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Compared to developed countries, only a limited number of studies systematically engage with India’s experience with the burden of childhood cancer and its implications for public healthcare in the country. This study aims to assess the long-term trend in the incidence of cancerous conditions, demographic factors, and the burden of the disease among children. The study has used the Madras Metropolitan Tumor Registry (MMTR), covering cancer cases reported among children (0–14 years) in Chennai for the last 34 years (1982–2016). The study analyses the incidence of the pediatric tumor for different age groups, gender, and type of cancer and the long-term trend over the years and compares the same with existing studies. The trend indicates that more cases are reported during 2007-11and the least number of cases are reported during 2012–2016 (respectively 16.7% and 11.9% of total cases reported).
The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
Srinivas Govindarajulu
The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
S. Kalpana
The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
Valarmathi Srinivasan
The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
Joseph Maria Adaikalam
The Tamil Nadu Dr. M.G.R. Medical University, Chennai, Tamil Nadu, India
*Address all correspondence to: sachusajnap@gmail.com
1. Introduction
Globally, the incidence of childhood cancer has been increasing steadily and throws new challenges in public health management and policy making. Its nature, types and risk factors vary across the countries. As a developing country, India’s experience with its given context is very important in understanding the role of epidemiological, demographic, socio-economic factors, and policy engagements in addressing public healthcare challenges. Several studies are looking into the experience of developed countries in addressing the cancer prevalence of cancer among children, their treatment, and attempts to connect them with countries’ epidemiological transition. Compared to this, only a limited number of studies systematically engage with India’s experience with the burden of childhood cancer and its implications for public healthcare in the country.
Available evidence indicates that India also experiences a steady increase in the number of children affected by different types of cancer. The details suggest that leukemia is the most common cancer affecting children followed by lymphoma and retinoblastoma. The profile of children affected by cancer shows variation across the age groups. The incidence of retinoblastoma, renal tumors, neuroblastoma, and hepatic tumors was found higher among children aged below five years whereas lymphoma, leukemia, bone tumors, and central nervous system tumors were found more among children aged above five years [1].
Globally, the annual number of new cases of childhood cancer exceeds 2, 00,000 and more than 80 percent of the reported cases are from the developing world [2]. Thirteen percent of the annual deaths worldwide are cancer-related and 70 percent of them are in the low- and middle-income countries [3]. Childhood cancer (age at diagnosis 0–14 years) is associated with a variety of malignancies and its incidence varies by age, sex, ethnicity, and geography, as reported by canceretiology [4, 5]. The incidence of childhood cancer across the countries ranges from 75 to 150 per million children per year. For instance, only 0.5 percent of all cancer cases reported in England occur in children less than 15 years of age whereas in India this proportion appears higher at 1.6–4.8 percent with variation by place of residence. This is related to the population structure (33% of the population in India is less than 15 years of age compared to 18% in England) [6, 7]. Though it remains less than the cases reported in the developed world, about 1.6 to 4.8 percent of all cancer reported in India are found in children below 15 years of age, and the overall incidence of 38 to 124 per million children, per year [8].
As 75 percent of the world population lives in these countries, developing countries bear more than half of the global cancer burden [9]. Because of population growth, aging and urbanization, changing dietary habits, better control of infections, and increasing tobacco consumption, developing countries are anticipated to bear a greater cancer burden, including that of greater lympho-hemopoietic malignancies [10]. India found to have 3 million persons is reported with cancer at any time, with 0.8 million new cases of cancer diagnosed each year [11]. There is a constant rise in cancer cases, but the trend and pattern vary according to the geographical region [12].
India’s experience with a fast-growing economy and change in lifestyle-related behaviors can be connected to increasing cancer load [13, 14]. The relative differences in the incidence of lympho-hemopoietic malignancies in urban and rural populations can be connected with the differences in the environmental and socioeconomic factors affecting the dietary habits and lifestyle in rural and urban areas [15]. They tend to follow the larger trends noticed in terms of disease risk connected with the relative contributions of environment and genetics in the etiology of specific cancers. Studies consider their contribution to risk due to variation in exposure to carcinogens (in the external environment, or through lifestyle choices), or in genetic susceptibility to them [16].
