Punjab’s ‘cancer belt’: A misplaced crisis

FOR a decade, a singular image has shaped the conversation about Punjab's public health — Train No. 14888, the ‘Cancer Express’. To those who take this midnight trip from Bathinda to Bikaner, and to the documentary filmmakers from the West, this is a physical representation of a "failed" land — a punya bhoomi allegedly harmed by its agricultural successes. However, upon rigorous inspection of this situation through the lens of critical thinking, the folly of this argument becomes obvious.‘Cancer belt’ & ‘cancer train’Unfortunately, an outsider hearing the term ‘cancer belt’ of the Malwa region assumes that this science-sounding conclusion is based on some long-term research studies, which is not at all the case.The first documented media use of this term appeared in Down to Earth magazine in June 2005. The term is a product of a strategic linguistic shift from the decade-old term ‘cotton belt’ to refer to the Malwa region. Ever since, environmental journalists worldwide have featured this story in various formats.There is no reason for the ‘cancer train’ to exist other than a commendable community service. Since the 1940s, Bikaner's Acharya Tulsi Regional Cancer Hospital (which later became the 13th Regional Cancer Centre of the country) has been providing free cancer treatment to nearby patients, including those from the Malwa region of Punjab.In addition, since the 1990s, the Indian Railways has provided 100% free travel to cancer patients and 75% concession for their escorts in sleeper and AC-3 classes.Thus, the "cluster" of people on this train is due to a pull factor of access to affordable healthcare combined with free tickets, rather than a push factor of localised toxins.An examination of the baseline rates, the Age-Adjusted Incidence Rate (AAIR) — the gold standard metric used to make statistical comparisons among different populations — reveals how quickly the illusion fades.Based on ICMR-NCDIR (2025-26) data, the cancer AAIR for Bathinda is 125 cases per one lakh population. While a bit higher than the national average of approximately 100, this is significantly lower than the rate for Delhi (146) or Kerala (135). In Mizoram, the AAIR skyrockets to 256.If Punjab's 125 is 'cancer belt', then Mizoram's 256 should be 'national emergency', yet only Punjab is targeted.The longevity paradoxThe most ignored factor in this crisis is, paradoxically, Punjab's high achievement in health and nutrition.During the 2006-2010 period, when those viral documentaries were released, Punjab had been one of the most affluent states in India, with a life expectancy of 70.6 years — 4.5 years higher than the national average then.Even though the life expectancy gap continued to narrow ever since, presumably owing to air pollution, Punjab's figure is still above the national average.A higher life expectancy in Punjab wasn't because of lucky genetics, but because of the culture of resilience of the Punjabi community, prioritising langar and seva.Cancer is a disease of late life. For example, a village with more 80-year-olds will have more cancer prevalence compared with its neighbouring village, even if the water there is purer.In states with low life expectancy, many succumb to infectious diseases or cardiovascular problems before they reach what can be called the "cancer age".We see more cancer in the Malwa area because the population is surviving the dangers of early mortality that plague the other areas.It is noteworthy that all those states with higher cancer AAIR than Punjab (Kerala, Delhi and Mizoram) also have higher life expectancy figures.By correctly recognising the ‘cancer belt’ narrative as nothing but a myth, we can direct our scientific attention and resources towards the actual health and environmental issues of the region, such as Hepatitis C, metabolic syndrome, fatty liver disease, air pollution, municipal waste management, heavy metal toxicity and high levels of endocrine-disrupting chemicals like nonylphenol.For the last many years, Punjab has continued to be the epicentre of Hepatitis C infections in India, accounting for approximately 35% of all confirmed cases in India. At 44.2%, Punjab is the obesity capital of India, while at 53%, Chandigarh has the highest incidence of fatty liver disease in India.Punjab is indeed an epicentre for several health and environmental crises — but the data clearly shows that cancer is not one of them.Let us not hide Punjab's flaws, but at the same time, let us also demand epidemiological accuracy. We cannot allow our regional identity to be shaped by false perceptions created by statistical illusions.Towards a holistic wisdomIt is time to break the reactive cycle of the ‘cancer belt’ and the ‘cancer train’ by dismantling a 20-year-old myth using logical reasoning and cold, hard statistics.Let us lead the proactive ‘Naya Bharat’ movement by adopting a shared vision of health and a healthy environment that integrates our modern scientific knowledge with our ancient logical prowess.

Punjab’s ‘cancer belt’: A misplaced crisis

Punjab is indeed an epicentre for several health and environmental crises — but the data clearly shows that cancer is not one of them.

RP Tiwari and Felix Bast

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