A project of the National Cancer Registry Programme (Indian Council of Medical Research)
The main objectives of the project are:
(i) To obtain an overview of patterns of cancer in different parts of the country ;
(ii) To calculate estimates of cancer incidence wherever feasible.
The overall aim of the study is to get to know the similarities and differences in patterns of cancer across the country in a relatively cost-effective way using recent advances in computer and information technology transmission. Knowing patterns of cancer across the country would provide important leads in undertaking aetiological research, in targeting cancer control measures and in examining clinical outcomes.
Certain subsidiary objectives that emerge out of this exercise include:
a) Strengthening of departments of pathology in medical colleges and other hospitals
computers and internet connection;
b) Providing orientation/ training in cancer registration and epidemiology to pathologists.
The cancer registries under the National Cancer Registry Programme (NCRP) have provided since 1982 an idea of the magnitude and pattern of cancer in selected urban centres and in a couple of rural pockets. However ,large
areas of the population, particularly the rural areas remain largely uncovered and therefore the patterns of cancer in several urban centres and rural areas remain largely unknown. India is a vast country with populations having varied cultures, customs and habits. The environment differs and so does dietary praises, and socioeconomic status. Important differences exist in the ways of living of the urban and rural populations. Geographic differences in patterns of cancer have already been observed among the different registries. For example, cancer of the gall bladder has a comparatively higher incidence in the population based cancer registries (PBCRs) of Delhi and Bhopal, while cancer of the stomach has been the consistent leading site of cancer among males in Chennai and Bangalore. The incidence of some sites of cancer like female breast and cancer oesophagus have shown a statistically significant increase over the years in some registries, whereas others like cancer of the cervix and oral cavity have recorded a decline.
Therefore, the broad purpose is to develop an atlas for the whole of India. Minimal additional resources from this project were being given for few selected institutional in essentially areas not covered by the NCRP so as to obtain the largest amount of additional information. The information already available from all existing population and hospital registries under the NCRP would be very important and crucial for the main objectives of the project.
Concept and Design:
Setting up of new registries throughout the country as in some western countries would involve enormous cost in establishing and maintaining the same. The basic principle in this project is - since over 85-90% of cancers (as per the data of the NCRP) have a microscopic diagnosis the point of capture of cases would be the pathology department of medical colleges and major cancer hospitals. It is envisaged to have a network of computers linked to a web-site, so that the information (mainly patient identification details including area of living, and site and morphology of tumour) on all malignant cases would be transmitted as and when they are reported in the department of pathology.
The response from pathologists across the country has been overwhelming and over 96 centres out of the 212 letters sent have responded so far and over 50% of these centres have already started collation of information on malignant neoplasms reported from 1 January 2001. As of now the WHO has provided grants and computers for support of 30 centres. Requests for more funds have been made and attempts are being made to cover more centres with existing funds. Following a preliminary meeting visits have been made to about 23 centres and based on visit reports agreements have been reached with 17 centres.
The project also includes conduct of four regional workshops in the four zones of the country. Pathologists of all medical colleges and major hospitals (both government and private) are being invited to these workshops. Those who have commenced work will be presenting their papers and discussing the difficulties encountered in completing patient details especially with reference to residential status. The southern regional workshop was held on 11th and 12th May at Bangalore, West-Mumbai-8-9 June 2001; East-Calcutta 15-16 June 2001; The workshop in the northern region is scheduled at Lucknow 14-15 September 2001. Besides a Review workshop/Meeting is scheduled during early 2002.