This study broadly highlights the intensity of childhood cancer and its implications for child healthcare and health management in the global, national and local contexts. It aims to assess the long-term trend in the incidence of cancerous conditions, demographic factors, and the burden of the disease among children in Chennai from 1982 to 2016.
This study has used the Madras Metropolitan Tumor Registry (MMTR), a population-based cancer registry (PBCR) based at the Cancer Institute (WIA), Chennai covering all cases reported among children (0–14 years) in Chennai for the last 34 years (1982–2016). All cases of childhood cancer from 0 to 14 years of age that were registered from 1st January 1982 to 31st December 2016 were included in this study. The study analyses the data on the incidence of the pediatric tumor for different age group, gender, and type of cancer and the long-term trend over the years and compare the same with existing studies. Childhood cancers (age at diagnosis 0–14 years) comprise a variety of malignancies, with incidence varied by age, sex, and ethnicity that provided insights into cancer etiology. The analysis looks into the types and incidence rate of cancer across the different age groups of children. The proposal was reviewed and approved by the ethical and scientific committees of the university.
The analysis covers 34 years (1982 and 2016) and shows the trend of the cancerous condition of children of madras. The long-term trend indicates that more number of cases is reported during 2007–2011 (639cases) constitutes 16.7 percent of the total cases reported during this period. At the same time, the least number of cases are reported during 2012–2016 (458cases), constituting 11.9 percent of the total cases reported (Figure 1).
Figure 1.
Number of cases reported: 1982–2016.
Table 1 describes the Sex-wise distribution of pediatric cancer during this period and shows that more number of cases are reported among male children (2313 cases) constituting 60.3% of total cases reported (3834). Compared to this, only 1521 cases (39.7%) are reported among female children.
SEX
Frequency
Percent (%)
Male
2313
60.3
Female
1521
39.7
Total
3834
100
Table 1.
Sex-wise distribution of reported cases (1982–2016).
Figure 2 describes the age group distribution of pediatric cancer reported from 1982 to 2016. When the children are classified into three agegroups, the data shows that more pediatric cancer is reported in 0–4 years of age (1417 cases) accounting for 37 percent of the total cases reported (3834 cases). The details show that the highest number of cases (370 cases, constituting 9.7%) was reported at three years of age.
Figure 2.
Distribution of reported cases across the age groups (share in %).
Table 2 shows the distribution of reported cases among the major religious groups. Compared to other religious groups, more pediatric cancer cases were reported in the Hindu community, (3172 cases) constituting 82.7 percent of the total 3834 cases. A large number of cases were reported among children from Muslim (392 cases, 10.2%), and Christian (247 cases 6.4%) communities.
Religion
Frequency
Percent (%)
Hindu
3172
82.7
Muslim
392
10.2
Christian
247
6.4
Sikh
1
0.0
Jain
22
0.6
Total
3834
100
Table 2.
Religion-wise distribution of reported cases 1982–2016.
Table 3 describes the distribution of different types of pediatric cancer reported during this period. The trend indicates that lymphoid leukemia is the most common type of cancer reported (1002 cases, constituting 26.1% of 3834 cases). Non-Hodgkin’s lymphoma, Myeloid Leukemia, Hodgkin’s disease, Brain Tumor, Eye Cancer, and other type’s cancers.
Type of CA
Frequency
Percent (%)
Lymphoid Leukemia
1002
26.1
NHL
297
7.7
Myeloid Leukemia
261
6.8
Hodgkin’s Disease
204
5.3
Brain Tumor
139
3.6
Eye Cancer
120
3.1
Other Cancer
1124
29.3
Bone Cancer
95
2.5
Rectum Cancer
192
5.0
Testis Cancer
53
1.4
Adrenal gland Cancer
69
1.8
Liver Cancer
40
1.0
Kidney Cancer
140
3.7
Leukemia unspecific
46
1.2
Multiple myeloma
52
1.4
Total
3834
100
Table 3.
Major types of cancer reported 1982–2016.
