Annual Incident Cancer Cases in Females and in Males

Incidence of Urologic, Genital and Urogenital Neoplasms in different geographical regions of India categorized according to location of population-based cancer registries

Urologic neoplasms

Of all urologic neoplasms, bladder neoplasms were associated both with the highest incidence and risk, irrespective of the sexes. It was followed by neoplasms of the kidney. For both the sites, the incidence and the risk were consistently higher for the males as compared to females across all the regions. The incidence of bladder neoplasms in males was the highest in the North (8/100,000), the associated risk too was the highest in the North (one in 250). The Northeastern and Northern regions reported the highest incidence of bladder neoplasms (2/100,000) for the females, with the risk being the same across all the regions (one in 1000, where applicable) [Table 3].

Incidence of Urologic Neoplasms in different geographical regions of India categorized according to location of population-based cancer registries

For males, both the incidence and the risk of developing kidney neoplasms was the highest in the Northern, Southern, and Western Regions (Rate: 3/100,000, Risk: one in 500). The highest incidence of kidney neoplasms was seen in the Western region for females (2/100,000). The risk of developing kidney neoplasms in females was same across the regions (one in 1000, where applicable). The Western region had a marginally greater burden of incidence and risk as compared to other regions for both the sexes.

For the neoplasms of the renal pelvis and ureter, both the incidence and risk were quite low for all genders across all the regions. Overall, both the incidences and risk of development of urologic cancers in both the sexes was highest in the North (Rate: 7/100,000; Risk: one in 250) [Table 2].

Genital neoplasms (female)

Northeast saw the highest incident burden of cervical neoplasms (23/100,000) followed by South, North, and Rural west (16/100,000). Risk of developing cervical neoplasms followed along; one in 50 in the Northeast and one in 83 in the South, North, and Rural West [Table 4]. The incidence and the risk of developing neoplasms of uterine body were highest in the Southern and Northern regions (6/100,000; one in 250), followed closely by Rural West and East (4/100,000; one in 333). For incident ovarian neoplasms, the Northern region came at the top (10/100,000), followed closely by Northeast (9/100,000). Both regions displayed the highest risk (one in 143) compared to other regions. While the incidence of vaginal neoplasm was low in all the regions, the incidences in the West, Rural West, and South were slightly higher (2/100,000). The incidences of vulvar, placental, and other female neoplasms were quite low. Cervical neoplasms had the highest incidence among female genital neoplasms, followed by neoplasms of uterine body. The Northeastern region showed the highest incident burden and risk of female genital neoplasms, followed by the Rural West, South, and North [Table 2].

Incidence of Female Genital Neoplasms in different geographical regions of India categorized according to location of population-based cancer registries

Incidence of Male Genital Neoplasms in different geographical regions of India categorized according to location of population-based cancer registries

Discussion

Gender differences were observed for the incidence and risk profiles of specific and generalized sites. Both the incidence and the risk of developing urologic neoplasms were almost four times higher in males as compared to females across all the regions. The higher risk of urologic neoplasm in males is due to higher occupational exposure and smoking among males.[8] [9] [10] The incidence of neoplasms of the female genital tract was more than three times the incidence of neoplasms of the male genital tract. For both the genders, the genital tract neoplasms contributed a greater proportion to the overall urogenital neoplasm incidence and risk. This was, especially true for the female gender, which suffered from lower incidence and risk of urologic neoplasms, and very high incidence and risk of genital tract neoplasms. The complex interplay between endocrinal and reproductive factors in the maintenance of fertile female genitalia has been implicated.

Cervical neoplasms were the most common site of female genital neoplasms. Incidence and risk of development of cervical cancer have increased compared to GLOBOCAN 2012 report and from an earlier study utilizing 2007–2008 data.[1] [11] The northeastern region has seen a substantial increase in risk (from 1 in 82 to 1 in 50) since then. HPV infection is the most important factor significantly associated with the development of cervical cancer. Lack of a national screening program and high costs of HPV vaccination,[3] [12] [13] stand as a major roadblock in improving outcomes associated with cervical cancer. The incidence of uterine neoplasms has increased almost two-fold compared to values reported by a study utilizing data spanning 1980–2003 from a limited set of registries.[14] Compared to the same study, incidence of ovarian neoplasms too showed an increase albeit of lesser magnitude.

Prostate was the most common site of male genital neoplasms. Despite conventionally low incidences in Asian and African countries, earlier studies had indicated a slowly but steadily rising burden.[15] [16] The values reported by present study conform to this trend. The urinary bladder was the most common site for the development of urologic neoplasms, followed by kidney. Smoking is an established risk factor for both the sites.[17] [18] In addition, occupational exposure is an independent risk factor for the development of bladder neoplasms.[8]

The site-specific neoplasms contributing to the bulk of urogenital neoplasm burden, all have risk factors that can be directly addressed. By reducing smoking, HPV prevalence, and occupational exposure, the burden of urogenital neoplasms can be substantially reduced. What lacking is the incorporation of risk profile assessment and dissemination of advice at appropriate centers.

Conclusions

Making people aware of urogenital neoplasms and their risk factors are important for the public health awareness point of view. Centers that deal with either management of urogenital cases or/and screening of genital neoplasms could serve as the designated centers for creating such awareness. Efforts can be concentrated in regions with higher incidence/risk, namely the Northern and Southern regions. In addition, there is a dire need to increase the number of Population-Based Cancer Registries (PBCRs) across the regions to allow for a more wholesome visualization of distribution.

Conflict of Interest

There are no conflicts of interest.

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Publication History

Article published online:
17 June 2021

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