FormalPara Key Points

  • India’s Tribal populations are likely to be at increased risk of poor cancer outcomes due to poverty, poor general health, low health literacy, and poor access to healthcare.

  • Oral cancers are common among India’s Tribal population, with very high use of tobacco (smoking and smokeless forms). In some areas, 90% of youth use tobacco.

  • Cervical cancer is the second-most common cancer among Tribal women, but many women have little knowledge about prevention and early detection.

  • India’s Tribal communities need improved access to cancer screening and prevention information.

  • Establishing specific cohorts of Tribal populations and linking them with cancer registries would improve understanding about cancer incidence and outcomes in India.

India is a diverse country with multiple ethnic groups and the world’s second-largest Tribal population, following Africa [1]. India is home to around 635 different Tribes, comprising 8.9% of the total population; 73 of these considered to be ancient [2]. Despite this significant proportion, India’s Tribal population has limited access to healthcare, and factors such as poverty, low literacy, and poor living conditions are linked to failure to diagnose or delayed diagnosis and increased mortality due to cancer. In addition, Tribal communities experience higher rates of noncommunicable diseases such as diabetes, hypertension, and cardiovascular disease. While rates of diseases such as diabetes and high blood pressure are reported in India and are known to be high in Tribal populations, the cancer incidence in these groups is not reported [3]. No population-based studies accurately describe the incidence of cancer across all Tribal communities in India.

Tribal populations in India are likely to be at increased risk of poor cancer outcomes, due to factors such as malnutrition, poor general health, poverty, and low health literacy. Research suggests that 72% of Tribal peoples use tobacco and more than 50% consume alcohol [4]. In addition, Tribal people typically have limited access to healthcare facilities and health information.

Available Data About Cancer in Tribal Populations

While a few states document cancer incidence through population-based cancer registries, research publications, and hospital registries, available data indicate that states in the northeast, including Mizoram, Manipur, and Arunachal Pradesh, have the highest cancer incidence, especially among men [5].

Oral cancer is the most prevalent cancer among India’s Tribal population, accounting for around 30% of all cancers [6]. While treatment and survival for oral cancer have improved, prevention and early diagnosis remain an ongoing challenge. It is likely that poor access to healthcare and high levels of tobacco use (both smoking and smokeless) are key contributors to oral cancer for the Tribal population.

Overall, in the northeast region where the proportion of Tribal populations is higher, the most common cancers include nasopharynx, hypopharynx, esophagus, stomach, liver, gallbladder, larynx, lung, breast, and cervix uteri. While Manipur and Mizoram report the highest numbers of lung cancer, the East Khasi Hills district of Meghalaya reports the highest proportion of tobacco-related cancer. Beyond the northeast, the most prevalent malignancies among Tribal men are nasopharynx, throat, esophagus, stomach, and lung. The Tamil Nadu Cancer Registry Project (TNCRP), which is a joint population-based cancer surveillance study by the Cancer Institute (WIA) and department of health and family welfare, government of Tamil Nadu, reveals a variable cancer incidence pattern in Nilgiris district, which has a sizeable Tribal population; here cancer of the esophagus was the most common among men, unlike in the rest of the state [7].

Some research has examined tobacco use among the Tribal population. In Madhya Pradesh, for example, nearly 37% of Tribal women and 34% of Tribal men chew tobacco [8], with the smokeless tobacco products supari, gutka, and naswar the most commonly used. Tobacco smoking is more widespread than tobacco chewing, with nearly 80% of India’s Tribal population found to smoke tobacco, often beginning at around age 10 years [9]. Tobacco use in Madhya Pradesh is initiated as a form of tooth cleansing and is more common among women [9]. Similarly in South India, nearly 65% of the Narikurava population use tobacco, with 29% smoking tobacco, 63% using smokeless tobacco, and nearly 8% using both. In this population, tobacco use is particularly high among youth, with approximately 90% using some form of tobacco. There are calls to educate the young Tribal community on the harmful effects of tobacco and to offer cessation services to quit [9].

In the southern state of Andhra Pradesh, researchers examined knowledge and attitudes toward cervical cancer screening. Cervical cancer is the second-most common cancer among Tribal women, but many women have little knowledge about prevention and early detection. The Government of India has introduced cervical cancer screening programs and awareness campaigns. In the general Indian population, major barriers to cervical cancer screening include modesty, anxiety about screening procedures, stigma, and fear of being judged. Among Tribal women, barriers also include the unavailability of regular cervical cancer screening programs, lack of awareness, and low interest in being screened [10]. A study among the Koraga, Malekudiya, and Marathi Naika Tribes of the Udupi district in Karnataka reported that Tribal women were unaware of cancer risk factors but had a positive attitude toward cancer screening. In a study of breast cancer screening among Tribal women in the Nilgiris district, Tamil Nadu, researchers found that most women had heard of breast cancer, but only half were aware of the symptoms. The research suggests that knowledge about early detection and screening is yet to benefit the community [11, 12]. In another study, only 16% of Tribal people were found to be aware of the risk of oral cancers and that they are preventable with lifestyle modification [13].

Education about cancer for India’s Tribal populations is increasing. A randomized controlled trial in Kerala tested the efficacy of small-group education, reinforcement sessions, telephone reminders, navigation, guidance about Pap smear tests, and a follow-up visit for improving awareness of cancer and increasing take-up of screening [14]. The study found that community-based intervention was effective in improving screening among Tribal women. Ongoing education through motivation and regular reinforcement were reported as effective strategies [14]. However, barriers to screening remain, including the paucity of health facilities, out-of-pocket costs, misconceptions about screening, trust in traditional healers, and low priority given to health issues [15].

Conclusions

Financial burden remains a major barrier to cancer screening in India, including for Tribal populations. A report by the Indian Ministry of Health and Family Welfare found that nearly 50% of outpatient visits for the Tribal population are to public centers. The same report highlighted a 40% shortfall in primary health centers and 31% shortfall in community health centers in Tribal communities [2].

India’s Tribal population urgently needs improved cancer control initiatives through the establishment of a convenient, appropriate, and reliable system that gives them access to cancer screening and information about prevention. Interventions must be tailored to communities’ cultural norms and languages, and local healthcare workers need training to better identify cancer symptoms and improve community education. Mobile health services could address some of the geographic barriers, and media information could improve awareness. In addition, establishing specific cohorts of Tribal populations and linking with cancer registries are essential to fully understand cancer incidence and outcomes among India’s Tribal populations.