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Background The Covid-19 pandemic and subsequent lockdown in India caused disruptions in cancer treatment due to the restriction on movement of patients. We aimed to maintain continuity in cancer treatment during the lockdown through teleconsultations. We tried to reach out to our patients using telephonic consultations by establishing a Teleconsult Centre facility run by a team of doctors and patient navigators. Methods We telephonically contacted all patients who had outpatient appointments from 23 March to 30 April 2020 at our centre through the Teleconsult Centre to understand their current circumstances, feasibility of follow-up, local resources and offered best possible alternatives to continue cancer treatment, if required. Results Of the 2686 patients scheduled for follow-up during this period, we could contact 1783 patients in 9 working days. Through teleconsultations, we could defer follow-ups of 1034 patients (57.99%, 95% confidence interval [CI] 55.6%–60.3%), thus reducing the need for patients to travel to the hospital. Change in systemic therapy was made in 75 patients (4.2%, 95% CI 3.3%–5.2%) as per the requirements and available resources. Symptoms suggestive of disease progression were picked up in 12 patients (0.67%, 95% CI 0.35%–1.17%), who were advised to meet local physicians. Conclusion Our study suggests that the majority of patients on follow-up can be managed with teleconsultation in times of crisis. Teleconsultation has the potential of being one of the standard methods of patient follow-up even during periods of normalcy.

Worldwide the incidence of esophagus squamous cell carcinoma (ESCC), remains one of the most common causes of cancer death. ESCC is one of the leading types of cancer in the North and Northeast regions of India among both genders. Risk factors of ESCC include tobacco, alcohol, areca nut, hot beverages, low fruit diet, poor oral hygiene, unpiped water, and human papillomavirus infection. This review tries to elaborate on various modifiable risk factors for ESCC, which have been studied worldwide and need to be studied in India. PubMed was used as a search platform using keywords, such as “esophagus cancer,” “esophagus squamous cell carcinoma,” “epidemiology,” “India,” “incidence,” “mortality,” “risk factors,” “treatment,” “survival,” “prevention” and their corresponding Medical Subject Heading terms, were used in combination with Boolean operators “OR” and “AND.” Studies from India are mostly hospital-based case-control studies from the North region. Further research is required in India to understand the etiology, to design large-scale screening and prevention strategies.

Tobacco products are used in vary many forms in India. Although the risk of tobacco uses in developing head and neck cancer (HNC) is known, risk by exclusive use of different tobacco products on HNC and its subtypes is poorly understood. A case-control study was conducted at a tertiary cancer hospital, which receives cases from different geographical regions of India with use of different types of tobacco products. The study included 824 oral cavity (OC), 149 oropharynx (OPX) 104 hypopharyngeal (HPX) and 81 larynx (LX) cancer cases and 1206 visitor controls. Information on 11 different types of tobacco products and exposure to secondhand smoke was collected through structured questionnaires. Odds ratios (OR) and 95% confidence intervals (CI), for the association of various HNC subtypes with exclusive use of each tobacco product compared to nonusers of tobacco were estimated using logistic regression models, after adjusting for potential confounders. Exclusive use of any type of smokeless tobacco product was strongly associated with all subtypes of HNC. Gutka chewing (only) had highest risk (OR = 33.67; 95% CI = 19.8-57.0) while exclusive users of betel quid with tobacco (BQ + T), tobacco quid, Khaini, Mawa and Mishri users had a OR of 14.77, 24.20, 5.33, 2.96 and 3.32, respectively, for development of OC. Bidi smoking and secondhand smoke was independently associated with increased risk of HNC. Our study indicates that tobacco control policies should focus on product specific awareness messaging that switching between tobacco product types is not a safe alternative to complete cessation.

There is an entrenched belief among pathologists, biologists and clinicians alike that metastatic tumours are histologically similar to the primary. Although this belief has never been scientifically tested, it forms the conceptual foundation upon which metastasis research has been based for decades. In order to scientifically test this dogma, we conducted a blinded experiment in which three highly experienced professor grade cancer pathologists were asked to predict the site of origin of 298 metastatic tumours arising at nine different sites. The accuracy of prediction of all three examiners was just under 50%. However, there was very little inter-observer agreement, and Kappa statistic generated the value of 0.27 which is much below the figure of 0.4 required to detect even a moderate level of concordance. In only 56 / 298 (18.8%) cases did the examiners agree with each other’s diagnosis. Thus the possibility cannot be excluded that the correct diagnoses made by the examiners had happened by play of chance. Our finding suggests that histological relationship between primary and metastatic tumours requires further investigation.

