Epidemiology of adolescent and young adult cancer and associated disparities in cancer pattern and care in India: findings from Varanasi’s population-based cancer registry, 2017–2019

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INTRODUCTION: Adolescents and Young Adults (AYAs) aged 15-39 represent a unique oncology demographic due to their distinct developmental needs. However, there is limited data on cancer burden and care disparities among the Indian AYAs. This study examines the burden, pattern, and disparities among AYAs in Varanasi, Uttar Pradesh. METHODS: This study collected data from Varanasi's population-based cancer registry (PBCR) between 2017 and 2019. Data were analyzed for demographic, clinical, and cancer-related variables. Sex and site-specific crude, age-adjusted, and truncated rates for incidence and mortality per 100,000 population were calculated. Disparities in cancer pattern for age, sex, cancer site, and geographical region, sociodemographic and cancer care characteristics were assessed using standardized rate ratios and multivariable regression. Adjusted ratios with 95% confidence intervals were calculated. AAIR of the leading cancer site was compared with 24 Indian PBCRs from Cancer Incidence Five data and GLOBOCAN (2022) data. RESULTS: Of 6821 cancer patients, 1105 (16.2%) were AYAs. The truncated age-adjusted incidence rate (AAIR) was 21 per 100,000 population, with mouth (16.5%), breast (12.2%), and tongue (6.2%) cancers leading. Oral cancer was most common cancer in male AYAs, with truncated AAIR of 9.2 per 100,000, ranking third highest among Indian PBCRs. Females had higher risks of stomach, gallbladder, and thyroid cancers. AYAs were more likely to access diagnostic and definitive treatment but faced income and employment vulnerabilities when compared with adults aged ≥ 40 years. CONCLUSION: This study highlights significant cancer burden and disparities among AYAs in Varanasi. Targeted screening, tobacco control policies, and region-specific interventions, especially social support schemes, are crucial to addressing these inequities and improving outcomes.

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