Table 4 shows that the pattern of reported cases changes across the years. Types of major cancer reported between different periods show that more number of cases were reported during 2007–2011 (639 cases, 16.7%). Major types include Non-Hodgkin’s lymphoma (39 cases, 6.1%), brain tumor (29 cases, 4.5%), rectum cancer (37 cases, 5.8%), kidney cancer (33cases, 5.2%), and other cancers (219cases, 34.3%). The other categories of cancer include cancers of the Nose, Pinna, fingers, nasopharyngeal cancers, etc.
Types
1982–1986
1987–1991
1992–1996
1997–2001
2002–2006
2007–2011
2012–2016
Total
Lymphoid Leukemia
92 (19.4)
106 (21.7)
173 (28.7)
138 (25.5)
209 (33.2)
172 (26.9)
112 (24.5)
1002 (26.1)
NHL
51 (10.7)
43 (8.8)
57 (9.5)
48 (8.9)
34 (5.4)
39 (6.1)
25 (5.5)
297 (7.7)
Myeloid Leukemia
44 (9.3)
50 (10.2)
34 (5.6)
32 (5.9)
41 (6.5)
31 (4.9)
29 (6.3)
261 (6.8)
Hodgkin’s D
19 (4.0)
38 (7.8)
35 (5.8)
35 (6.5)
31 (4.9)
26 (4.1)
20 (4.4)
204 (5.3)
Brain Tumor
14 (2.9)
30 (6.1)
14 (2.3)
13 (2.4)
22 (3.5)
29 (4.5)
17 (3.7)
139 (3.6)
Eye Cancer
29 (6.1)
18 (3.7)
26 (4.3)
39 (7.2)
8 (1.3)
0 (0.0)
0 (0.0)
120 (3.1)
Other CA
147 (30.9)
138 (28.3)
165 (27.4)
136 (25.1)
164 (26.0)
219 (34.3)
155 (33.8)
1124 (29.3)
Bone CA
13 (2.7)
16 (3.3)
13 (2.2)
13 (2.4)
16 (2.5)
10 (1.6)
14 (3.1)
95 (2.5)
Rectum CA
24 (5.1)
23 (4.7)
31 (5.1)
24 (4.4)
28 (4.4)
37 (5.8)
25 (5.5)
192 (5.0)
Testis CA
11 (2.3)
8 (1.6)
12 (2.0)
8 (1.5)
9 (1.4)
2 (0.3)
3 (0.7)
53 (1.4)
Adrenal gland CA
3 (0.6)
0 (0.0)
0 (0.0)
8 (1.5)
18 (2.9)
18 (2.8)
22 (4.8)
69 (1.8)
Liver CA
3 (0.6)
2 (0.4)
11 (1.8)
3 (0.6)
8 (1.3)
7 (1.1)
6 (1.3)
40 (1.0)
Kidney CA
14 (2.9)
10 (2.0)
14 (2.3)
22 (4.1)
27 (4.3)
33 (5.2)
20 (4.4)
140 (3.7)
Leukemia unspecific
3 (0.6)
4 (0.8)
8 (1.3)
14 (2.6)
9 (1.4)
5 (0.8)
3 (0.7)
46 (1.2)
Multiple myeloma
8 (1.7)
2 (0.4)
9 (1.5)
9 (1.7)
6 (1.0)
11 (1.7)
7 (1.5)
52 (1.4)
Total
475 (100)
488 (100)
602 (100)
542 (100)
630 (100)
639 (100)
458 (100)
3834 (100)
Table 4.
Major types of cancer: Trends across specific intervals (share in %).
Figure 3 shows the distribution of reported cases with their types and gender. The trend indicates that most types of cancer reported remain high among the male children, except myeloid leukemia (7.1%), eye cancer (4%), bone cancer (2.7%), liver cancer (1.2%), kidney cancer (4.1%) and other types of cancers (33.9%).
Figure 3.
Sex-wise distributions of reported cases and types of cancer (share in %).
