SummaryBackgroundPrevious efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available.MethodsWe used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India.Findings8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016.InterpretationThe substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focu...

BACKGROUND:The Agricultural Health Study (AHS) is a prospective cohort study of licensed pesticide applicators from Iowa and North Carolina enrolled 1993-1997 and followed for incident cancer through 2002. A previous investigation in this cohort linked exposure to the organophosphate fonofos with incident prostate cancer in subjects with family history of prostate cancer. OBJECTIVES: This finding along with findings of associations between organophosphate pesticides and cancer more broadly led to this study of fonofos and risk of any cancers among 45,372 pesticide applicators enrolled in the AHS. METHODS: Pesticide exposure and other data were collected using self-administered questionnaires. Poisson regression was used to calculate rate ratios (RRs) and 95% confidence intervals (CIs) while controlling for potential confounders. RESULTS: Relative to the unexposed, leukemia risk was elevated in the highest category of lifetime (RR = 2.24; 95% CI, 0.94-5.34, p trend = 0.07) and intensity-weighted exposure-days (RR = 2.67; 95% CI, 1.06-6.70, p trend = 0.04), a measure that takes into account factors that modify pesticide exposure. Although prostate cancer risk was unrelated to fonofos use overall, among applicators with a family history of prostate cancer, we observed a significant dose-response trend for lifetime exposure-days (p trend = 0.02, RR highest tertile vs. unexposed = 1.77, 95% CI, 1.03-3.05; RR interaction = 1.28, 95% CI, 1.07-1.54). Intensity-weighted results were similar. No associations were observed with other examined cancer sites. CONCLUSIONS: Further study is warranted to confirm findings with respect to leukemia and determine whether genetic susceptibility modifies prostate cancer risk from pesticide exposure.

Obesity is associated with increased risks of several cancers including, colon, lower esophagus, kidney, female breast, and endometrium. Some studies have associated pesticides with higher risks of cancer in agricultural populations. The interaction between obesity and pesticide use on cancer risk has not been well studied. Using data from the Agricultural Health Study we examined the association between body mass index (BMI) and the risk of cancer at 17 sites, and the interaction between BMI and pesticide use. Pesticide applicators (primarly farmers), and their spouses residing in Iowa and North Carolina were enrolled between 1993 and 1997 and followed through 2005. This analysis included 39,628 men and 28,319 women who provided information on pesticide use, height and weight data, and were cancer-free at enrollment. Of all subjects, 64% were overweight or obese, and 4,432 incident cancers were diagnosed during the follow-up period. We found positive associations between BMI (continuous) and colon cancer among men (Hazard Ratio (HR) 1.05, 95% confidence interval (CI) 1.02-1.09) and breast cancer among postmenopausal women (HR 1.03, 95% CI 1.01-1.06), as well as an inverse association with lung cancer among men who were ever smokers (HR 0.92, 95% CI 0.88-0.96). Men who ever used carbofuran (HR=1.10, 95% CI 1.04-1.17), metolachlor (HR=1.09, 95% CI 1.04-1.15), and alachlor (HR=1.08, 95% CI 1.03-1.13) had significant positive associations between BMI and colon cancer, but non-users did not. Men who ever smoked and used carbofuran had a positive, although not significant, association between BMI and lung cancer, while users of carbofuran had a significant inverse association. These findings, which suggest that certain pesticides may modify the association between BMI and colon and lung cancer risk, should be further evaluated in other populations.