In developed countries, there has been a definite change in the histopathological spectrum of esophageal cancer towards adenocarcinoma. There are limited data from India regarding the histopathological profile of patients with esophageal cancer.We retrospectively evaluated patients with histologically proven esophageal cancer who were registered at the Tata Memorial Hospital (Mumbai, India) between 2003 and 2018. The primary aim of the study was to analyze the time-trend of the histological pattern of esophageal cancer. Our secondary objectives included evaluating whether there was any correlation between the histology of the esophageal cancer and the age, sex, socioeconomic status (the paying ability of the patient, which was reflected in the treatment category of the patient, i.e., private [full payment], general [subsidized payment], or no charge), comorbidities, and a history of substance abuse.Among 7874 patients with esophageal cancer, 5092 (64.7%) were men, with a male-to-female ratio of 1.8:1. The median age was 57 years (IQR, 50-65). Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, 1360 (27.7%) had no history of substance abuse. A majority of the tumors (2942, 37.4%) originated in the middle-third of the esophagus. Squamous cell carcinoma was the predominant histological type, noted in 6413 (81.4%) patients and remained the most common histologic type consistently through the study with no evidence of a time-trend in the histological pattern. On the multivariate analysis, female sex and a history of substance abuse were associated with higher odds of squamous cell carcinoma, while the presence of comorbidities and lower esophageal/gastroesophageal junction primaries were associated with higher odds of adenocarcinoma.There is no evidence of an epidemiological shift in the histopathologic spectrum of esophageal cancer in India over the last two decades. Four out of five Indian patients with esophageal cancer have squamous cell histology, with the commonest site of origin being the middle third. This is important to recognize, given the varying molecular spectrum and efficacy of therapeutic modalities based on histopathology.

Studies on the extent to which long-term exposure to ambient particulate matter (PM) with aerodynamic diameterWe conducted a retrospective cohort study within the Million Death Study (MDS) to provide the first-ever quantification of national mortality from exposure toWe calculated relative risks (RRs) by linking a total of ten 3-y intervals of satellite-based estimatedDirect epidemiological measurements, despite inherent limitations, yielded associations between mortality and long-term

Population-based cancer survival is a key measurement of cancer control performance linked to diagnosis and treatment, but benchmarking studies that include lower-income settings and that link results to health systems and human development are scarce. SURVCAN-3 is an international collaboration of population-based cancer registries that aims to benchmark timely and comparable cancer survival estimates in Africa, central and south America, and Asia.In SURVCAN-3, population-based cancer registries from Africa, central and south America, and Asia were invited to contribute data. Quality control and data checks were carried out in collaboration with population-based cancer registries and, where applicable, active follow-up was performed at the registry. Patient-level data (sex, age at diagnosis, date of diagnosis, morphology and topography, stage, vital status, and date of death or last contact) were included, comprising patients diagnosed between Jan 1, 2008, and Dec 31, 2012, and followed up for at least 2 years (until Dec 31, 2014). Age-standardised net survival (survival where cancer was the only possible cause of death), with 95% CIs, at 1 year, 3 years, and 5 years after diagnosis were calculated using Pohar-Perme estimators for 15 major cancers. 1-year, 3-year, and 5-year net survival estimates were stratified by countries within continents (Africa, central and south America, and Asia), and countries according to the four-tier Human Development Index (HDI; low, medium, high, and very high).1 400 435 cancer cases from 68 population-based cancer registries in 32 countries were included. Net survival varied substantially between countries and world regions, with estimates steadily rising with increasing levels of the HDI. Across the included cancer types, countries within the lowest HDI category (eg, CÔte d'Ivoire) had a maximum 3-year net survival of 54·6% (95% CI 33·3-71·6; prostate cancer), whereas those within the highest HDI categories (eg, Israel) had a maximum survival of 96·8% (96·1-97·3; prostate cancer). Three distinct groups with varying outcomes by country and HDI dependant on cancer type were identified: cancers with low median 3-year net survival (30%) and small differences by HDI category (eg, lung and stomach), cancers with intermediate median 3-year net survival (30-79%) and moderate difference by HDI (eg, cervix and colorectum), and cancers with high median 3-year net survival (≥80%) and large difference by HDI (eg, breast and prostate).Disparities in cancer survival across countries were linked to a country's developmental position, and the availability and efficiency of health services. These data can inform policy makers on priorities in cancer control to reduce apparent inequality in cancer outcome.Tata Memorial Hospital, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer.