Table 5 shows the incidence of different types of pediatric cancer for different age groups. More pediatric cancers are reported in 0–4 years of age (1417 cases, 37%) out of 3834cases. Which include myeloid leukemia (14.7%), eye cancer (6.4%), adrenal gland cancer (3.8%), liver cancer (2.3%), and multiple myeloma (1.5%). Compared to this, more cases of lymphoid leukemia (29.1%), non-Hodgkin’s lymphoma (9%), Hodgkin’s disease (7%), brain tumor (5.2%), rectum cancer (5.1%), testis cancer (2.3%), kidney cancer (4.2%), and unspecific leukemia (1.3%) were reported in 5–9 years of age. The number of cases reported on Bone cancer (2.5%), and other cancer (29.3%) was found high among the children 10–14 years of age.
Type of CA
00–04 Years
05–09 Years
10–14 Years
Lymphoid Leukemia
28.9
29.1
26.1
NHL
4.7
9.0
7.7
Myeloid Leukemia
14.7
3.7
6.8
Hodgkin’s Disease
1.7
7.0
5.3
Brain Tumor
2.5
5.2
3.6
Eye Cancer
6.4
2.0
3.1
Other Cancer
24.3
27.5
29.3
Bone Cancer
.5
1.3
2.5
Rectum Cancer
3.9
5.1
5.0
Testis Cancer
.6
2.3
1.4
Adrenal gland Cancer
3.8
0.8
1.8
Liver Cancer
2.3
0.5
1.0
Kidney Cancer
3.1
4.2
3.7
Leukemia unspecific
1.0
1.3
1.2
Multiple myeloma
1.5
1.0
1.4
Total
100
100
100
Table 5.
Incidence of pediatric cancer across age group (share in %).
The overall incidence of pediatric cancer has gradually decreased in Chennai during the period 2012–2016, compared to the previous years. Leukemia emerges as the most common pediatric cancer as indicated by many studies (Table 4). The results broadly follow some of the existing studies like the highest incidence occurring between 0 and 4 years of age (Table 2) and non-Hodgkin’s disease exceeds Hodgkin’s disease (Table 4) as reported in India between 2012 and 2014 (Suman Das et. al) [17]. Similarly, overall cancer in children is more common among males than females (Stiller C 2007; [18] Gurney JG. et al. 2006) [19]. Existing studies report that both Hodgkin’s and Non-Hodgkin’s disease had the highest incidence among 10–14 years age group for both sexes (Suman Das.et al. 2017) whereas the present study finds that the Non-Hodgkin’s disease and Hodgkin’s disease had the highest incidence among 5–9 years of age group (Table 5). Our analysis also highlights that brain tumor had the highest incidence among 5–9 years of the age group for both sexes (Table 5). Eye and liver tumors had the highest incidence among the 0–4 years age group while bone and gastrointestinal tumors had the highest incidence among the 10–14 years age group for both sexes (Table 5).
The analysis covers three thousand eight hundred and thirty-four cases of pediatric cancer registered at Madras Metropolitan Tumor Registry from 1982 to 2016. Overall, the results indicate a gradual decline in childhood cancer during this period and indicate that maximum cases are reported during 2007–2011. The results confirm some of the established patterns including a higher incidence of cancer among male children (60.3%), and a high incidence among the children in 0–4 yearsage group. Leukemia is the most common pediatric cancer and it constitutes 27 percent in males and 25 percent in females. Overall cancers are more reported in the Hindu community, while specific types like myeloid leukemia, NHL, brain tumor, and multiple myeloma are found high in the Jain community. Lymphoid leukemia and rectum ca are more common in the Muslim community.
The pediatric tumor showed wide variation concerning different age groups. The genetic and environmental factors played role in the etiology of pediatric cancer. Most pediatric cancer is curable if it has been detected early. Thus, the study offers some important insights and updates on the pediatric cancer trends in the city of Chennai and may serve as a reference source for clinicians and researchers on pediatric oncology and policymakers engaged in public health.
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Written By
Sajna Panolan, Srinivas Govindarajulu, S. Kalpana, Valarmathi Srinivasan and Joseph Maria Adaikalam
Submitted: 15 June 2022Reviewed: 23 June 2022Published: 16 October 2023
Open access peer-reviewed chapter
