title: Trends in mouth cancer incidence in Mumbai, India (1995-2009): An age-period-cohort analysis.
abstract: Despite tobacco control and health promotion efforts, the incidence rates of mouth cancer are increasing across most regions in India. Analysing the influence of age, time period and birth cohort on these secular trends can point towards underlying factors and help identify high-risk populations for improved cancer control programmes.
  
  
  
  We evaluated secular changes in mouth cancer incidence among men and women aged 25-74 years in Mumbai between 1995 and 2009 by calculating age-specific and age-standardized incidence rates (ASR). We estimated the age-adjusted linear trend for annual percent change (EAPC) using the drift parameter, and conducted an age-period-cohort (APC) analysis to quantify recent time trends and to evaluate the significance of birth cohort and calendar period effects.
  
  
  
  Over the 15-year period, age-standardized incidence rates of mouth cancer in men in Mumbai increased by 2.7% annually (95% CI:1.9 to 3.4), p<0.0001) while rates among women decreased (EAPC=-0.01% (95% CI:-0.02 to -0.002), p=0.03). APC analysis revealed significant non-linear positive period and cohort effects in men, with higher effects among younger men (25-49 years). Non-significant increasing trends were observed in younger women (25-49 years).
  
  
  
  APC analyses from the Mumbai cancer registry indicate a significant linear increase of mouth cancer incidence from 1995 to 2009 in men, which was driven by younger men aged 25-49 years, and a non-significant upward trend in similarly aged younger women. Health promotion efforts should more effectively target younger cohorts.
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Gurgaon 122002, Haryana, India. Electronic address: g.krithiga@phfi.org.
authors.forename: Krithiga
authors.initials: K
authors.lastname: Shridhar
authors.affiliation: Centre for Global Health, National Cancer Institute, Bethesda, USA. Electronic address: rajarama@mail.nih.gov.
authors.forename: Preetha
authors.initials: P
authors.lastname: Rajaraman
authors.affiliation: Mumbai Cancer Registry, 74, Jerbai Wadia Road, Bhoiwada, Parel, Mumbai 400 012, India. Electronic address: bcrics@vsnl.com.
authors.forename: Shravani
authors.initials: S
authors.lastname: Koyande
authors.affiliation: Mumbai Cancer Registry, 74, Jerbai Wadia Road, Bhoiwada, Parel, Mumbai 400 012, India. Electronic address: purvish@rediffmail.com.
authors.forename: Purvish M
authors.initials: PM
authors.lastname: Parikh
authors.affiliation: Head and Neck Surgery, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai 400012, India. Electronic address: drchaturvedip@rediffmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Gurgaon 122002, Haryana, India. Electronic address: preet.dhillon@phfi.org.
authors.forename: Preet K
authors.initials: PK
authors.lastname: Dhillon
authors.affiliation: Centre for Cancer Epidemiology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai 400 012, India. Electronic address: dixr24@hotmail.com.
authors.forename: Rajesh P
authors.initials: RP
authors.lastname: Dikshit
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D007194:India; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology*; D062789:Tobacco Products
keywords: Age standardized rate; Age-period-cohort analysis; Age-specific rate; Cancer registry; Cancer trend; India; Mouth cancer; Mumbai; Net drift; Risk factors