Globally, cervical cancer is the fourth most common cancer among females and a major public health problem in low- and middle-income countries (LMICs). There are several screening tests available for cervical cancer screening; however, due to a lack of organised screening facilities as well as factors such as low participation rates in screening programmes, many women die due to cervical cancer. To reach out to a large number of women, an easy, non-invasive and time-saving screening method is required. Evidence supports that cervical cancer screening with human papillomavirus deoxyribonucleic acid (HPV DNA) testing is the most effective technique for lowering the incidence and mortality associated with cervical cancer when compared to other screening methods. Furthermore, a small number of studies have reported that menstrual blood can be used as an alternative sample for HPV detection for cervical cancer screening. We have done a systematic review of the studies that have reported the diagnostic accuracy of menstrual blood to detect HPV. We found five studies in our literature search. The studies showed the diagnostic accuracy of menstrual blood in terms of sensitivity ranging from 82.8% to 97.7% and specificity ranging from 50.0% to 98.0% in cervical intraepithelial neoplasia or HPV infection detection. This review supports the use of menstrual blood as a screening tool for cervical cancer especially in LMICs where women are reluctant to participate in cervical cancer screening due to issues such as embarrassment and discomfort to test procedures as well as busy schedules. However, further studies are required to compare the diagnostic accuracy of menstrual blood in detecting HPV compared to other self-sampled HPV detection methods. This is one of the methods that can be explored further for use as a cervical cancer screening test.

Worldwide 8.2 million people die from cancer & 2/3rd of them are from LMIC. Tobacco-related cancer (TRCs) accounts a major share. In India, 45% of male's and 20% of female's cancer is due to tobacco use. Nearly half of all cancers in men occur at sites associated with tobacco use( Farhood and et al., 2018 Mar) .11 Objective This attempt to find out impact of tobacco prevalence on incidence rate of Tobacco related cancers across various states of India. This can help policy makers to understand and formulate control measures to curb the increasing trend of TRCs. Methods Age standardised incidence rate of TRCs from Global Burden of Diseases, Injuries, and Risk Factors Study and tobacco prevalence from NFHS-4 data was observed. State-wise data harmonisation towards tobacco prevalence and cancer incidence was performed. Results Reduction of tobacco consumption prevalence only 1% may decline incidence of lip, oral cavity and larynx cancer by 23.56 per 10 lac female populations and incidence of pharynx cancer by 25.31 per 10 lac male populations. Conclusion Tobacco consumption contributes substantial AAR of TRCs among both sexes in most of the Indian states while, other factors need to be considered too. Hence, systematic, multi-sectorial coercive approach to curtail the burden related to TRCs is imperative.

Background The coronavirus infection is rapidly spreading, putting a strain on health care services across the globe. Patients with oral cancer are susceptible often immunosuppressed due to the disease and/or the treatment received. Methods We performed a simulation of the currently available data using a multistate and hazards model to provide an objective model for counseling and decision making for health care workers. Results Stage IV patients with oral cancer who did not receive treatment had progression of disease and an increased mortality rate compared to patients who receive treatment but did not contract COVID‐19. The patients who received treatment and got affected with COVID‐19 had a far worse impact and higher mortality rate than all other groups. Conclusion Isolation and deferring treatment for stage IV patients with oral cancer, so as to avoid hospital visits and contraction of COVID‐19, is an advisable strategy based on this model.

