Dietary Patterns, Risk Factors, Trends & Incidence of Gastrointestinal Tract Cancers in Kashmir Region of India

Cancer is a non- transmissible disease. Over three-fifths of demises worldwide are caused by non- transmissible diseases. Cancer is rapidly emerging disease in past few years. Incidence of new cancer cases rising day by day all over the world. According to the latest statistics, over 10 million people die yearly due to cancer and 70% of them are from developing countries. Gastrointestinal cancers encompass a group of cancers that effect the digestive system. These cancers can arise in various parts of the gastrointestinal tract (GI) including the oesophagus, GEJ Junction, stomach, colon, rectum, gallbladder and pancreas. While some GI cancers are more common, such as oesophagus, stomach, colorectal cancer. Cancer is an uncontrollable and irregular cell division in a definite portion of the body that can spread to other parts (metastasis). The main causes of GI tract cancers are consumption of beef (non-vegetarian), smoking both active & passive, high consumption of tea particularly pink tea or noon-chai, use of chemicals, preservatives, synthetic colorants & dyes, adulterated spices like meta nil in turmeric, unpredictable genetic changes, environmental factors. The main reasons for increasing incidence rate of cancer cases are certain lifestyle choices like consuming unhealthy foods, lack of physical activities, obesity and exposure to harmful pollutants. Diagnosis of cancer involves a comprehensive approach (biochemical assessment like blood tests like CBCs, LFTs, KFTs, tumour markers screening (CEA, CA-19-9, Ca-125, endoscopy, CT-SCAN, endoscopic biopsy. Mostly GI Tract cancers are of adenocarcinoma (mucosa layer producing mucus), type. Diagnosis of cancer in early stage is difficult and very few cases are diagnosed because cancer in early stage is painless which patients usually ignores that’s why delayed treatment is one of the factors of progress of cancer which by then metastasise in many patients. The main symptoms are: dysphagia, anaemia, frequent burps, blood tarry stools, uncontrolled pain in later stage, diarrhoea, ascites,  hurt burn, stomach ache, vomiting etc. Kashmir is located at very high altitude in the northernmost extreme part of India. It is also northern most Union Territory of India. Kashmir’s weather conditions, food habits, culture, customs and values are different from rest of India. Kashmir has Muslim majority population having unique cultural and traditional practices, beautiful hilly terrain, snow covered deep valleys and rich flora and fauna. The total population of Kashmir region is 6907623 approximately as per the 2011 census. From 2018-19 to 2023-24, the total number of cancer patients in Kashmir is approximately 80000. It’s through the National Cancer Control Program, “SKIMS (Sher -Kashmir Institute of medical sciences)”, a cancer referral centre delivering facilities to entire Kashmir, was freshly selected as a regional. Cancer can be detected by endoscopy and biopsy. The age group in which cancer is frequently occurring is 65-74 for males and 55 to 64 for females. Gastrointestinal cancer is highly predominant in the Kashmir region as compared to the other parts of the country.

Trends of cancer in Kashmir region

Worldwide, an increase in the incidence of cancer has also become evident for the population of Kashmir who have suffered from cancer in the last years. Kashmir’s Regional Cancer Centre is the only one that maintains the number of cancer patients. From the year 2018-2021, 22002 persons died due to cancer at Sher-e-Kashmir Medical Institute, Saura, Kashmir. From the above number of patients, 4.5, 31 and 32% of the deaths occurred in 2018, 2019, and 2020, respectively. In the year 2021, the number of deaths due to cancer increased to 7189. Here are some of the trends in cancer from different years (Table 1).

Table 1 Trends of cancer cases in Kashmir region from 2016 to 2022

Source: Qadri et al.  (2023)

Observations:

Present study was conducted in Medical Oncology department of Super Speciality Hospital department of medical oncology Govt. Medical College Srinagar. A sample of 100 patients was taken for study. Researcher himself visited the hospital and an interview and questionnaire methods were adopted for the study. The main concern was to know the lifestyle and dietary habits of the patients, as a result the main contributory reasons for this disease were came in to light. Recent years, cancer is spreading like a wildfire due to increasing vendors, restaurants in Kashmir. The vendors and restaurants using synthetic colourants, decomposed meat, meat from those animals which are prohibited because scientifically they are not fit to eat and also ways of cutting and import from other states of India as because halal method is better than jhatka method. In halal method microbial growth is less as compared to jhatka meat. Due to this incidence rate is increasing and hospital are receiving patients in huge numbers. In Kashmir incidence rate of gastrointestinal tract cancer is higher as compared to other states because of eating more non-vegetarian food by Kashmiri people as compared to other states people. Due to this growing rate government is now on foot to carack down on storage houses of edible food products which were found unhygienic and decomposed. Cancer a bomb is exploding in every corner and districts of Kashmir. As we have taken 100 patients it was found that different contributory reasons for cancer.

