Introduction
Cancer remains one of the leading causes of death worldwide, claiming nearly 10 million lives annually. World Cancer Day, observed on February 4, serves as a global call to action to raise awareness and promote equitable access to cancer care. The 2025-2027 theme, “United by Unique,” emphasises the importance of people-centred solutions tailored to the diverse needs of individuals and communities. In India, the cancer burden is rising alarmingly, with North East India, particularly Meghalaya, facing unique challenges. Often called the “cancer capital of India,” Meghalaya’s crisis extends beyond tobacco use, demanding a deeper exploration of cultural, dietary, and environmental factors.
Global Overview of Cancer
Cancer remains a leading cause of death worldwide, with nearly 20 million new cases and 9.7 million deaths reported in 2022. Lung cancer was the most commonly diagnosed cancer globally, accounting for 12.4% of new cases, followed by breast and colorectal cancers. By 2050, cancer cases are projected to rise to 35 million due to population growth, aging, and increased exposure to risk factors like tobacco, alcohol, obesity, and air pollution. Disparities in cancer care persist, with low-income countries expected to see the sharpest increases in cases and deaths, underscoring the urgent need for equitable access to prevention and treatment.
Indian Cancer Burden
India faces a growing cancer crisis, with 1.46 million new cases reported in 2022 and an estimated 12.8% increase projected by 2025. One in nine Indians is likely to develop cancer during their lifetime. Breast cancer is the most common among women, while lung and oral cancers dominate among men. Together, cervical, oral, breast, lung, and colorectal cancers account for nearly half of all cases. Tobacco use remains a significant driver of cancer in India, along with lifestyle changes, obesity, and late-stage diagnosis. Disparities in access to early detection and treatment further compound the burden, especially in rural areas.
Meghalaya’s Cancer Burden
Behavioural and Cultural Factors:
North East India has a distinct cancer profile, with a high prevalence of cancers in the oesophagus, stomach, and hypopharynx regions. These cancers are primarily linked to tobacco use and specific dietary practices, such as consuming chili peppers, smoked meat, and some fermented food items like fermented pork fat. According to the National Centre for Disease Informatics and Research (ICMR-NCDIR) 2021 report, Meghalaya has the second- highest cancer prevalence among men (227.9 cases per 100,000) and ranks 11th among women (118.6 cases per 100,000). Oesophageal cancer is the most prevalent in Meghalaya, with rates ten times higher than the national average. This is strongly associated with betel nut chewing, a cultural habit often combined with tobacco, slaked lime, and areca nut. Studies show that this habit significantly increases the risk of oral, oesophageal, and hypopharyngeal cancers. The risk doubles when combined with smoking and alcohol consumption. Lung cancer is another leading type of cancer in Meghalaya. While smoking remains the primary cause, indoor air pollution from burning woodfire, coal, and biomass for cooking and heating also plays a significant role. These practices release toxic compounds like particulate matter and nitrogen oxides, which heighten lung cancer risks when combined with cigarette smoke. Additionally, areas like South West Khasi Hills have elevated radon levels due to uranium-rich soil, further contributing to lung cancer cases. Meghalaya’s dietary habits and environmental factors also contribute to stomach, cervical, and gallbladder cancers. The widespread consumption of smoked, fermented, and preserved foods introduces carcinogenic compounds like nitrosamines, which are linked to stomach cancer. Low consumption of fruits and vegetables reduces antioxidant levels in the body, increasing susceptibility to DNA damage from carcinogens. This dietary deficiency exacerbates cervical cancer risks. Gallbladder cancer is particularly prevalent among women due to a combination of dietary patterns and hormonal factors.
Challenges in Cancer Care:
Cancer care in Meghalaya faces numerous challenges. Infrastructural and economic barriers are significant obstacles, but health-seeking behaviour poses the greatest challenge. Delayed care-seeking is common due to cultural beliefs that illness stems from “poison” or ill intent. Stigma surrounding cancer diagnoses and apprehension about treatment methods further discourage timely intervention. Many individuals rely on self-management or traditional medicine for treatment due to economic constraints. Out-of-pocket expenses for travel, diagnosis, and treatment can consume up to 25% of household income in remote areas where affordable transportation is scarce. When it comes to community-based screening for cervical and breast cancer, certain areas in Meghalaya face challenges related to ensuring privacy during the screening process. To address these issues, it is crucial to improve healthcare infrastructure and expand insurance coverage. Overcoming cultural stigma through community education programs can encourage early detection and treatment adherence while reducing reliance on traditional medicine.
Path Forward: People- Centred Solutions
Addressing cancer effectively requires a holistic approach that prioritises people-centred solutions. Awareness campaigns play a crucial role in dispelling myths, promoting early detection, and encouraging healthy lifestyles. Initiatives like Meg Can Care educate communities on recognising symptoms and the importance of screening for cancers such as cervical, breast, and oral cancers. Mission-based programmes like Meghalaya Cancer Mission focuses on early detection through mass screenings for individuals over 30 years old. It also incorporates AYUSH techniques for managing stress and preventing relapses. Policy interventions are vital to strengthen anti-tobacco laws, promote HPV vaccination, and improve access to affordable care. Investments in healthcare infrastructure, such as establishing cancer care centres and training healthcare workers, are essential to bridge gaps in rural areas. Meaningful handholding of the communities by collaborating with the Village Health Councils (VHCs) across Meghalaya can be of help. The VHCs can raise awareness in the communities about adopting healthy lifestyles, including educating individuals on the harmful effects of tobacco and alcohol and encouraging them to quit these habits. This can significantly reduce the risk of various health issues, including cancer, while promoting overall well-being. Additionally, promoting organic farming initiatives by distributing vegetable seeds, saplings, and manure to encourage pesticide-free food production. Training local volunteers for palliative care and caregiver training sessions is equally important. Communities can harness the power of their social capital to improve their health. Hence, by combining these strategies, we can foster equitable access to prevention and treatment. This people-centred approach aligns with the World Cancer Day theme, “United by Unique,” ensuring that every individual’s needs are addressed with empathy and care.
Conclusion
In conclusion, tackling the cancer crisis in Meghalaya and beyond requires a multifaceted approach that addresses the root causes while empowering communities. By acknowledging the interplay of cultural, dietary, and environmental factors unique to regions like Meghalaya, we can design targeted interventions that resonate with local populations. Strengthening healthcare infrastructure, promoting early detection, and investing in education to dispel myths and reduce stigma are critical steps forward. Collaboration among policymakers, healthcare providers, and community leaders is essential to bridge gaps in access and affordability. Ultimately, a unified effort that combines scientific advancements with culturally sensitive solutions can not only reduce the cancer burden but also improve overall health outcomes, ensuring that no one is left behind in the fight against this devastating disease.
(The authors are students of Master of Public Health Students at the Indian Institute Of Public Health, Shillong)