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emaciation and cachexia characteristic alike of Cancer and many chronic
infectious diseases and the acute infections, which are so often the imme-
diate cause of death in cases of malignant disease, mask the true dimen-
sions of Cancer mortality in India. To appreciate the size of the Cancer
problem in India, an investigation was made under the auspices of the
Indian Research Fund Association which utilised information available
from the records of pathological units and in-patients departments of hos-
pitals connected with medical schools and colleges throughout India and
Burma. This survey covered records of 22,753 pathological Post Mortem
examinations yielding 869 cases of malignant disease, which meant that
one out of every 26 autopsis related to a cause of malignant disease. The
proportion of Cancer to Sarcoma in this series was as 4.8:1. In every
province the preponderating incidence of Cancer—over 50 per cent.—was
on the gastro-intestinal tract.. Female genital organs came next in order,
then carcinomas of the buccal cavity, breast, skin and penis.
2. The records of pathological laboratories of teaching hospitals were also
consulted. Malignant disease was diagnosed in 9,982 cases. Approxi
mately one out of every five biopsy specimens examined was diagnosed
malignant. Because of the paucity of explanatory operations for diseases
of the G. I. tract, cancer of this site did not occupy a prominent position
in this series. The sites in order of frequency were female genitals, buccal,
breast, skin, penis and G. I. tract.
3. The records of 7,93,929 in-patients from hospitals attached to medical
colleges and schools were studied and 17,991 cases of malignant disease
came under notice, representing a proportion of 1:44.7. One does not
expect conformity in regional frequency between histological and clinical
records, because the latter concern many cases of malignant disease of
inaccessible sites as well. The order of frequency in regard to sites affected
in cases clinically diagnosed was as follows:—Female genitals, buccal, G. I.
tract, breast, penis and skin.
4. It is difficult to offer an analysis of all the sites affected, which
leaves a substantial number of cases to be classified under the heading mis-
cellaneous.
5. The age of maximum incidence of Cancer in this country is at least
ten years earlier than in the Western countries and Japan and in the case
of cancer of the female generative organs earlier by 15-20 years. In every
province including Burma, the incidence of cancer of cervix falls heaviest
on Hindu women. The incidence of buccal cancer falls heavier on the male
than on the female and on Muslims more than the Hindus. This form of
cancer has its lowest incidence in the Punjab, where Pan chewing is not
indulged in to the same extent as in other parts of India. Unhappily this
habit is growing rapidly in that province as well. Penis cancer is peculiar-
ly a disease of the uncircumsized communities and out of a
total of 611 cases noted in biopsy records and 1,080 cases in clinical records
only 17 cases were recorded among Mohammedans in the former series and
29 in the latter.
6. In the whole of this enquiry the aetiological role of irritation in the
incidence of Cancer has stood out prominently. Whether it was the cervix
O