<p>A recent conversation your columnist had with Sanjay Bansal, Managing Partner of Aurum, a boutique investment bank, ambled into an unexpected subject. Sanjay mentioned his hypothesis on the rising instances of cancer in India. Could a part of the explanation lie in what we are eating and drinking, particularly the pesticides, fertilisers and other chemicals used in agriculture? It is a question worth asking because the numbers are painful. India recorded roughly 800,000 new cancer cases at the beginning of this century. The current estimate is around 1.5 million a year. Some of that increase is understandable. India has a larger population and also the fact that people are living longer. Cancer is, clearly, far more common as we age.</p><p>Be that as it may, the rise cannot just be dismissed as extrapolation. More people are being diagnosed, the pattern of cancers is changing and what was once thought of largely as an urban predicament, is clearly not one anymore. Cancer is now found across rural India and studies of cancer mortality have shown that rural and urban rates can be similar. In parts of rural Tamil Nadu, cancer incidence has risen considerably over the past two decades. That is what makes the agricultural angle worth probing. If cancer were largely an urban phenomenon, we would have an easy collection of suspects. Air pollution, lifestyles, obesity, alcohol, junk food and tobacco would all feature. So might the stresses of city life, although stress is far more evidently linked to cardiovascular illness, than directly to cancer. But when a serious disease appears across both cities and villages, one begins looking for exposures that cut across locations. Food and water do that.</p><p>India has transformed agricultural production over the past half century. Fertilisers and pesticides have played a crucial role in raising yields and feeding a much larger population. Nobody sensible would argue for their wholesale abandonment. The issue is how they are used and how carefully that is monitored. India consumes enormous quantities of nitrogen fertiliser, particularly urea. Urea itself is not established as a cause of cancer and it would be wrong to say otherwise. But excessive use of nitrogen fertiliser can lead to nitrate contamination of groundwater. One large study using data from millions of wells estimated that tens of millions of Indians may be exposed to groundwater with higher nitrate levels, much of it in rural areas.</p><p>Pesticides are another matter and here the evidence is stronger, especially for people who work with them. International cancer researchers have linked exposure to certain pesticides with higher risks of some cancers. That does not mean that the vegetables on our dining tables are poisoning us. It does mean, however, that excessive spraying and weak monitoring deserve more attention than they currently receive. India's own monitoring programme has found that a small but meaningful share of food samples exceed permitted pesticide residue limits. The percentage is not terrifying enough to suggest that our entire food chain is unsafe. But neither is it inconsequential when multiplied across a country of 1.4 billion people. The larger point is not that fertilisers and pesticides explain India's cancer burden. Tobacco remains a major cause. So do infections such as HPV and hepatitis, air pollution, alcohol, obesity, diet and simple ageing. Better diagnosis also means that cancers which might once have gone unrecorded are now identified.</p><p>Sanjay's hypothesis is therefore best treated not as an answer but as a very valid question. Are farmers using chemicals in the right quantities? Is groundwater adequately monitored? We probably know less than we should. That is the worrying bit.</p><p>For a country that frets about cancer after it appears, perhaps we should spend a little more time worrying about what may be helping it appear in the first place.</p>
<p>A recent conversation your columnist had with Sanjay Bansal, Managing Partner of Aurum, a boutique investment bank, ambled into an unexpected subject. Sanjay mentioned his hypothesis on the rising instances of cancer in India. Could a part of the explanation lie in what we are eating and drinking, particularly the pesticides, fertilisers and other chemicals used in agriculture? It is a question worth asking because the numbers are painful. India recorded roughly 800,000 new cancer cases at the beginning of this century. The current estimate is around 1.5 million a year. Some of that increase is understandable. India has a larger population and also the fact that people are living longer. Cancer is, clearly, far more common as we age.</p><p>Be that as it may, the rise cannot just be dismissed as extrapolation. More people are being diagnosed, the pattern of cancers is changing and what was once thought of largely as an urban predicament, is clearly not one anymore. Cancer is now found across rural India and studies of cancer mortality have shown that rural and urban rates can be similar. In parts of rural Tamil Nadu, cancer incidence has risen considerably over the past two decades. That is what makes the agricultural angle worth probing. If cancer were largely an urban phenomenon, we would have an easy collection of suspects. Air pollution, lifestyles, obesity, alcohol, junk food and tobacco would all feature. So might the stresses of city life, although stress is far more evidently linked to cardiovascular illness, than directly to cancer. But when a serious disease appears across both cities and villages, one begins looking for exposures that cut across locations. Food and water do that.</p><p>India has transformed agricultural production over the past half century. Fertilisers and pesticides have played a crucial role in raising yields and feeding a much larger population. Nobody sensible would argue for their wholesale abandonment. The issue is how they are used and how carefully that is monitored. India consumes enormous quantities of nitrogen fertiliser, particularly urea. Urea itself is not established as a cause of cancer and it would be wrong to say otherwise. But excessive use of nitrogen fertiliser can lead to nitrate contamination of groundwater. One large study using data from millions of wells estimated that tens of millions of Indians may be exposed to groundwater with higher nitrate levels, much of it in rural areas.</p><p>Pesticides are another matter and here the evidence is stronger, especially for people who work with them. International cancer researchers have linked exposure to certain pesticides with higher risks of some cancers. That does not mean that the vegetables on our dining tables are poisoning us. It does mean, however, that excessive spraying and weak monitoring deserve more attention than they currently receive. India's own monitoring programme has found that a small but meaningful share of food samples exceed permitted pesticide residue limits. The percentage is not terrifying enough to suggest that our entire food chain is unsafe. But neither is it inconsequential when multiplied across a country of 1.4 billion people. The larger point is not that fertilisers and pesticides explain India's cancer burden. Tobacco remains a major cause. So do infections such as HPV and hepatitis, air pollution, alcohol, obesity, diet and simple ageing. Better diagnosis also means that cancers which might once have gone unrecorded are now identified.</p><p>Sanjay's hypothesis is therefore best treated not as an answer but as a very valid question. Are farmers using chemicals in the right quantities? Is groundwater adequately monitored? We probably know less than we should. That is the worrying bit.</p><p>For a country that frets about cancer after it appears, perhaps we should spend a little more time worrying about what may be helping it appear in the first place.</p>