Introduction: We used data from MOBI-Kids, a 14-country international collaborative case-control study of brain tumors (BTs), to study clinical characteristics of the tumors in older children (10 years or older), adolescents and young adults (up to the age of 24). Methods: Information from clinical records was obtained for 899 BT cases, including signs and symptoms, symptom onset, diagnosis date, tumor type and location. Results: Overall, 64% of all tumors were low-grade, 76% were neuroepithelial tumors and 62% gliomas. There were more males than females among neuroepithelial and embryonal tumor cases, but more females with meningeal tumors. The most frequent locations were cerebellum (22%) and frontal (16%) lobe. The most frequent symptom was headaches (60%), overall, as well as for gliomas, embryonal and 'non-neuroepithelial' tumors; it was convulsions/seizures for neuroepithelial tumors other than glioma, and visual signs and symptoms for meningiomas. A cluster analysis showed that headaches and nausea/vomiting was the only combination of symptoms that exceeded a cutoff of 50%, with a joint occurrence of 67%. Overall, the median time from first symptom to diagnosis was 1.42 months (IQR 0.53-4.80); it exceeded 1 year in 12% of cases, though no particular symptom was associated with exceptionally long or short delays.Conclusions: This is the largest clinical epidemiology study of BT in young people conducted so far. Many signs and symptoms were identified, dominated by headaches and nausea/vomiting. Diagnosis was generally rapid but in 12% diagnostic delay exceeded 1 year with none of the symptoms been associated with a distinctly long time until diagnosis. This work was supported by the MOBI-Kids study and the work in this study was obtained from the European Community's Seventh Framework Programme under Grant Agreements Number 226873—the MOBI-Kids Project—and 603794—the GERoNiMO project. Additional funds for the coordination of MOBI-Kids were obtained from the Spanish Ministry of Science and Innovation (MINECO), while complementary funds for the conduct of MOBI-Kids in Spain were obtained from the Spanish Health Research Fund (FIS) of the National Institute for Health Carlos III. Italian participation is partially supported by a Ministry of Health grant (RF-2009-1546284). In Canada, funding was provided by a grant from the Canadian Institutes for Health Research under a peer-reviewed university-industry partnership program that involved the Canadian Wireless Telecommunications Association, who provided technical data on wireless telecommunications practices in Canada. The German study centre received additional support by the Federal Office for Radiation Protection (BfS). Japanese participation in MOBI-Kids was supported by the Ministry of Internal Affairs and Communications. New Zealand participation was supported by Health Research Council and Cure Kids. In France, this study received funds from the French National Agency for Sanitary Safety of Food, Environment and Labour (ANSES, contract FSRF2008-3), French National Cancer Institute (INCa), Pfizer Foundation and League against cancer. India received funding from Board of Research in Nuclear Sciences (BRNS). The funding sources had no role in: the study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the article for publication.

Although a subset of head and neck cancers (HNC) has been associated worldwide with mucosal high-risk human papillomaviruses (HPV), information on the prevalence of HPV-positive HNC in India is limited. In this study, we examined the prevalence of 21 subtypes of HPV in sub-sites of HNC (

Background. This manuscript describes the genetic features of SARS-CoV-2 mutations, prevalent phylogenetic lineages, and the disease severity amongst COVID-19-vaccinated individuals in a tertiary cancer hospital during the second wave of the pandemic in Mumbai, India. Methods. This observational study included 159 COVID-19 patients during the second wave of the pandemic from 17th March to 1st June 2021 at a tertiary cancer care centre in Mumbai. The cohort comprised of healthcare workers, staff relatives, cancer patients, and patient relatives. For comparison, 700 SARS-CoV-2 genomes sequenced during the first wave (23rd April to 25th September 2020) at the same centre were also analysed. Patients were assigned to nonvaccinated (no vaccination or p = 0.27). There was no occurrence of severe COVID-19 in the dose 2 group (0/38, 0% vs. 14/121, 11.6%; p = 0.02). SARS-CoV-2 genomes from all three severe COVID-19 patients in the vaccinated group belonged to the delta lineage (3/28, 10.7% vs. 0/39, 0.0%, p = 0.04). Conclusions. Sequencing analysis of SARS-COV-2 genomes from Mumbai during the second wave of COVID-19 suggests the prevalence of the kappa B.1.617.1 and the delta B.1.627.2 variants among both vaccinated and unvaccinated individuals. Continued evaluation of genomic sequencing data from breakthrough COVID-19 is necessary for monitoring the properties of evolving variants of concern and formulating appropriate immune response boosting and therapeutic strategies.

Background: In Punjab, esophageal carcinoma has been reported as leading cancer in rural population. Reason for this high incidence of esophageal carcinoma in this region is unknown. The life style of people in Punjab is different from those of other areas in India. Therefore, the risk factors contributing to esophageal carcinoma in Punjab may also be different than the other parts of India. There are no previous studies on risk factors for high incidence of esophageal carcinoma in this region. Use of pesticides is much higher in Punjab state. Also there is no evidence available for association of use of pesticides/fumigants in occurrence of esophageal carcinoma. Hence this study is planned to identify the risk factors, especially the role of chemical toxicity (Pesticides/fumigants/heavy metals) associated with development of esophageal carcinoma among inhibitants of Punjab. Methods: A case-control design will be used to identify potential risk factors associated with development of carcinoma esophagus in Punjab. Cases will be recruited from PGIMER, Chandigarh, Population based cancer registry Mansa, Sangrur, SAS Nagar and Punjab Cancer control cell. For each esophageal cancer case 2 controls will be selected after matching for gender, age and area of residence. A pre designed questionnaire, including demographic characteristics, family cancer history, personal medical history, height, weight, life-style (habits such as smoking, tobacco chewing, alcohol drinking, etc.), dietary habits, fumigants and pesticide usage and practices etc, will be used. Urine samples will be taken for the analysis of pesticide metabolites. Heavy metals analysis will be done in water samples. Oral health will be examined for mucosal changes as well as for oral hygiene. Discussion: This study will results in identification of risk factors for high occurrence of esophagus carcinoma in Punjab, so that measures for early detection, prevention and control of esophagus carcinoma could be initiated.

