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Cancer is taking Kashmir by a surprise as more and more people are being diagnosed with one or the other type, despite minimal awareness and diagnostic facilities. Gastro-intestinal malignancies, some of which could be attributed to heavy metal contaminations, are the highest recorded cancers in Kashmir, but poorly researched.
In Kashmir, cancer cases registered with the only cancer centre, Regional Cancer Centre at Sher-i-Kashmir Institute of Medical Sciences, have more than doubled since 2007. While in 2007, 2097 patients were registered at RCC, in 2015 this number was 4438. This doubling of patients with cancer has been steadily on the rise over the years. In the two and a half months of 2016, 865 new cancer patients have been registered at RCC, pointing to a steep rise in cancers in this region.
Of all cancers, cancers of the gastro-intestinal tract have the highest occurrence, accounting for over 30 percent of cancers in Kashmir. Since 2009, 8122 patients with gastro-intestinal (GI) tract cancers have been registered at RCC. Total number of patients registered during this time was 23708. Cancers of oesophagus, stomach, GE Junction, colon and rectum constitute for 34 percent cancers at RCC registers.
‘Cancer in Kashmir, India: Burden and pattern of disease’, a 2012 study conducted at SKIMS states: “Consumption of high salt content (including salted tea) and infection with Helicobacter pylori bacteria may be the possible reasons for the high incidence of this cancer (stomach) in the Kashmiri population.” It also argues that the high incidence rate of CRC (colo-rectal cancer) has been associated with food habits and life style patterns. Four years back too, this study had concluded: “The malignancies of gastro-intestinal tract were the most common in the Kashmiri population.”
Many dyes, used in industries and sometimes in foods, are also thought as human carcinogens. Some of these colors, added to food generally, have been banned in some countries due to concerns about their link to some cancers. Some of these dyes such as Citrus Red 2, Blue#1 (E133), Yellow#5 (tartazine) and yellow#6 (E110) have been linked to various kidney tumors, brain cancers and defects in genes and nerve tissues. One of these dyes, tartazine, has been found as a coloring agent in many edibles, spices and condiments in Kashmir. This yellow coloring agent metabolises to benzidine and 4-aminobiphenyl, listed under ‘Known Carcinogen’ category in 13th Report on Carcinogens by US Department of Health and Human Services.
Many international studies have linked presence of heavy metals in soil, vegetables, fruits and drinking water to GI cancers. A study carried out in Turkey and published in Journal of Environmental Toxicology and Pharmacology, has found soils, water, fruits and vegetables with heavy metal contaminations as ‘potential carcinogenic risk factors which may be related to the high prevalence of the regional upper GI cancers’. Lead, listed as ‘direct carcinogen’ in many studies and books, such as Hypothermia in Oncology by Clifford L K Pang, is a common pollutant. The book states, ‘incidences of cancers… among patients with lead poisoning are 2.5 times higher than those with no lead poisoning’.
Despite growing incidence of GI and other cancers, and the mounting evidence linking heavy metal contaminations in food and water to the occurrence, there is very little research and monitoring locally. “There definitely is a need to investigate role of heavy metals contaminations vis-a-vis cancer. Just because we have not looked for something, does not mean it does not exist,” said Dr. SanuallahKuchay, HoD Radiation Oncology at SMHS Hospital.