Smoked foods

Smoked foods barbeques like meat, chicken fish, pickles and salted foods: Patients were taking high consumption of salted foods like nun chai (salted tea, a combination of salt & sodium bicarbonate), pickled vegetables and processed meat. This is one of the main reasons of growing gastrointestinal cancer in Kashmir region.

Low consumption of fruits and vegetables

The patient’s diet was not including fruits and vegetables which was a reason for higher risk for gastrointestinal cancer.

Consumption red meat:

The selected patients were taking red meat in their diet. Its high consumption leads to increase in the risk of stomach cancer.

Lack of physical activity and sedentary lifestyle

As Kashmir experiences heavy snowfall in winter season and temperature drops to below zero degrees. The patients in the present study were not doing any physical activity. And thus, lack of physical activity contributes to the reasons of growing cancer in Kashmir region.

Smoking (Hukkah and Cigarette):

The use of hukkah is very much prevalent in rural Kashmir region. Smoking is of two types active smoking as well as passive smoking. The patients in present study were consuming hukkah and cigarette in their daily life means they were active smokers while patients belong to the category of passive smokers as well while they were inhaling the smoke by coming in to the contact of their family members because in winters due to very low temperature doors and windows of the houses are keep shut and there is no fresh air entering in to the house. This habit highly leads to the reason for growing cancer in Kashmir region.

Delayed treatment:

In rural Kashmir people are not aware of the treatment of the diseases. There is a delayed diagnosis for many of the diseases. The patients in present study were illiterate. And due the low literacy rate in this region of India, people are not aware about various diseases. At first, they totally ignore the disease and at later stage it becomes problematic sometimes diagnostic errors, diagnosis errors well

Eating excessive non-vegetarian food

Rice is staple food of Kashmir but eating excessive non-vegetarian particularly beef, dried fishes along with rice is one of the reasons for causing cancer in Kashmir. Patients in present study were taking non-vegetarian in their food making it as the main possible reason for cancer.

Wazwan:

Wazwan a both vegetarian and non-vegetarian food (Synthetic Colourants, excessive flavouring agents like monosodium glutamate).  patients were taking wazwan occasionally but it increased since from last 5 years. This also increases the risk for cancer.

Adulterated spices

Use of adulterated spices having potential carcinogens leads to cancer, as spices are present in every household. Very few patients were consuming whole spices

High consumption of refined cereals and oils

Use of excess refined oils is also a main reason of cancer in Kashmir region.

Micro-plastics

microplastics is also now becoming a major reason for growing cancer in India and in Kashmir.

Helicobacter pylori

Helicobacter pylori (Gram negative bacterial infection which is prevalent in Kashmir due to unhygienic life style.

Sedentary lifestyle

Changing lifestyle and dietary habits some patients were taking fast food regularly. By the adoption of Westernized diets and lifestyles also perform a big part in the growing of incidence rate of cancer in Kashmir.

Genetic and hereditary reasons

Some patients have cancer in their family history. This is also a major reason for growing cancer in Kashmir region.

Preheating of foods is common in Kashmir

Foods are prepared usually for two time i.e. for dinner and next day lunch. During heating of food again and again nutritive value of food is decreased and carcinogenic products are formed. Patients were found to fall in this category. Cancer risk increases through this method of eating. Freshly prepared food should be consumed in order to be away from such diseases like cancer.

Use of chemicals, fungicides

Another risk factor responsible for disease of cancer is spraying of chemical and fertilizer without proper protocol means without proper veiled clothes, eating drinking and smoking while spraying is the most common factor for carcinoma.

Inhalation of petroleum products

Inhalation of petroleum products smoke, wood shavings, sawdust also increases risk for cancer for high motor vehicles drivers, carpenters, painters. About 9 % patients in present study were having this type of risk factor for cancer.

RESULTS:

After recorded all the contributory reasons via questionnaire & interview method. The observations were analysed. It was found that all the patients were 18-80 age group. 5% were of this 18-40 age group. Rest patients were 45-80 age group. 82% patients were uneducated & 18% were educated. 79% were from rural areas and 21% were from urban areas. Different types of gastrointestinal tract cancer were admitted such as oesophagus cancer, stomach cancer, colorectal cancer, pancreas cancer, liver cancer, gallbladder cancer (%age is given in pie chart 1) also bar diagram (2). Various contributory reasons were recorded and analysed which are shown in table number (2) and also in bar diagram number (1).

Table: 2 Major contributory reasons for growing of cancer

Table: 3 Incidence Rate of Cancer

DISCUSSION: