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Regional Cancer Patterns Ten
to Fifteen years Post-Pokran

Drs RG Sharma, MS Maheshwari and SC Lodha of SN Medical College, Jodhpur, Rajasthan, reported a data collection exercise of cases of various kinds of cancers entering the records of government hospitals as well as private clinics [this presumably being a non- comprehensive list] in Jodhpur in the period 1984-1988; - that is, ten years after the first Indian underground nuclear blast at Pokran. The results were published in the Indian Journal of Cancer [volume 29, pages 126-135] in September 1992. In the light of continuing nuclear explosion activity in the area, it is useful to summarize and comment on the findings in that paper.

The findings are from non-exhaustive sources and they take no account of precisely where the patients came from or who they were in demographic terms. The data therefore cannot be interpreted to say anything at all about the absolute incidence of cancers. They cannot even be definitive about the relative frequencies of different kinds of cancers in a specific area, although they probably provide data on patients who are mainly local to the region. It must also be remembered that the data will be biased in favor of the more obvious cancers relatively easily diagnosable without laboratory investigations. Finally, since no data are given for comparison in the Jodhpur region from before the 1974 nuclear blast, any conclusions, if at all drawn, must be extremely tentative indeed.

The data reported consist of three tables and a figure. The figure is simply a graph of the age distribution of all cases of cancer, with men and women being shown separately. It says that the highest frequency is between the ages of fifty and seventy, but there does not seem to be anything peculiar about this fact, nor do the authors comment on it as such.

The first table gives the numbers of cancer cases reported for various organs of the body, and its only utility is to provide the sample size for each percentage value calculated that is used in the other two tables. The categories of tumors used in the three tables show significant differences, so that extrapolation is not always possible. Nonetheless, the sample size in the first table suggests that a frequency of 0.5%, which is at the lower end of the range reported in the other two tables, is equivalent to about five cases.

The second table compares the percentile representation of cancers of various kinds in the Jodhpur region over 1984-1988 with the global statistics for 1980 [WHO data as separate figures for developed and developing countries]. Cancers of the mouth and throat, which would be obvious quite early and can be diagnosed clinically by looking at them and feeling them, are even more prominent in Jodhpur-1984-1988 [25/12\:M/F] than in developing countries [11/6\:M/F], leave alone the developed countries [5/2\:M/F]. Cancers of the colon and rectum, larynx, breast and uterus are at about the same frequencies as the average figures for developing countries. Oesophagus, stomach, liver, pancreas, urinary bladder and prostate cancers, which would perhaps be relatively harder to diagnose clinically, are relatively under-represented. One would think that ovarian cancers, lymphomas and leukemias would present quite as much difficulty for simple clinical diagnosis and need laboratory investigations. Despite this, the frequencies are higher for these cancers, suggesting that they may be genuinely more frequent in the population being studied. Ovarian cancers are more frequent by fifty percent compared to the average figures for either developed or developing countries. While lymphomas in women are not increased in frequency, lymphomas in men and leukemias in both men and women are more frequent by fifty to eighty percent than in the average figures for developed or developing countries.

The third table compares the percentile representation of cancers of various kinds in the Jodhpur region over 1984-1988 with the frequencies reported to the National Cancer Registry in 1983 from various cities the length and breadth of India, - from Dibrugarh to Thiruvananthapuram. Unfortunately, all the cancer categories in the second table are not shown in the third table; - there are some missing and some new ones. There are some correlations and some dissonances with the second table, however. Cancer of the urinary bladder seems to be over-represented in Jodhpur compared to other Indian cities, but since the Jodhpur figure is close to the world average, it is not clear how significant this would be. While the lymphomas do not seem to be overrepresented in Jodhpur, leukemias certainly are, by a factor of fifty to one hundred and fifty percent, in comparison with other Indian cities, confirming the trend seen in the second table. Finally, bone and skin tumors, which are not given in the second table, are increased in their relative frequency in Jodhpur by a factor of forty to three hundred percent compared to other Indian cities.

So there are interesting correlations of some possible increase in frequencies of urinary bladder, skin, bone and ovarian cancers as well as lymphomas in Jodhpur, and a more consistent increase in the frequency of leukemias. With the exception of the skin, none of these cancers is easy to diagnose clinically under difficult conditions, so ease of diagnosis cannot be invoked as a reason for the relative increase in frequency. Bone cancers and leukemias have been strongly causally linked to radiation exposure worldwide in many studies, and their prominence in these data is therefore specially troubling when Pokran-I is remembered. At the very least, these data are sufficient reason for a transparently designed and conducted cancer epidemiological survey of the region in the context of possible exposure to nuclear radiation.