Prevalence of Colon Cancer in Indian Males
Colon cancer has a low overall incidence rate in India compared to Western countries and East Asian nations, though the incidence is gradually increasing with urbanization and adoption of Western lifestyles. 1
Epidemiological Data
Incidence Rates
- According to pan-Asian adapted ESMO guidelines, India has an overall low incidence rate of colorectal cancer compared to other Asian and Western countries 1
- The incidence rates of colon cancer in Indian population registries vary from 0.7 to 3.7 per 100,000 among men 2
- For rectal cancer, incidence rates range from 1.6 to 5.5 per 100,000 among Indian men 2
- In 2022, colorectal cancer ranked as the fourth most common cancer in India with 64,863 cases and 38,367 deaths across both sexes 3
Urban-Rural Differences
- Urban areas in India show significantly higher incidence rates than rural areas 3
- Rural incidence rates for large bowel cancers are approximately half of urban rates 2
- A study from North Bengal showed increased urban incidence of colorectal carcinoma compared to rural population with an Odds ratio of 1.8 4
Trends
- While Western countries are experiencing declining rates of colorectal cancer, various regions in India are seeing an increasing trend 3
- The Bombay registry has reported a significant increase in colon cancer incidence over two decades for both men and women, though rectal cancer rates remain steady 2
Risk Factors Specific to Indian Males
Age
- Age is the major unchangeable risk factor, with nearly 70% of colon cancer patients being over 65 years of age 1
- In North Bengal, increasing age showed statistically significant risk with Odds ratios of 2.83 for 41-50 years, 13.6 for 51-60 years, and 42.5 for those over 60 years 4
Ethnic Susceptibility
- Evidence suggests that certain ethnic groups in Asia (Japanese, Korean, and Chinese) have higher susceptibility to colorectal cancer 1
- Indians generally have lower susceptibility compared to these East Asian populations 1
Lifestyle Factors
- Risk factors identified in Indian studies include:
Unique Features
- One intriguing observation is the occurrence of rectal cancer in young Indians, which could suggest a different etiopathogenesis that is neither inherited nor traditional diet-related 2
- The prevalence of adenomas is rare in elderly Indians undergoing colonoscopy, even in those with large bowel cancers 2
Changing Patterns
The incidence of colorectal cancer in India is changing due to:
Urbanization and Western lifestyle changes:
- Less physical activity
- Westernized diet (more red meat, less vegetables and fiber)
- Obesity
- Increased alcohol consumption
- Smoking 1
Despite the overall low incidence, survival rates for colorectal cancer in India are lower than in developed countries, suggesting deficiencies in early diagnosis and effective treatment 5
Clinical Implications
The low but increasing incidence of colorectal cancer in Indian males suggests that:
- Traditional Indian dietary patterns (high starch intake and natural antioxidants like curcumin) may be protective 2
- Maintaining traditional lifestyle while improving awareness of risk factors could be beneficial
- Investments in early diagnosis and adequate treatment are needed to improve survival rates 5
- Population-based screening may not be cost-effective given the current low burden of colorectal cancer 5
High-Risk Groups
Special attention should be paid to:
- Urban-dwelling Indian males
- Those with inflammatory bowel disease (cumulative risk of CRC in Indian UC patients is as high as 23.6% at 30 years) 6
- Those with family history of colorectal cancer or polyps
- Those with inherited syndromes (5-10% of all colon cancers) 1
In conclusion, while colon cancer prevalence remains relatively low in Indian males compared to Western and East Asian populations, the increasing trend with urbanization warrants attention to modifiable risk factors and improved diagnostic capabilities.