For years I read and saw every day in the media, on TV and newspapers that the number of cancer cases in Kashmir were constantly going up day by day. I had a longing to know and explore about it in the last year of my Masters when I had my research topic dedicated to the investigation of the cancer incidents in Kashmir and it has been quite alarming to find the number of cancer cases and examine them. A single visible aberration, the ‘Kangri burn cancer', was the only medical mystery of the Kashmir Valley for more than a hundred years: a lethal skin cancer resulting from the traditional use of charcoal fire pots under pheran. Today, however, a much more subtle, multi-layered oncological crisis is threatening the Himalayan basin. A detailed new review titled “Kashmir, The Crucible of Cancer: A Phenomenological Review Article on Rising Prevalence of Cancer in the Valley from 1986 to 2026”, by Kamran Hamid Bhat and Munnu Prasad V, systematically exposes a harsh truth that has unfolded over the past four decades. The data suggests an inevitable answer: cancer in the Valley is not merely increasing, it is transforming into a complex epidemic that is becoming extremely difficult to escape from; one that is influenced by a combination of cultural habits, molecular susceptibility, and modern agro-chemical hazards. The scale of the crisis, however, is astounding and, when analysed across the hospital registries, Indian Council of Medical Research estimates and Right to Information disclosures, the malignancies have been steadily rising in the region. The region's main tertiary care facility, Sher-I-Kashmir Institute of Medical Sciences, Soura, reported 50,302 new cancer cases just during the same time period. However, the number of cancer cases diagnosed at this one institute has increased drastically, rising from 3,940 cases in 2014 to a record 5,791 cases in 2025, a 47 percent increase in less than a decade. In this institute, along with Government Medical College Srinagar and Government Medical College Jammu, data from 2025 was the first calendar year in which registrations of cancer cases in tertiary care exceeded 10000 cases in the territory. This newly combined information paints a picture of a health-care system increasingly straining under the "epidemiological triple-load" of gastrointestinal, tobacco-related and chemical-induced cancer. Moreover, there is a significant diagnostic problem within the rural population with around 20% of adult patients presenting with advanced, distant metastasis at their first visit. These late presentations substantially affect their treatment outcomes and clearly demonstrate the lack of infrastructure to detect these situations at an early stage in the peripheral areas. In Kashmir, gastrointestinal tract cancers are the most common primary cancers, in contrast to other parts of the world, where pulmonary and mammary malignancies are common primary cancers. One of the key tertiary care audits reported in the review indicated that gastrointestinal malignancy constitutes more than thirty-five percent of all the cancers in the region and gastric cancer is the absolute top cancer in the region at 17.2 per cent. The geographical distribution, as shown in the advanced spatiotemporal mapping, is very clear and South Kashmir has emerged as a high-risk gastric cancer belt. This surge in the gastrointestinal region is very concentrated, especially in the southern agricultural regions. In the district-level data, Kulgam has the highest incidence rate with 10.33 per 10,000 population, followed closely by Shopian, Pulwama and Srinagar with 8.79, 8.58 and 7.32 respectively. Of the 12 years, Kulgam suffered a terrible four-fold increase in gastric cancer cases, rising by 146.7 per cent. This is heavily skewed towards males, who account for 75.59 percent of the total stomach cancer cohort, and this incidence rate is rising at a significant rate after the age of forty. The researchers refer to this as "behavioural carcinogenesis" because the strategies that help animals survive some of the most extreme sub-zero winters are deeply intertwined with the region's cancer profile. Noon-Chai is the Valley's traditional salted pink tea that is a double whammy for the esophagus. The tea is ingested several times a day and causes chronic thermal trauma of the mucosal lining. The tea base made from this when boiled with sodium bicarbonate releases volatile amines that combine with the native dietary nitrite to form highly potent N-nitroso complexes that are aggressive carcinogens. When genetic studies are performed on these tumours, the point mutations found are due to these chemicals specifically, and not to the ageing of the cell. Contrary to the local myth that hookah water serves as a filter, the study shows that the stagnant water chamber soon turns into a saturated reservoir of carbon monoxide, tobacco-specific nitrosamines and volatile polycyclic aromatic hydrocarbons. This means that hookah smokers are