Cancer in the Sindhi Population of Greater Bombay D. J. JUSSAWALLA, MS, FRCS, FACS, FAMS, FA%* B. B. YEOLE, MSc,t M. V. NATEKAR, MSC,t AND T. R. RAJAGOPALAN, BSc* The Sindhis are a Hindu subgroup identified by their place of origin and their written spoken language. These are the people who were originally inhabitants of the Province of Sind, which formed a part of the large Bombay Presidency in Undivided India before 1947. The Sindhi Hindus migrated en masse to India after partition. An attempt has been made here to examine the differences found in the site-specific cancer risks among the Sindhi community, the other Hindu groups (such as the Marathi and Gujrati populations) and the Parsi community of Greater Bombay. As the Indian Census Board does not provide age distribution details for the Sindhis, analysis of the data was undertaken employing frequency ratios. Age-standardized cancer ratios (ASCAR) were also utilized for certain calculations. The common sites of cancer appear to vary greatly between the total Bombay population and the Sindhi group. In Sindhi men, for example, cancers of the lung, large bowel, prostate, kidneys and leukemias are most com- monly seen, whereas laryngeal and oesophageal cancers predominate in the general population of Bombay. In Sindhi women the breast, uterus, ovary, and skin are the preferred sites, whereas cancers of the cervix and leukemias are predominant in the general population of Bombay. It is interesting to note that there is a degree of similarity in the incidence of cancer at certain anatomical sites, such as the prostate, large intestine, and leukemias in males, and breast, cervix, ovary and uterus in females, be- tween the Sindhi and Parsi communities of Greater Bombay. Cancer 46:2107-2115. 1980. HENEVER a migrant group settles in a new differences between the Parsi community and the rest country, their basic life-style (viz.diet, occupa- of the Bombay population in the incidence of cancer tion, recreational habits, and other activities of daily at various living) tends to be retained for varying lengths of time. Vast differences have been known to exist in the The country of birth can thus be utilized as a valuable habits and customs of different sections of the large marker to identify within a given population those and complex Hindu community in India. One of the communities whose earlier environmental exposure ways of identifying the different groups is on the basis and other characteristics differ from those of other of the written and spoken language, which, together migrant groups in the area and from the natives. Certain with the place of origin, are valuble objective charac- habits and customs may be retained, perhaps in modi- teristics identifying the different Hindu sects within fied forms, even in the second and third generation India. migrants, so that the origin of the parents and grand- The Sindhis are one such group of Hindus identifiable parents can help to distinguish the population groups on the basis of language and place of origin from with different environmental backgrounds. Previous other Hindus in the Indian subcontinent. These people studies at this Registry revealed striking and significant migrated en masse from the province of Sind after the partition of India, which had formed in the previous From the Tata Memorial Hospital and Cancer Research Institute, era a part of the large Bombay Presidency. They still Bombay; and the Bombay Cancer Registry, Indian Cancer Society, employ the Persian script in contrast to the Deonagri Parel, Bombay. Supported in part by Grant no. NIH-01-006-1 from the National or Sanskrit script. Sind was ceded to Pakistan in 1947 Cancer Institute, Bethesda, Maryland. and now forms an important part of that country. * Director, Tata Memorial Hospital; Chief, Bombay Cancer Registry: and Honorary Secretary and Managing Trustee, Indian Cancer Society. Purpose of the Study t Biostatistician, Bombay Cancer Registry. t Assistant Statistician, Bombay Cancer Registry. The Sindhis are distinguishable from the vast Address for reprints: Dr. D. J. Jussawalla, Bombay Cancer majority of Indians by their habits, customs, and socio- Registry, Indian Cancer Society, Dr. E. Borges Marg, Parel, Bombay-400 012, India. economic status and, though mainly residing in greater Accepted for publication November 26, 1979. Bombay, present striking differences from the total 0008-543X/80/1101/2107 $0.95 0 American Cancer Society 2107 2108 CANCERNovember I 1980 Vol. 46 became nonvegetarian and ceased to practice age-old orthodox Hindu customs. Because of initial political patronage shown towards minorities, they were able to acquire wealth through business enterprise and the benefits of a good education. Furthermore, having to survive within a somewhat hostile majority, they in- stinctively