Over 3% of all cancer patients in India are under 15; 4.6% under 20: Study

Childhood and adolescent cancers are growing as a matter of public health concern in India, accounting for a significant proportion of all cancers. 

Leukaemias were the most prominent type of cancer observed across the 0-19-year age group, according to the new study published in the India Pediatric journal’s January 2024 edition.

India reported 1,332,207 cancer cases between 2012 and 2019, according to 96 hospital cancer registries. About 3.2 per cent and 4.6 per cent patients of these cases were in the age groups 0-14 years and 0-19 years, respectively. 

Data from National Cancer Registry Programme (NCRP) is derived through a network of 38 population-based cancer registries and 246 hospital-based cancer registries. The NCRP was established by the Indian Council of Medical Research in 1981. 

“The study is based on the largest dataset on childhood cancers from India that has been published formally in a peer-reviewed medical journal, with an analysis of a large cohort of 60,720 paediatric cancers,” Ramandeep Singh Arora, consultant paediatric oncologist at Max Superspeciality Hospital in New Delhi, told Down to Earth. Dr Arora was a part of the documentation and analysis.

Paediatric oncologists across cancer facilities in the country, like Rajiv Gandhi Cancer Institute and Research Centre in Delhi, Adyar Cancer Institute in Chennai, Amala Institute of Medical Sciences in Thrissur and Nizam’s Institute of Medical Sciences in Hyderabad, collated the data and arrived at the conclusions.

Leukaemias highest cancer burden under 5

Leukaemias constituted nearly half of all cancers in the 0-4 year age group (42.1 per cent) and the 5-9 year age group (42.5 per cent). Lymphoid leukaemia, including acute lymphoblastic leukaemia, comprised most of the common leukaemia types diagnosed among children.

“This was followed by lymphomas (12.3 per cent ) that had the most significant proportion in the 5-9 year age group (15.7 per cent ), of which Hodgkin lymphoma was the most typical (7.9 per cent ),” the paper said.

Childhood cancers are divided into two age groups of 0-14 and 0-19 years based on the International Classification of Childhood Cancer’s third edition.

Among the 0-19 year age group, the four leading cancers were leukaemia (36 per cent), lymphoma (12 per cent), bone (11 per cent) and central nervous system tumour (10 per cent). Lymphomas were more common among males than females (15 per cent vs 8 per cent). However, the reverse was observed for carcinomas (5 per cent vs 7 per cent) and germ cells (2 per cent vs 4 per cent), the study said.

The four leading groups of cancers among 0-14 year age group were leukaemia (40 per cent), lymphoma (12 per cent), central nervous system (CNS) tumours (11 per cent) and bone cancer (8 per cent). The distribution among boys and girls was broadly similar, except that the proportion of lymphoma was higher in boys (15 per cent) than in girls (7 per cent), the study added.

A higher proportion of male children being diagnosed with cancer in India was ascribed to male birth preferences that outnumber female births in India and general social determinants such as gender discrimination. The sex disparity in the cancer registry mirrors data reported in low- and middle-income countries (LMIC) and was attributed to low female literacy rates, the paper pointed out.

The proportion of leukaemias and bone cancers was comparatively higher in the rest of the world due to differences in hospital referral practices, according to the International Incidence of Childhood Cancer, 2001–10: A Population-based Registry study, published in The Lancet Oncology in June 2017. Further, the distribution of CNS tumours reported internationally (17-26 per cent) is higher than that observed in the country.

“One explanation for this wide gap is that CNS tumours are possibly treated in neurosurgical centres in multispeciality (general) hospitals rather than dedicated cancer centres in India. Another explanation could be that currently, the NCRP only registers ‘malignant’ (defined as World Health Organization Grade 3 and 4) CNS tumours,” the paper said. 

Non-Hodgkin lymphomas increased with age groups, particularly in males, resulting from innate hormone and biological changes.  More girls were affected by malignant bone tumours due to earlier skeletal maturity, the study added.

Clinical trials

By participating in trials, paediatric cancer patients can access the latest therapies and protocols available and benefit from the scientific rigour and research oversight, pushing the boundaries of medical treatment.

In 2015, the Indian Pediatric Oncology Group (InPOG) was established to develop multicentre childhood cancer clinical trials. InPOG is pursuing 31 clinical studies on paediatric cancer. With a total funding of Rs 6 crore till date, it is estimated that 2 per cent of children with cancer in India are now enrolling in multicentre research studies. 

In 2021, InPOG evolved into Indian Pediatric Hematology Oncology Group (INPHOG) Research Foundation. “With the formalised structure and ability to raise and utilise greater funds, INPHOG aims that 10 per cent of children with cancer should be able to access multicentre clinical research over the next five years,” Arora said.

Of global cancer cases, LMICs report 90% of the burden, but LMICs are awarded less than 0.1% funding for pediatric cancer research.

“In India, the concept of multi-center trials in childhood cancer is relatively new. Though single-centre trials in Tata Memorial Centre or AIIMS enrol patients in trials, vast majority of pediatric cancer patients have not had access to cancer trials,” Arora said.

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