Purpose: Identifying infectious pathogens by collecting intravenous blood (IVB) is a well-established procedure, however, the collection of IVB in field epidemiological study is challenging. The dried blood spot (DBS) as an alternative to IVB has been introduced, although, there is a limited study to demonstrate the utility of DBS stored at various storage conditions and transported at different periods. This is an observational study, which evaluates the effectiveness of DBS in field epidemiological studies to identify infectious pathogens. Materials and Methods: A total of 264 paired DBS samples prepared from IVB, stored at 4°C, −20°C after period 24, 48 and 72 h. Serologically, enzyme-linked immunosorbent assay [ELISA] IgG antibody detected against Helicobacter pylori infection from DBS and compared with IVB. Results: Quantitatively, IgG antibody reactivity showed >87% correlation between IVB and DBS samples stored at 4°C or −20°C within 48 h of transport duration. DBS stored at 4°C shows, equal sensitivity 87.5% and specificity 95% before 48 h of transport duration, while at −20°C storage similar sensitivity 87.5% observed but slightly less specificity 86.36% observed as compared to 24 h of transport duration. One-way analysis of variance showed, nonsignificant difference at both (−20°C and 4°C) the stored condition with P value (P > 0.851) and (P > 0.477). Kappa values showed good inter-rater reliability between DBS and IVB in a range (0.77–0.81). Conclusion: No significant difference was observed in detecting H. pylori when ELISA was conducted using IVB or DBS stored at 4°C and transported even after 48 h. This confirms that DBS collected even in compromised conditions in the field can be used for detecting infection.

The aim was to determine the prevalence and predictors of depression among less symptomatic COVID-19 patients.A questionnaire-based assessment was conducted among asymptomatic or mildly symptomatic COVID-19 patients when admitted in a COVID-19 facility (T1) and after 6 months (T2). Interviews were conducted using the Patient Health Questionnaire-9 instrument. Socio-demographic details and length of facility stay were recorded. Changes in scores between the two-time points T1 and T2 were compared. Factors predicting depression were determined using Chi-square and Mann-Whitney U test during facility stay, and those predicting worsening over time were obtained using multivariate regression models.Among the 91.4% (There is a need for actively detecting and managing depression in institutionally quarantined survivors, considering limiting such quarantine to no more than a week, and providing routine screening and care for depression beyond this period.

ObjectiveTo understand the outcome of hospitalised patients from Mumbai City, which had the highest number of COVID-19 cases in India.DesignObservational study with follow-up.SettingData extraction from medical records of patients with COVID-19 admitted to Nair Hospital & TN Medical College, Mumbai, India.Participants689 patients with COVID-19 were admitted in the hospital from 26 March 2020 to 11 May 2020.Primary and secondary outcome measuresIn-hospital mortality; joint effect of comorbidity and age on the risk of dying.ResultsA total of 689 patients (median age 44 years) admitted with RT-PCR-confirmed COVID-19 were included in the study. Of these, 77.36% of patients were discharged alive while 22.64% died. 11.61% required some kind of oxygen support while 2.8% of patients required intensive care unit admissions. Older age (HR 2.88, 95% CI 2.09 to 3.98), presence of comorbidities (HR 2.56, 95% CI 1.84 to 3.55), history of hypertension (HR 3.19, 95% CI 1.67 to 6.08), and presence of symptoms at the time of admission (HR 3.21, 95% CI 1.41 to 7.26) were associated with increased risk of in-hospital mortality. Treatment with a combination of azithromycin with hydroxychloroquine, antiviral or steroid compared with no treatment did not alter the disease course and in-hospital mortality. The combined effect of old age and presence of comorbid conditions was more pronounced in women than men.ConclusionsIn-hospital patients were younger, less symptomatic with lesser need of ventilators and oxygen support as compared with many western countries.Trial registrationNot applicable (observational study, not a clinical trial).

