Analysis of mesothelioma cases and National Cancer Registry data to assess asbestos exposure in India

Our plain-English summary of Analysis of mesothelioma cases and National Cancer Registry data to assess asbestos exposure in India, by R. Singh, A.L. Frank (Public Health Action, 2024).

The study

• Authors: R. Singh, A.L. Frank
• Journal: Public Health Action
• Published: 2024;14(1):30-33
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Setting: Asbestos exposure can cause mesothelioma, a form of cancer which should be recorded by cancer registries. However, such registries currently cover only a small fraction (16%) of the population in India. Because India still uses asbestos, it is important to understand its health impact, especially the number of mesothelioma cases.

Objective: To assess the number of mesothelioma cases in India and compare these to the number reported to the National Cancer Registry.

Design: We used the Right to Information Act 2005 to gather data for 83 hospitals across India from 2012 to 2022-2023.

Results: From a total of 83 hospitals, there were 2,213 cases of mesothelioma from 2012 onwards. During the 2012-2016 period, the number of reported cases in the Cancer Registry was 54, whereas 1,126 cases were reported by these hospitals for this period. Only 21 (25%) of the hospitals assessed in this study were part of the population-based national cancer registry programme. Overall, cases of mesothelioma occur far more frequently than are reported in cancer registries.

Conclusion: National record-keeping is inadequate and the system needs to be expanded and improved across all of India. This will provide more effective reporting and help to highlight the risk of exposure to asbestos.

© 2024 The Authors.

In plain English

This study counted mesothelioma cases reported by public hospitals in India and compared them with India's National Cancer Registry. Using requests under India's Right to Information Act 2005, the authors asked 83 government or publicly funded hospitals for yearly mesothelioma diagnoses (ICD-10 code C45) from 2012 to 2022, some into 2023; several gave multi-year totals, which the authors averaged. Patients' asbestos exposure was not measured. The hospitals reported 2,213 cases. For 2012 to 2016, the period for which published registry data existed, the hospitals reported 1,126 cases while the registry recorded 54. Only 21 (25%) of the 83 hospitals were part of a population-based registry, and only 10 had a hospital-based registry. At one Gujarat institute, 99 of 303 cases recorded from 2012 to July 2023 came from neighbouring Rajasthan. The authors noted that patients seen at several hospitals may have been counted more than once, that private hospitals were mostly not covered except through Tamil Nadu's state registry, and that averaged yearly figures may not be accurate. The authors concluded that mesothelioma occurs far more often than cancer registries report.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Data collection through Right to Information Act requests to hospitals for mesothelioma case counts, compared with published National Cancer Registry data
• Who was studied: Mesothelioma cases diagnosed at 83 government or publicly funded hospitals across India, 2012 to 2022 (some hospitals to 2023); data collected in mid to late 2023. Private hospitals were not included, except through Tamil Nadu's state registry data.
• Exposure: Not measured. The study counted diagnosed mesothelioma cases; the authors describe mesothelioma as almost always associated with previous asbestos exposure, occupational or non-occupational. No fiber types, products or jobs were studied.
• Main results:
  • The 83 hospitals reported a total of 2,213 mesothelioma cases from 2012 to 2022 (in some hospitals to 2023)
  • For 2012 to 2016, the national registry (NCDIR) recorded 54 cases, while the study's hospitals reported 1,126 cases
  • Only 21 (25%) of the 83 hospitals were part of a population-based cancer registry under the national programme
  • Only 10 of the 83 hospitals had a hospital-based cancer registry under the national programme
  • At the Gujarat Cancer and Research Institute, 303 mesothelioma cases were recorded from 2012 to July 2023. Of these, 99 (about 32.67%) were from Rajasthan, 23 (7.59%) from Madhya Pradesh, 6 (about 1.99%) from other States and 175 (about 57.75%) from Gujarat.
• The authors' conclusion: The authors concluded that mesothelioma cases occur far more frequently than cancer registries report and that national record-keeping is inadequate. They also called for asbestos use to be better regulated or banned, and for cancer record-keeping in India to be improved.
• Limitations the authors state:
  • Duplicate records were not accounted for, so a patient who visited several hospitals may have been counted more than once
  • Only public hospitals were covered, because the Right to Information Act applies only to public authorities, so several private hospitals were not included. The exception was the Tamil Nadu Cancer Registry, whose combined data include private hospitals.
  • Mesothelioma may have causes other than asbestos
  • Some hospitals gave combined figures for several years, and the authors used averages for those years, which may not accurately represent the data

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cancer Registry, Asbestos Exposure.

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