became socially and economically aggres- sive. As Sind was then predominantly a desert area, many of them left for other parts of the country to earn a better livelihood. Soon this enterprising people blossomed into an interregional trading community. These then were the people who migrated to India in 1947. Once again, within a short time many of them proceeded to other parts of the world, outside India, in pursuit of economic betterment, but continued to keep their roots in India. Area and Population of Greater Bombay FIG. 1. Map showing the areas of origin of Sindhis, Marathis, and Gujratis. Greater Bombay is a cosmopolitan city, which by 1971 had acquired a population of 5.97 million, drawn in sizeable numbers from every state in the Indian Bombay population in the relative frequency with Union. This urban center is thus representative of a which cancer arises at various sites. An appraisal of true cross-section of the heterogenous peoples of the the situation was thus considered promising in ascer- country. Hindus, Moslems, Christians, and Parsis taining whether or not these apparent differences constitute 68.8, 14.1, 6.3, and 1.1% of the total popula- could be ascribed to any recognizable variations in their tion. Of the Hindus, 60% are from the State of Maha- life-style. We have made an attempt to investigate rashtra, 29% came from Gujrat, and the Sindhis ac- the site patterns of cancer in this community and count for only 3.3% of the population (Fig. l.)I to define the magnitude and nature of the differences The Marathi-speaking Hindus hail from districts to observed. the south and east of Bombay, whereas the Gujratis come from the western seaboard to the north of the Historical Background city. Due to the spurt in commerce and industry in With the advent of the Aryans in India about 2000 Bombay that began in the latter part of the 19th cen- years ago from the region known historically as “Asia tury, both these Hindu groups migrated to the city in minor,” the cradle of the Indo-Germanic civilization, search of employment. The Gujratis soon formed the and the migration of the original (Dravidian) native bulk of the commercial community as elsewhere, population southwards, the Indo-Gangetic plains be- whereas the Marathi group gained employment as in- came the final homeland of a people of Aryan and dustrial workers, joined the armed forces, and took to mixed Dravido-Aryan stock, professing the Hindu the clerical and teaching professions. The Sindhis, and later the Buddhist faith. This state of affairs con- however, established themselves in Bombay as pro- tinued up to 1500 A.D.; when Sind became the first fessionals, businessmen, and traders. part of the country to come under the rule of the in- This densely populated metropolis on the west coast vading Moghuls from the central Asian hinterland. Due of India covers an area of 437.7 sq km. to the subsequent conversion from Hinduism and Buddhism to Islam and by the migration that continued Materials and Methods from Moslem countries to the north and northwest of Sind, the ultimate religious denomination of the The basic data utilized for this study were collected majority of the local people soon changed, so that by the Bombay Cancer Registry, which restricts its by 1843, when the British conquered Sind from the coverage to proved residents of Greater Bombay. Any ruling Mirs, barely 10% of the population was known person who has lived in the city for one or more years to profess the Hindu faith. prior to the date of diagnosis is considered a resident. Living in the midst of a Moslem majority, this During the period under review (1964-72), 3 1,770 Hindu minority adopted an unorthodox character, new cancer cases were registered in the Metropolis, No. 9 CANCERIN SINDHIS. Jussawalla et al. 2 109 of whom 662 were Sindhis. Three hundred thirty-seven TABLE1. World Standardized Cancer Ratios and Crude Cancer Ratios for Different Population Groups in were males and 325 females. Greater Bombay by Age As the Indian census does not provide information on the Sindhi population by age, we have for the present World Population groups Age standard analyzed only the frequency ratios in this community. group distribution Marathi Gujrati Sindhi Parsi Comparisons made on the basis of relative frequencies, without simultaneous consideration of the different 0- 14 5.0 3.3 2.7 2.9 1.1 15-24 5.0 3.0 2.5 2.4 1.0 age groups, can be misleading to some extent. Any 25-34 5.0 8.0 4.5 4.5 2.5 comparison between specific groups of cancer cases 35-44 10.0 19.7 13.0 12.5 7.4 is thus difficult to make, in the absence of adequate 45-54 15.0 28.0 25.9 23.8 13.8 details in the population data. In order to facilitate 55-64 20.0 22.5 26.6 26.7 23.5 65 - 74 25.0 11.5 17.7 17.5 29.5 reasonably adequate assessment, age-standardized 75 f 15.0 4.0 7.