancer as the most common and biggest killer of women, whereas lung and oral cancer are the most common types of cancers among men.
Assistant Professor, Pediatric Oncology, SKIMS, Dr Faisal Guru, told Greater Kashmir that the department sees 300 to 350 pediatric cancer patients every year, calling it an alarming trend.
“There is definitely surge in pediatric cancers too,” Dr Guru said. “We see all the pediatric malignancy at the department and we are fully equipped as we have a dedicated oncology unit.” Dr Guru said, while there is an rise in pediatric cancers, however fortunately kids respond very well to the treatment.” He said that the department takes several steps in order to provide quality patientcare. He said the department has a legacy of observing Childhood Cancer Awareness Month and Childhood Cancer Survivorship Day in which focus is on the issues pertaining to survivorship in patients suffering from cancer. Dr Guru said that the parents have expressed their satisfaction with treatment and care provided by the Department of Pediatric Medical Oncology SKIMS.
In an alarming trend, every day, two new cases of cancer are diagnosed in Kashmir, while the majority of patients come from the summer capital of Srinagar. This number is constantly adding to the 5000 odd cases already suffering from the life consuming ailment in the Valley. Even as the number of cancer cases has been on rise across the state, Kashmir seems to be bearing the brunt. As per data collected from government sources, last year4632 cases of cancer were received by the Sher-e-Kashmir Institute of Medical Sciences Soura and the SMHS Hospital alone. What is more alarming is that most of the cases are detected only when the disease has reached the last stage, meaning that chances of survival through treatment are bleak, or zero.
Burden of Cancer
As per the World Health Organization, cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases. The WHO continues to raise awareness regarding several types of cancers. Cancer burden continues to grow globally, exerting tremendous physical, emotional and financial strain on individuals, families, communities and health systems. The WHO experts maintain that many health systems in low- and middle-income countries are least prepared to manage this burden, and large numbers of cancer patients globally do not have access to timely quality diagnosis and treatment. In countries where health systems are strong, survival rates of many types of cancers are improving thanks to accessible early detection, quality treatment and survivorship care. As per the WHO, change in lifestyle can prove a preventive measure. According WHO more than 30 per cent of cancer deaths could be prevented by modifying or avoiding key risk factors, including: tobacco use, being overweight or obese, unhealthy diet with low fruit and vegetable intake, lack of physical activity, alcohol use, sexually transmitted HPV-infection, infection by HBV, ionizing and non-ionizing radiation, urban air pollution and indoor smoke from household use of solid fuels.