POPULATION BASED CANCER REGISTRY, DELHI Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi.

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1 POPULATION BASED CANCER REGISTRY, DELHI Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New. Dr Vinod Raina, MD, FRCP Professor of Medical Oncology & Head, Cancer Registry Dr B.B. Tyagi, M.Sc., Ph.D., Scientist-IV, Cancer Registry Mr N. Manoharan, M.Sc., PGDCA, Scientist-I, Cancer Registry The population based cancer registry at Dr. B.R. Ambedkar Institute Rotary Cancer Hospital (IRCH), All India Institute of Medical Sciences (AIIMS), New was established in January 1986 with the aim of obtaining reliable morbidity and mortality data on cancer among the Urban residents so as to assess and control the impact of malignant disease in the community. The Union Territory of, the capital of India, covering an area of 1483 sq. kms is a densely populated urban metropolis situated between the Himalayas and the Aravalli range in the heart of Indian sub-continent. It lies between 28 25' and 28 53' north altitude and 76 50' and 73 20' east longitude. The state for the purpose of census was divided into (i) New Municipal Corporation (Urban) (ii) New Municipal Committee, (iii) Cantonment and (iv) 20 Census towns and (v) Rural areas. According to 2001 census the population of was 1,37,82,976 with 3.81% annual growth rate and 46.31% decennial growth rate during The sex ratio in is 821 females per 1000 males. The literacy rate is 82% (males-87%, females-75%). The density of population is 9294 persons per square kms. has multi religion and multi lingual population representing every state in the union, approximately 82% being Hindus, 11% Muslims, 4% Sikhs and 3% others. As per population census 2001 the total area of is 1483 sq. kms and its rural and urban composition are sq. kms and sq. kms respectively. As per 2001 census, the population in UT Urban and rural as on March 1, 2001 was 1,28,19,761 and 9,63,215 respectively. The PBCR covers an urban area of sq. kms of Municipal Corporation, New Municipal Committee and Cantonment and 29 census towns. The registry collects morbidity and mortality data on cancer patients from 160 major Government Hospital / Centres / Institutions, more than 250 private hospitals and nursing homes and from the department of Vital Statistics of the Municipal Corporation, New Municipal Committee and the Cantonment Board. 154

2 Medical Social Service Officers (MSSO) visits various hospitals and nursing homes and interviews the patients who are either undergoing cancer treatment or being investigated for cancer at radiotherapy departments. They also examine the case records maintained by various departments of these hospitals viz. pathology, hematology, and radiology etc., All the information collected is crosschecked for completeness of the data. Sometimes same patient may register his / her name in more than one hospital for treatment. So care has been taken to exclude duplicates and ensure that each patient is included only once in the records. The main criteria for registration is that the cases should have been residing in for at least one year at the time of first diagnosis of cancer. MSSO's also personally visit the offices of New Municipal Committee and Municipal Corporation of and collect information about deaths where the death certificates states the cause of death as cancer or tumours. These death records are then matched with the morbidity records. Cases not matching with the records are registered as Death Certificate only cases (DCO's) in that corresponding year. The estimated population of Urban area as on July 1, 2002 was 1,36,50,863. Among them 74,98,567(55%) were males and 61,52,296(45%) were females. During the period , a total of 31,156 incidence cases were registered with 16,112 (52%) males and 15,044 (48%) females. The average crude rate (CR), age adjusted incidence rate (AAR) for world population and truncated rate (TR) were 71.6, and among males and 81.5, and among females respectively per 100,000 persons. The common sites of cancers among males were lung (10.5%), larynx (5.9%), tongue (5.4%), prostate (5.3%) and NHL (5.1%). Among females breast cancer (25.1%) was the predominant type of cancer followed by cervix uteri (14.9%), ovary (7.1%), gall bladder (5.8%), corpus uteri (3.3%). The reliability of data and quality of the registration has been improved. During the year the percentage of microscopically confirmed cases was 82% and the proportion of cases diagnosed / registered through death certificates only was 1.3%. Registry staff faced a lot of problem in collecting the death information from Vital statistics division of NDMC and MCD. The death registration system is not being maintained properly and the information available is often inadequate. So there is a dearth in the mortality data. Now efforts are being made to improve the system by conducting meetings with NDMC and MCD officials. The registry publishes yearly / biennial report regularly. The registry data has been widely used by the Government for National Cancer Control Programme and researchers in the field of cancer. Efforts are also now being made by the Cancer Registry to make cancer as a 'Notifiable Disease'. 155

3 Registry Staff (PBCR) Dr. Vinod Raina MD, FRCP Dr. B.B.Tyagi M.Sc., Ph.D. Mr. N. Manoharan M.Sc., PGDCA Mr. Ashok Kumar M.S.W. Mr. Ratnesh Kumar M.S.W. Mr. S.P. Bhadola M.A. Ms. Gayatri Sharma M.A. Ms. Indu Gaur M.S.W. Mr. S.K. Rai M.S.W. Ms. Sudha Saxena M.A. Mr. C.P. Singh Yadav M.S.W. Mr. Anand Kumar Sharma Ms. Garima Negi : Head : Scientist - IV : Scientist - I : Medical Social Service Officer-Gr. I : Medical Social Service Officer-Gr.I : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Medical Social Service Officer-Gr.II : Lower Division Clerk 156

4 Figure DEL-1 Population Pyramid showing Age Distribution: Males (%) Females (%) 157

5 TABLE: DEL - 1 Population by Five Year Age Group and Gender: Number and Relative Proportion (%) MALES FEMALES Age Group Number % Number %

6 TABLE : DEL- 2 Main Sources of Registration of Incident Cases of Cancer : Name of the Institution Number % AIIMS/IRCH Rajiv Gandhi C.H CRC/MAMC/LNJP Safdarjung Gangaram Batra Dharamshila H RMLH UCMS/GTB LHMC/KSH Others Apollo H GB Pant ESI St.Stephen Deen Dayal AIIMS/IRCH Anand Hospital Holy Family Others Total Institutions listed have registered at least one percent of all cases in the registry for the combined years The numbers and proportion listed are the minimum number of cases. Institutions could have registered / reported more cases, since duplicate registrations and non-resident/registry cases are not included. 159

7 TABLE DEL-3 (a): Number of Incident Cancers by Five Year Age Group and Site (ICD-10): Males %= Relative Proportion of Cancers of All Sites. ICD-10 Site Unkn Total % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C60 Penis C61 Prostate C62 Testis C63 Other Male Genital C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

8 TABLE DEL-3 (b): Number of Incident Cancers by Five Year Age Group and Site (ICD-10): Females %= Relative Proportion of Cancers of All Sites. ICD-10 Site Unkn Total % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C51 Vulva C52 Vagina C53 Cervix Uteri C54 Corpus Uteri C55 Uterus Unspecified C56 Ovary etc C57 Other Female Genital C58 Placenta C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

9 TABLE: DEL 4(a): Average Annual Age Specific,Crude (CR), Age Adjusted (AAR) (with Standard Error(SE)) and Truncated (35-64 yrs) (TR) Incidence Rate per 100,000 population: Males ICD >75 CR AAR SE TR C C C C C C C C C C C C C C C C C C C C C C C C C C C C47+C C C C C C C C C C C C C C C C C C C C82-85,C C C C C O&U All

10 TABLE: DEL 4(b): Average Annual Age Specific,Crude (CR), Age Adjusted (AAR) (with Standard Error(SE)) and Truncated (35-64 yrs) (TR) Incidence Rate per 100,000 population: Females ICD >75 CR AAR SE TR C C C C C C C C C C C C C C C C C C C C C C C C C C C C47+C C C C C C C C C C C C C C C C C C C C C C C C82-85,C C C C C O&U All

11 TABLE: DEL-5(a): Number (#) and Proportion (%) of Cancers by Site (ICD-10) and Method of Diagnosis: Males ICD-10 Site Microscopic X-Ray / imaging Clinical Others D.C.O Total # % # % # % # % # % # % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C60 Penis C61 Prostate C62 Testis C63 Other Male Genital C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

12 TABLE: DEL-5(b): Number (#) and Proportion (%) of Cancers by Site (ICD-10) and Method of Diagnosis : Females ICD-10 Site Microscopic X-Ray / imaging Clinical Others D.C.O Total # % # % # % # % # % # % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C51 Vulva C52 Vagina C53 Cervix Uteri C54 Corpus Uteri C55 Uterus Unspecified C56 Ovary etc C57 Other Female Genital C58 Placenta C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

13 TABLE: DEL-6(a): Number (#) and Proportion (%) of Cancers by Site (ICD-10) and Detailed Microscopic Diagnosis, Males : ICD-10 Site Pri. Hist Sec. Hist Cytology Blood Film Bone Marrow Others Total # % # % # % # % # % # % # % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C60 Penis C61 Prostate C62 Testis C63 Other Male Genital C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

14 TABLE: DEL-6(b): Number (#) and Proportion (%) of Cancers by Site (ICD-10) and Detailed Microscopic Diagnosis, Females : ICD-10 Site Pri. Hist Sec. Hist Cytology Blood Film Bone Marrow Others Total # % # % # % # % # % # % # % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C51 Vulva C52 Vagina C53 Cervix Uteri C54 Corpus Uteri C55 Uterus Unspecified C56 Ovary etc C57 Other Female Genital C58 Placenta C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

15 TABLE DEL-7 (a): Number of Cancer Deaths by Five Year Age Group and Site (ICD-10): Males %= Relative Proportion of Cancers of All Sites. ICD-10 Site Unkn Total % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C60 Penis C61 Prostate C62 Testis C63 Other Male Genital C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

16 TABLE DEL-7 (b): Number of Cancer Deaths by Five Year Age Group and Site (ICD-10): Females %= Relative Proportion of Cancers of All Sites. ICD-10 Site Unkn Total % C00 Lip C01-02 Tongue C03-06 Mouth C07-8 Salivary Gland C09 Tonsil C10 Oth. Oropharynx C11 Nasopharynx C12-13 Hypopharynx C14 Pharynx Unspecified C15 Oesophagus C16 Stomach C17 Small Intestine C18 Colon C19-20 Rectum C21 Anus & Anal Canal C22 Liver C23-24 Gallbladder etc C25 Pancreas C30-31 Nose, Sinuses etc C32 Larynx C33-34 Lung etc C37-38 Other Thoracic Organs C40-41 Bone C43 Melanoma of Skin C44 Other Skin C45 Mesothelioma C46 Kaposi Sarcoma C47+C49 Conn. & Soft Tissue C50 Breast C51 Vulva C52 Vagina C53 Cervix Uteri C54 Corpus Uteri C55 Uterus Unspecified C56 Ovary etc C57 Other Female Genital C58 Placenta C64 Kidney etc C65 Renal Pelvis C66 Ureter C67 Bladder C68 Uns.Urinary Organs C69 Eye C70-72 Brain, Nervous System C73 Thyroid C74 Adrenal Gland C77 Sec Lymph Nodes C78 Sec Resp & Digestive C79 Sec Others C81 Hodgkins Disease C82-85,C96 NHL C90 Multiple Myeloma C91 Lymphoid Leuk C92-94 Myeloid Leukaemia C95 Leukaemia Uns O&U Other and Uns All Sites

17 TABLE: DEL-8(a): Average Annual Age Specific, Crude (CR), Age Adjusted (AAR) (with Standard Error(SE)) and Truncated (35-64 Yrs) (TR) Mortality Rate per 100,000 population: Males ICD >75 CR AAR SE TR C C C C C C C C C C C C C C C C C C C C C C C C C C C C47+C C C C C C C C C C C C C C C C C C C C82-85,C C C C C O&U All

18 TABLE: DEL-8(b): Average Annual Age Specific, Crude (CR), Age Adjusted (AAR) (with Standard Error(SE)) and Truncated (35-64 Yrs) (TR) Mortality Rate per 100,000 population: Females ICD >75 CR AAR SE TR C C C C C C C C C C C C C C C C C C C C C C C C C C C C47+C C C C C C C C C C C C C C C C C C C C C C C C82-85,C C C C C O&U All