almost 6x times more likely to suffer from lung cancer as non-smokers. Furthermore, the portable Kangri charcoal fire pot maintains the heat around the abdomen and thighs of about 150 °F/65.56 °C on a localized level. This constant and prolonged heat stress disrupts the repair of DNA in the affected area, and eventually leads to the mutation of normal skin to become an invasive and very aggressive squamous cell carcinoma. The historical vector is cultural while the economic one is much more aggressive in the form of intensive agro-chemical exposure. Kashmir's huge apple orchard industry consumes an estimated 10,936 metric tonnes of hazardous chemicals each year and a lot of these chemicals are chlorpyrifos, captan and mancozeb. In fact, certain international organisations such as the European Union have either limited or completely banned the use of mancozeb and captan, which have well established carcinogenic and endocrine-disrupting properties, and they are being sprayed in high densities in orchards throughout South Kashmir. Perhaps the most shocking finding of the study is the neuro-oncological effects of the chemicals. The researchers cite a significant study on neurosurgery that showed that 90.04 percent of all cases of primary malignant brain cancer were registered in people with "long term" exposure to orchard pesticides either as a job or a residence. All of these 389 cases of exposure to pesticide demonstrated extremely aggressive high-grade cancers, such as glioblastoma multiforme. Unfortunately, the victims were all extremely young, with almost one-third, or nearly 30, being children under the age of 40, and 23 pregnant women, with significant concern for fetal neurotoxic exposure and transplacental exposure. These high-density neuro-oncology zones are not only geographically linked with the gastric cancer hotspots in South Kashmir apple belt but also with the apple belt of Punnan in Shimla district of Himachal Pradesh. One of the reviewers, a senior oncologist, gave a scathing criticism of the damage done to the environment and said the food safety and public health engineering department has been "criminally silent" about pesticide contamination of drinking water.
If stratifying on the basis of age the oncological spectrum will vary significantly and this indicates significant differences between adults and young patients. Paediatric cancers (2.66 percent of regional burden) are predominantly haematological and embryonal in type with acute lymphoblastic leukaemia and lymphomas dominating. The treatment completion rate for the paediatric population is excellent at 92.4 percent, despite the many challenges of logistic and economic issues. This incredible clinical retention can be attributed to the aggressive structured financial support provided by dedicated local NGOs such as the Cancer Society of Kashmir, which provides a successful template of targeted public health support. Much bigger, however, is the infrastructural bottleneck for the entire adult population. The State Government recently revealed that 79 percent of all cancer cases reported in the state in the past three years are confined to Kashmir division which has 54 per cent of the state's population. Although there has been improvement in the diagnostic capacity of the centre, with number of PET scans increasing by 60 per cent over the past year from 1,410 to 2,250, there is no dedicated oncology service in rural peripheral healthcare at all. The high incidence areas of South Kashmir are isolated and rural where patients have to cover a distance of 90 kms with steep inclines, just to avail basic chemotherapy, which is a major reason for delayed treatment and high treatment default rates. Bhat-Prasad review is a history lesson as well as a warning for the public health. Given this situation, the authors suggest that the regional administration should not only continue to expand urban tertiary facilities, but also adopt a proactive and multi-sector public health approach to ease the crisis. They urge the peripheralization of care in the context of setting up separate oncology day-care centres in the district hospitals to debar the distance. In addition, they require complete administrative support to develop a detailed Population Based Cancer Registry, rather than relying on the available piecemeal institutional data for cancer surveillance. Most importantly, there is a critical need for a strict and well-enforced pesticide ban on high toxicity orchard pesticides such as mancozeb and for agricultural workers to follow strict safety measures, as well as for groundwater basins in the area to be tested systematically. Until the state takes action to banish the chemical onslaught from its orchards and to make the state's oncological monitoring a lot more efficient, the complex epidemic described in this pioneering review will continue to take thousands more lives in the battle against cancer.
Email:-------------------kamranbhatt029@gmail.com
