Cancer Institute (W.I.A)- Salient Features

        The Cancer Institute (W.I.A), is a non-profit charitable institution, founded in 1954 by a team of dedicated women with a social commitment under the leadership of Dr. (Mrs) Muthulakshmi Reddy, the first women in India to graduate in medicine. Presently, it comprises four components: (i) the post graduate teaching hospital with a bed strength of 428 consisting of the departments of surgical, radiation and medical oncology, (ii) the Research Centre including laboratories of Molecular Oncology, Microbiology, Bio-chemistry, Bio-physics, Immunology, Cytogenetics and Electron Microscopy (iii) the Division of Preventive Oncology comprising two components (a) Cancer prevention and early detection - essentially educational at the public and professional levels. Over 750 VHNs and 250 rural medical practitioners have been trained (b) Registries: Demographic and Hospital - carrying out cancer registration activities and (iv) the College of oncological sciences offering super specialty degree courses in oncology. The Cancer Institute (WIA), Chennai,, is a Regional Cancer Centre for treatment of cancer in the Ministry of Health and Family Welfare, Government of India, since 1975. It enters the Golden Jubilee year in 2004 after 50 years of committed service in cancer care and research.

Hospital Cancer Registry (HCR)

        The HCR at the institute has 40 staff members serving in different capacities, besides a principal investigator and a co-investigator. The HCR has been responsible for descriptive statistics on the total number of patients seen, diagnosed as and / or treated for cancer annually, categorized by the site, socio-demographic factors, extent of disease at presentation, providing information to PBCRs and other research activities and basic data for epidemiological studies and different types of cases studies including survival analysis. In 2002, a total of 12,021 patients were registered; 7,306 (61%) of them were diagnosed to have cancer with the gender ratio of 116 females to 100 males. Cancers of the cervix (35%), breast (20%) and oral cavity (7%) in that order remained the most common cancers in women. The rank order among men was cancer of the oral cavity (13%) followed by stomach (9%) and oropharynx (7%). The localized cancers comprised 6%, locally advanced 50% and distant metastasis 9% among all cancers together.

        The HCR from its inception has focused on the continued well-being and care of the patient and therefore places great emphasis on "follow-up". Follow up is an integral activity of the HCR at the Cancer Institute. A lifetime follow up of cancer cases is pursued until the death of the patient. With the follow up of cases being an arduous task in any developing environment, our HCR has evolved an efficient system of active follow up methods to augment the passive follow up. Staff is dedicated exclusively to communicate with patients and relatives through letters, telephone and E-mail for follow-up. The availability of a complete follow-up at five years from diagnosis, for any given site at any given time, is in the range of 70-90 %. This rate is higher for specialized studies like clinical trials/protocol and survival. This has facilitated conduct of survival studies on common and selected cancers and publishing of the overall and disease free estimates in a routine manner.

        The high resolution data collection in the HCR has facilitated the conduct of many analytical epidemiological studies on cervix, female breast, stomach, oral cavity, occupational related cancers to name a few. Many inter department co-operative projects focusing on molecular and basic sciences research, are also being carried out. With the gradual increase in the level of computerization of hospital registration system, recent data on all aspects of cancer is readily available.

Population Based Cancer Registry (PBCR)

        The PBCR that is based at the institute is called the Madras Metropolitan Tumour Registry (MMTR). It is in existence since 1981 as part of the National Cancer Registry Program (NCRP) of the Indian Council of Medical Research (ICMR), New Delhi. MMTR has completed 21 years of data collection on incident cancer cases among the residents of Chennai city.

        For a PBCR, the emphasis is on public health and epidemiology. MMTR records data on incident cancer patients within the metropolitan limits of Chennai irrespective of the hospitals attended by them. It caters to a total urban population of 4.2 millions as on date registering an average of 4,000 cases annually. Since cancer is still not a notifiable disease in India, registration of cases is predominantly active. The average annual crude incidence rate (CIR) of cancer in the year 2000 is estimated to be 91.0 per 100,000 {cumulative risk (0-74 years): one in 8} among males and 103.2 per 100,000 among females (one in 8). The ranking of common cancers in males is stomach (CIR:10.9), lung (8.5), oesophagus (7.3) and oral cavity (6.3); among females, the order is cervix (25.4), breast (23.5), oral cavity (5.1) and stomach (4.7). The high quality of data from MMTR has been recognized by its acceptance by the IARC for publication in its quinquennial monograph, "Cancer Incidence in Five Continents", volumes VII and VIII, without any reservation. The completeness of coverage of reportable cancers in MMTR is estimated as 96%.

        The MMTR is following a unique form of data collection whereby data on all deaths, irrespective of the stated cause on the death certificate, occurring in the city of Chennai is abstracted from the Vital Statistics Division of Corporation of Chennai and computerized in the registry. This has resulted in a two-fold increase in the availability of mortality information of registered cancer cases: from a mortality to incidence ratio of 23-25% in 1982-83 to 50-55% in 1992-2000. This method has been recommended for adoption by other registries too.

        Besides these, MMTR has been in the forefront by being the first in many spheres of cancer registration: trace back activities for unmatched death certificate notifications since 1984, active follow up in the form of house visits/postal enquiries since 1985, linkage of data from different departments of the same hospital to enhance the quality of data since 1991, making available the survival statistics on top ten cancers in 1998. MMTR has been instrumental in the launching of the first population based Hereditary Cancer Registry in 2002. MMTR has been the resource centre for imparting training to participants of IARC course on cancer registration and epidemiology. Personnel from Regional Cancer Centres elsewhere in India have also undergone training here. MMTR has been regularly conducting workshops on cancer registration for the personnel of medical records departments of government and private hospitals in Tamil Nadu and personnel from the Vital Statistics Division of Corporation of Chennai. MMTR has extended its expertise in starting HCRs in government and private hospitals which form the source of data collection and in the installation of the software for cancer registration with minimum needed information in the medical records departments of several hospitals depending on the level of computerization existing there.

        In summary, both the registries were part of the WHO-ICMR Project of Development of an Atlas on Cancer in India by sending the needed data for the years 2001-02. The hospital registry is unique and the only one of its kind for the excellent quality of medical documentation and nearly 70-90% follow up of patients treated. MMTR has the distinction of formulating a unique method of mortality data collection to improve the mortality and many other statistics on incident cancers. This should dispel the often quoted remark that data collection and survival data is not possible in a developing environment. All it needs is the commitment.

Tobacco Related Cancers

Select Year      ICD Code     Select Gender         2001 2002 2001-2002 9 10 Males Females

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