Variations in cancer incidence, mortality and pattern exist in rural and urban areas. Understanding these differences helps in developing targeted cancer prevention and control strategies. However, no previous studies have explored the differences in cancer demographics between the rural and urban areas of Nepal. The data of Kathmandu Valley (urban area) Population-Based Cancer Registry (PBCR) and Rukum (rural area) PBCR were analysed to identify the differences in cancer pattern in rural and urban areas. The age-adjusted incidence rate (AAR) in Kathmandu was higher than that in Rukum (1.6 times among males and 1.9 times among females). The top two leading sites in males were lungs and stomach in both the regions; however, the rates were higher in Kathmandu. The incidence rate for cancer of the urinary bladder among males in Kathmandu was particularly higher – 4.4 times that of Rukum. In females, the leading site of cancer in Kathmandu was breast, which was eight times higher compared to Rukum, whereas the incidence rate of cervix cancer in Kathmandu is 30% less than in Rukum. The incidence of tobacco-related cancer was found to be higher in Kathmandu compared to Rukum. These findings reveal the need for different policy priorities for cancer control in the urban versus rural regions of Nepal, based on the different demographics of cancer in the two areas. Similar studies from other regions of Nepal are needed to develop a targeted cancer control strategy.

In low and middle-income countries, access to cancer diagnosis and treatment is suboptimal. Further, compliance to cancer treatment is a major issue due to various reasons including financial barriers, lack of family support and fear of treatment. This article discusses the determinants of treatment completion in cancer patients of a government-run hospital, in a rural part of Punjab in India. The Sangrur hospital-based cancer registry data for the year 2018 have been used. We have registered 2,969 cancer cases, out of which 2,528 (85%) cases were eligible for the analysis. Of the total 2,528 cases, 1,362 (54%) cases completed the cancer directed treatment and 1,166 (46%) did not. The data have been collected from the electronic medical record (EMR) department and entered into CanReg5 software. The bivariate and multivariate binary logistic regression analysis was performed to see the effect of variables on the treatment completion. The results indicate that the elderly age group (>60 years) (odds ratio (OR): 0.52, (95% confidence interval (CI): 0.31–0.86)), distance from hospital (OR: 0.67, (95% CI: 0.50–0.89)) and access to government health schemes (OR: 0.13, (95% CI: 0.10–0.19)] have direct correlation with the treatment completion. The educated patients (OR: 1.49, (95% CI: 1.13–1.96)) and patients who received curative treatment (OR: 2.7, (95% CI: 1.88–3.88)) have shown 58% and 84% compliance to treatment completion, respectively. The other variables like the clinical extent of disease, religion, gender and income do not have any significant effect on the treatment completion. Determinants like age (young), education, distance from the hospital, curative treatment and availability of government health schemes for financial support have shown positive effects on treatment completion. These factors have to be considered by the cancer hospitals, health departments and policymakers while planning for cancer care or control in India.

Objective To test the efficacy of screening by clinical breast examination in downstaging breast cancer at diagnosis and in reducing mortality from the disease, when compared with no screening. Design Prospective, cluster randomised controlled trial. Setting 20 geographically distinct clusters located in Mumbai, India, randomly allocated to 10 screening and 10 control clusters; total trial duration was 20 years (recruitment began in May 1998; database locked in March 2019 for analysis). Participants 151 538 women aged 35-64 with no history of breast cancer. Interventions Women in the screening arm (n=75 360) received four screening rounds of clinical breast examination (conducted by trained female primary health workers) and cancer awareness every two years, followed by five rounds of active surveillance every two years. Women in the control arm (n=76 178) received one round of cancer awareness followed by eight rounds of active surveillance every two years. Main outcome measures Downstaging of breast cancer at diagnosis and reduction in mortality from breast cancer. Results Breast cancer was detected at an earlier age in the screening group than in the control group (age 55.18 (standard deviation 9.10) v 56.50 (9.10); P=0.01), with a significant reduction in the proportion of women with stage III or IV disease (37% (n=220) v 47% (n=271), P=0.001). A non-significant 15% reduction in breast cancer mortality was observed in the screening arm versus control arm in the overall study population (age 35-64; 20.82 deaths per 100 000 person years (95% confidence interval 18.25 to 23.97) v 24.62 (21.71 to 28.04); rate ratio 0.85 (95% confidence interval 0.71 to 1.01); P=0.07). However, a post hoc subset analysis showed nearly 30% relative reduction in breast cancer mortality in women aged 50 and older (24.62 (20.62 to 29.76) v 34.68 (27.54 to 44.37); 0.71 (0.54 to 0.94); P=0.02), but no significant reduction in women younger than 50 (19.53 (17.24 to 22.29) v 21.03 (18.97 to 23.44); 0.93 (0.79 to 1.09); P=0.37). A 5% reduction in all cause mortality was seen in the screening arm versus the control arm, but it was not statistically significant (rate ratio 0.95 (95% confidence interval 0.81 to 1.10); P=0.49). Conclusions These results indicate that clinical breast examination conducted every two years by primary health workers significantly downstaged breast cancer at diagnosis and led to a non-significant 15% reduction in breast cancer mortality overall (but a significant reduction of nearly 30% in mortality in women aged ≥50). No significant reduction in mortality was seen in women younger than 50 years. Clinical breast examination should be considered for breast cancer screening in low and middle income countries. Trial registration Clinical Trials Registry of India CTRI/2010/091/001205; ClinicalTrials.gov NCT00632047 .

