Cancer pattern and survival in a rural district in South India

Swaminathan, Rajaraman; Selvakumaran, R.; Esmy, Pulikattil Okkuru; Sampath, P.; Ferlay, Jacques; Jissa, V T; Shanta, V.; Cherian, Mary; Sankaranarayanan, Rengaswamy

doi:10.1016/j.canep.2009.09.008

Cited by 55 publications

(43 citation statements)

References 11 publications

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“…7 An almost 50% decline in cervical cancer incidence rates was observed in Dindigul district, Tamil Nadu after wide-spread use of VIA screening in the district. 27 Thus, there is a wide ranging evidence base on accuracy 28 and efficacy indicators 4,[24][25][26] that justify the use of visual screening tests for cervical cancer screening as an alternative approach to cytology in two contexts in settings where HPV testing is neither feasible nor affordable: either as a primary screening test or to triage women who have tested positive for high-risk HPV infection for directing treatment. Although currently available HPV tests are expensive, new more affordable HPV tests (e.g., careHPV test) are likely to be commercially available in the near future in low-resource countries.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

Deodhar

Sankaranarayanan

Jayant

et al. 2012

Intl Journal of Cancer

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The high burden of cervical cancer and inadequate/suboptimal cytology screening in developing countries led to the evaluation of visual screening tests, like visual inspection with acetic acid (VIA) and Lugol's iodine (VILI). We describe the performance of VIA, VILI and cytology, carried out in a multinational project called ''Screening Technologies to Advance Rapid Testing'' in 5,519 women aged 30-49 years, in detecting cervical intraepithelial neoplasia (CIN). VIA, VILI and cytology were positive in 16.9%, 15.6% and 6.1% women, respectively. We found 57 cases of CIN2, 55 of CIN3 and 12 of cervical cancer; 90% of CIN3 and 43% CIN2 cases were positive for p16 overexpression and high-risk HPV infection, indicating a high validity of histological diagnosis. The sensitivity of VIA, VILI and cytology to detect high-grade CIN were 64.5%, 64.5% and 67.7%, respectively; specificities were 84.2%, 85.5% and 95.4%. A high proportion of p16 positive CIN 3 (93.8%) and 2 (76.9%) were positive on cytology compared with visual tests (68.8% and 53.8%, respectively) indicating a higher sensitivity of cytology to detect p16 positive high-grade CIN. However, the immediate availability of the results from the visual tests permits diagnosis and/or treatment to be performed in the same sitting, which can potentially reduce loss to follow-up when women must be recalled following positive cytology. Organizing visual screening services in low-resource countries may facilitate the gradual building of an infrastructure committed to screening allowing the eventual introduction of more sensitive, highly objective, reproducible and affordable human papillomavirus screening tests in future.Early detection of high-grade cervical intraepithelial neoplasia (CIN 2-3 lesions) by screening and their effective treatment constitute the most common and widely used strategy to prevent cervical cancer throughout the world. Conventional cervical cytology is the most widely used screening test and the workhorse of large-scale cervical screening programs globally. Cytology is repeated frequently, at 1-5 year intervals, to ensure lesions missed in a given round of screening and incident lesions are detected in subsequent rounds. Collection of cervical cells, smear preparation, processing, reading and reporting requires several labor intensive steps as well as a laboratory infrastructure. Stringent quality assurance is vital to avoid any suboptimal performance of cytology in detecting cervical cancer precursors. The difficulties in ensuring optimal cytology screening with inadequate coverage for both testing and treatment of precursor lesions or lack of screening per se are responsible for the continuing high risk and burden of cervical cancer in developing countries.

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Section: Discussionmentioning

confidence: 99%

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

Deodhar

Sankaranarayanan

Jayant

et al. 2012

Intl Journal of Cancer

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“…However on comparing the cancer incidence across the various regions of the countries, it is evident that the south zone of India has a less incidence of cancer as compared to the other areas. Swaminathan et al (2009) studying rural districts of south India concluded that cancer incidence to be significantly lower, cancer patterns to be markedly different and population based cancer survival to be lower in rural than urban areas thus necessitating the estimation of realistic cancer burden. Manoharan et al (2010) have reported a statistically significant difference in cancer rates in rural vs. urban Delhi wherein the former the rates are even lower than other rural registries of the country.…”

Section: Cancer In Indian Subcontinent: a National Perspectivementioning

confidence: 99%

Head and Neck Cancer: Global Burden and Regional Trends in India

Mishra

Meherotra²

2014

Asian Pacific Journal of Cancer Prevention

157

100

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“…The Indian Cancer registry derives its data mainly from the metropolitan cities of the country which register a more urbane population. Selective reports from rural pockets of India (Mehrotra et al, 2008;Swaminathan et al, 2009;Manoharan et al, 2010;Nandi et al, 2013) have all reported cervix to be the leading cancer site in the country followed closely by the breast. The scenario will soon change as all the registries show an increasing trend in the percentage of breast cancer cases to the total number of cancer cases registered over the years.…”

Section: Indiamentioning

confidence: 99%

Hypofractionated Radiotherapy for Breast Cancers - Preliminary Results from a Tertiary Care Center in Eastern India

Nandi

Mahata²,

Mallick³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The standard radiotherapy (RT) fractionation in breast cancers practised in India and worldwide is 50Gy in 25 fractions over 5 weeks to the chest wall or whole breast followed by tumour bed boost in case of breast conservation (BCS). A body of validated data exists regarding hypofractionation in breast cancer. We here report initial results for 135 patients treated at our centre with the START-B type of fractionation. Materials and Methods: From May 2011 till July 2012, women with all stages of breast cancer (excluding metastatic), who had undergone BCS or mastectomy were planned for 40Gy in 15 fractions over 3weeks to chest wall/whole breast and supraclavicular fossa (where indicated) followed by tumour bed boost in BCS patients. Planning was done using Casebow's technique. The primary end point was to assess the acute toxicity and the cosmetic outcomes. Using cosmetic scales; patients were assessed during radiotherapy and at subsequent follow up visits with the radiation oncologist. Results: Of the 135 patients, 62 had undergone BCS and 73 mastectomy. Mean age of the population was 52 years. 80% were T1&T2 tumours in BCS group whereas most patients in mastectomy group had T3&T4 tumours (60%). 45% were node negative in BCS group whilst it was 23% in the mastectomy group. Average NPI scores were 3.9 and 4.9, respectively. Most frequently reported histopathology and 30% were Her 2 Neu positive. Triple negative tumours accounted for 13% and their mean age was younger than the general population (43 yrs.) The maximum acute skin toxicity at the end of treatment was Grade 1 in 94% of the mastectomy group of patients and 71% in BCS patients. Grade 2 toxicity was 6% in mastectomy group and 23% in BCS group. Grade 3 was 6% in BCS group, no grade 3 toxicity in mastectomy patients and there was no grade 4 skin toxicity in any case. Post RT at 1 month; 39% of BCS patients had persisting Grade I skin reaction which was only 7% in mastectomy patients. At 3 months post RT, 18% patients had persisting hyperpigmentation. At 6 months 8% patients had persisting erythema in the BCS group only. 3% of BCS and 8% of mastectomy patients had lymph edema till the date of evaluation. Cosmetic outcome in BCS patients remained good to excellent 6 months post surgery and radiotherapy. 1 patient of BCS and 3 patients of mastectomy had developed metastatic disease at the time of evaluation. Conclusions: Hypofractionated RT is well tolerated in Indian population with less acute skin toxicity and good cosmetic outcome. Regimens such as these should be encouraged in other centre to increase machine output time. The study is on-going to assess long term results.

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Cancer pattern and survival in a rural district in South India

Cited by 55 publications

References 11 publications

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

Accuracy of concurrent visual and cytology screening in detecting cervical cancer precursors in rural India

Head and Neck Cancer: Global Burden and Regional Trends in India

Hypofractionated Radiotherapy for Breast Cancers - Preliminary Results from a Tertiary Care Center in Eastern India

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