TRENDS OF CANCER OBSERVED IN A PREMIER INSTITUTE IN MUMBAI, INDIA DURING LAST THREE DECADES Dr. Ganesh B. Prof. & Head, Department of Medical Records, Biostatistics & Epidemiology, Tata Memorial Hospital, Mumbai, INDIA

About Tata Memorial Hospital … Tata Memorial Centre is amongst the oldest and largest cancer centres in the world, with over 75 years of exceptional patient care, high-quality training and innovative cancer research. Over the years, it has grown in size and stature, maintaining its pre-eminent position at the forefront of national and global cancer control efforts. Compassionate patient care remains the major focus of Tata Memorial Centre, with eleven Disease Management Groups (or multidisciplinary teams) breaking departmental silos and providing optimal care for every patient. This emphasis on team approach leverages the extensive experience and expertise of various specialists, thereby providing patients with evidence-based, yet individualized care, tailored not just to the cancer but also the patient’s unique physical, emotional and psychosocial needs. Researchers at the Tata Memorial Centre are world leaders in basic, translational, epidemiologic and clinical cancer research. Research at TMC includes studies to understand cancer biology, large community based screening trials for common cancers and cohort studies, neoadjuvant and adjuvant treatment, perioperative interventions, surgical trials, repurposing drugs and qualitative research to understand the patient journey. Our research focuses on impacting survival and quality of life i.e., living longer, or living better –endpoints that really matter to patients. Training and education form a major focus area for TMC, which remains the most sought after institution for oncology training nationally. Combining a world-class academic faculty and being amongst the highest volume cancer centres in the world, we take special pride that our alumni now provide specialist oncology care and hold leadership positions in several cancer centres in the country and internationally.

Tata Memorial Hospital Based Cancer Registry 1941 Hospital-Based Cancer Registry (HBCR) is functional since inception of the hospital 1941-1985 Several clinical and survival studies were published utilizing the HBCR data. Due to non-existence of computers, all statistical analysis was done manually using 80-coulmn punch cards, Sorting machines and Calculators 1963 Mumbai Cancer Registry was established in the premises of Tata Memorial Hospital (TMH) under Indian Cancer Society. All technical and administrative assistance was provided by TMH. 1982 Technical Wing of the National Cancer Registry Programme (NCRP), Indian Council of Medical Research (ICMR) was established in TMH premises 1985 Cancer Registry software was developed and Online data entry initiated. HBCR of TMH joined the network of National Cancer Registry Programme (NCRP) of Indian Council of Medical Research (ICMR). Annual submission of data to NCRP was initiated from the year 1987. The first Report of the TMH HBCR-NCRP network effort of 1984 registered cases seen in TMH was published in the year 1987.

Trend of All Cancers- 1985-2014 Source: HBCR, Tata Memorial Hospital , Mumbai

Trend of Cancer by Residence Source: HBCR, Tata Memorial Hospital , Mumbai

Head & Neck Cancers - Male Site % Change Hypopharynx 6.9 ­ Larynx 3.4 Oral Cavity 9.3  Oropharynx 8.7 Source: HBCR, Tata Memorial Hospital , Mumbai

Head & Neck Cancers - Male Site % Change Nasopharynx 0.4 ­ Para Nasal Sinus 0.6 Salivary Gland (Major) 0.1 ¯ Source: HBCR, Tata Memorial Hospital , Mumbai

Head & Neck Cancers - Female Site % Change Hypopharynx 1.7 ¯ Nasopharynx 0.0   Oral Cavity 0.4  Oropharynx 1.0 Source: HBCR, Tata Memorial Hospital , Mumbai

Head & Neck Cancers - Female Site % Change Larynx 0.2  Para Nasal Sinus 0.7 Salivary Gland (Major) 0.1 Source: HBCR, Tata Memorial Hospital , Mumbai

Gastrointestinal Cancers - Male Site % Change Colon 1.0  Gall Bladder 2.8 Oesophagus 4.8 ­ Pancreas 1.2 Source: HBCR, Tata Memorial Hospital , Mumbai

Gastrointestinal Cancers - Male Site % Change Anal Canal 0.1  Liver 1.6 Rectum 1.0 Small Intestine 0.2 Stomach 1.2 Source: HBCR, Tata Memorial Hospital , Mumbai

Gastrointestinal Cancers - Female Site % Change Colon 1.0 ­ Gall Bladder 5.5 Liver 0.6 Oesophagus 2.5  Source: HBCR, Tata Memorial Hospital , Mumbai

Gastrointestinal Cancers - Female Site % Change Anal Canal 0.1 ­ Pancreas 1.0 Rectum 0.7 Stomach 0.6 Source: HBCR, Tata Memorial Hospital , Mumbai

Genito-Urinary Cancers - Male Site % Change Kidney 1.0 ­ Urinary Bladder 1.1 Prostate 1.9 Testis 0.5  Penis 0.1 Source: HBCR, Tata Memorial Hospital , Mumbai

Genito-Urinary Cancers - Female Site % Change Kidney 0.3 ­ Urinary Bladder 0.1 Cervix 21.5  Ovary 2.4 Corpus Uteri 1.1 Source: HBCR, Tata Memorial Hospital , Mumbai

Hematolymphoid Malignancies- Male Site % Change Leukemia 0.9 ­ Multiple Myeloma 0.6 Non-Hodgkins Lymphoma 0.8 Hodgkins Disease ¯ Source: HBCR, Tata Memorial Hospital , Mumbai

Hematolymphoid Malignancies- Female Site % Change Leukemia 1.2 ­ Multiple Myeloma 0.2 Non-Hodgkins Lymphoma Hodgkins Disease 0.3  Source: HBCR, Tata Memorial Hospital , Mumbai

Trends in Common Cancers Site % Change Head & Neck 7.0 ¯ Breast 5.8 ­ Cervix 21.5 Years Source: HBCR, Tata Memorial Hospital , Mumbai

Comparison with other HBCRs – 1984-1993 Source: NCDIR, India

Comparison with other HBCRs – 1999-2003 Source: NCDIR, India

Clinical Extent of Disease – Head & Neck Cancers Source: HBCR, Tata Memorial Hospital , Mumbai

Trends in Treatment Modalities – Head & Neck Cancers 1985 1994 1999 1989 2004 2009 2014

Clinical Extent of Disease – Breast Cancer Source: HBCR, Tata Memorial Hospital , Mumbai

Trends in Treatment Modality – Breast Cancer 1985 1994 1999 1989 2004 2009 2014 Source: HBCR, Tata Memorial Hospital , Mumbai

Clinical Extent of Disease at time of presentation at TMH – Cervix Cancer Source: HBCR, Tata Memorial Hospital , Mumbai

Trends in Treatment Modality – Cervix Cancer 1985 1994 1999 1989 2004 2009 2014 Source: HBCR, Tata Memorial Hospital , Mumbai

Downstaging of Cervical Cancer over the years Source: HBCR, Tata Memorial Hospital , Mumbai

Bone Marrow Transplants at TMH Years Source: HBCR, Tata Memorial Hospital , Mumbai

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