Background In India, as elsewhere, the incidence of gall-bladder cancer (GBC) is substantially higher in women than in men. Yet, the relevance of reproductive factors to GBC remains poorly understood. Methods We used logistic regression adjusted for age, education and area to examine associations between reproductive factors and GBC risk, using 790 cases of histologically confirmed GBC and group-matched 1726 visitor controls. We tested the interaction of these associations by genetic variants known to increase the risk of GBC. Results Parity was strongly positively associated with GBC risk: each additional pregnancy was associated with an ∼25% higher risk {odds ratio [OR] 1.26 [95% confidence interval (95% CI) 1.17–1.37]}. After controlling for parity, GBC risk was weakly positively associated with later age of menarche [postmenopausal women, OR 1.11 (95% CI 1.00–1.22) per year], earlier menopause [OR 1.03 (95% CI 1.00–1.06) per year] and shorter reproductive lifespan [OR 1.04 (95% CI 1.01–1.07) per year], but there was little evidence of an association with breastfeeding duration or years since last pregnancy. Risk alleles of single-nucleotide polymorphisms in the ABCB4 and ABCB1 genetic regions had a multiplicative effect on the association with parity, but did not interact with other reproductive factors. Conclusions We observed higher GBC risk with higher parity and shorter reproductive lifespan, suggesting an important role for reproductive and hormonal factors.

Background India accounts for a quarter of the world cervical cancer burden. Cervical cancer is highly preventable. However, low level of participating women in screening is one of the major issues. The aim of this work was to study the factors that influence women to participate in cervical cancer screening by providing menstrual pads for human papillomavirus (HPV) testing. Methods Menstrual clothes were collected from two different populations from the rural areas of Maharashtra state for HPV testing to screen for cervical cancer. For this study, out of 945 participated women, 557 (58.9%) provided their menstrual pads. Multivariate logistic regression was applied to calculate the odds ratio (OR) and 95% confidence interval (95% CI). Results The probability of providing the menstrual pads was high among the women who were highly educated compared to those with less education (OR: 1.4; 95% CI: 1.0-1.9), having mobile phone facilities as compared to those with no mobile phones (OR: 1.4; 95% CI: 1.0-2.0), who were using new cloths as menstrual pads compared to those who did not use the same (OR: 8.5; 95% CI: 5.0-14.3), who did not have tobacco habit as compared to those who had tobacco habit (OR: 1.4; 95% CI: 1.1-1.9) and in the village where health worker was stationed as compared to the village where health worker was not stationed (OR: 1.8; 95% CI: 1.4-2.5). Conclusion Factors including health worker availability, using mobile phones for communication and high education level facilitate women's participation. To improve the participation, there is need to apply special strategies for older age group, less educated women and women having tobacco habit.

Background: Past history of gallstones is associated with increased risk of gallbladder cancer in observational studies. We conducted complementary observational and Mendelian randomization (MR) analyses to determine whether history of gallstones is causally related to development of gallbladder cancer in an Indian population. Methods: To investigate associations between history of gallstones and gallbladder cancer, we used questionnaire and imaging data from a gallbladder cancer case–control study conducted at Tata Memorial Hospital, Mumbai, Maharashtra, India (cases = 1,170; controls = 2,525). We then used 26 genetic variants identified in a genome-wide association study of 27,174 gallstone cases and 736,838 controls of European ancestry in an MR approach to assess causality. The association of these genetic variants with both gallstones and gallbladder cancer was examined in the gallbladder cancer case–control study. Various complementary MR approaches were used to evaluate the robustness of our results in the presence of pleiotropy and heterogeneity, and to consider the suitability of the selected SNPs as genetic instruments for gallstones in an Indian population. Results: We found a strong observational association between gallstones and gallbladder cancer using self-reported history of gallstones [OR = 4.5; 95% confidence interval (CI) = 3.5–5.8] and with objective measures of gallstone presence using imaging techniques (OR = 2.0; 95% CI = 1.5–2.7). We found consistent causal estimates across all MR techniques, with ORs for gallbladder cancer in the range of 1.3–1.6. Conclusions: Our findings indicate a causal relationship between history of gallstones and increased risk of gallbladder cancer, albeit of a smaller magnitude than those found in observational analysis. Impact: Our findings emphasize the importance of gallstone treatment for preventing gallbladder cancer in high-risk individuals.

Identifying infectious pathogens by collecting intravenous blood (IVB) is a well-established procedure, however, the collection of IVB in field epidemiological study is challenging. The dried blood spot (DBS) as an alternative to IVB has been introduced, although, there is a limited study to demonstrate the utility of DBS stored at various storage conditions and transported at different periods. This is an observational study, which evaluates the effectiveness of DBS in field epidemiological studies to identify infectious pathogens.A total of 264 paired DBS samples prepared from IVB, stored at 4°C, -20°C after period 24, 48 and 72 h. Serologically, enzyme-linked immunosorbent assay [ELISA] IgG antibody detected against Helicobacter pylori infection from DBS and compared with IVB.Quantitatively, IgG antibody reactivity showed87% correlation between IVB and DBS samples stored at 4°C or -20°C within 48 h of transport duration. DBS stored at 4°C shows, equal sensitivity 87.5% and specificity 95% before 48 h of transport duration, while at -20°C storage similar sensitivity 87.5% observed but slightly less specificity 86.36% observed as compared to 24 h of transport duration. One-way analysis of variance showed, nonsignificant difference at both (-20°C and 4°C) the stored condition with P value (P0.851) and (P0.477). Kappa values showed good inter-rater reliability between DBS and IVB in a range (0.77-0.81).No significant difference was observed in detecting H. pylori when ELISA was conducted using IVB or DBS stored at 4°C and transported even after 48 h. This confirms that DBS collected even in compromised conditions in the field can be used for detecting infection.

Background: Gallbladder cancer (GBC), a common cancer surrounding the Gangetic belt of India, accounts for 80%–90% of biliary tract cancers. GBC incidence shows striking geographical variation in India. Materials and Methods: We used the data from the National Cancer Registry Programme for the year 2001–2014 to study the time trends of GBC in the high- and low-risk geographical regions of India. Annual percentage change (APC) in age-adjusted incidence rates was computed by log-linear regression model. Results: Among females, a statistically significant increase in trend was observed in Cachar (APC: 7.0, P = 0.02), Delhi (APC: 4.0, P = 0.04), and Kamrup (APC: 4.3, P = 0.02) marked under high-risk region and in Bengaluru (APC: 5.7, P = 0.04) and Pune (APC: 3.4, P = 0.04) marked under low-risk region. Among males, increasing but statistically nonsignificant trends were observed in Cachar, Dibrugarh, Kamrup, Nagpur, and Sikkim, whereas decreasing trends were observed in Bengaluru, Barshi, Bhopal, and Kolkata. Aurangabad showed a statistically significant decrease in trend (APC: −14.5, P < 0.001) among males. Conclusion: The time trend and pattern of GBC have striking differences within the country as well as in state. Further large-scale region-wise studies are needed to find the risk factors of GBC.

Context: Head-and-neck cancers (HNCs) are most common cancer in Indian cancer registries. However, there is a huge variation and heterogeneity in use of different types of smokeless tobacco (SLT) consumption across India. Aims: The aims and objectives of this study were to investigate how different types of SLT use are distributed across Indian states and examined its association with different subsites of HNC incidence rates. Settings and Design: Ecological analysis of correlation between SLT prevalence and incidence rates from population-based cancer registries. Methods: Incidence data was extracted from population-based cancer registries report from the National Cancer Registry Programme database 2012–2014. The current SLT uses the prevalence of all Indian States and Union territories from Global Adult Tobacco Survey 2009–2010. Statistical Analysis Used: Pearson’s correlation coefficient was used to estimate an ecological correlation between the prevalence of types of SLT uses in different region of India and age-adjusted incidence rate of different subsites of HNC. Results: In our brief analysis, we found a significant correlation between certain types of SLT use and subsite of HNC. Betel quid and tobacco use are correlated (r = 0.53) with oropharynx cancer incidence. Khaini use is correlated with hypopharynx cancer incidence (r = 0.48). Gutka use is correlated with mouth cancer incidence (r = 0.54). Oral tobacco is correlated with mouth cancer incidence (r = 0.46). Other SLT use is correlated for hypopharynx cancer incidence (r = 0.47). Conclusions: The variations in SLT use across Indian states account for differences in incidence rates of HNC subsites across the states. The inferences from this brief analysis can be used as a base to modify and design observational epidemiological studies in the future.