Amid the golden fields of Punjab lies an unsettling narrative that has and is still haunting not only the region but the whole country ~ the infamous Bathinda-Bikaner “Cancer Train.” This metaphorical tale has become synonymous with despair and misrepresentation, perpetuating myths that link cancer cases in Punjab to the use of pesticides in agriculture. It’s high time we examine the facts, invent the truth, debunk the myths, and provide clarity to the masses.

Every day, the Bathinda Bikaner train carries hopeful patients and their attendants to the Acharya Tulsi Regional Cancer Treatment and Research Institute in Bikaner, Rajasthan. This institute, a beacon of compassion, offers free cancer treatment to patients, along with food and accommodation for their attendants. This lifeline symbolizes the resilience and resourcefulness of the Indian healthcare system in addressing cancer, yet it also serves as a grim reminder of the myths that stigmatize the disease. The institute’s efforts to alleviate suffering are commendable, but there is a need to highlight the pressing need to educate the public and policymakers about the actual causes of cancer in the region, instead of attributing it solely to pesticides.

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In my book Cancer Chronicles: Debunking Myths about Cancer, I have presented a well researched, data-driven perspective that questions the unsubstantiated link between pesticide use and cancer prevalence in Punjab. Here are some key insights: Recent statistics provide insights into the cancer scenario in Punjab: Punjab’s cancer incidence rate has been rising steadily, with an estimated 42,288 cases in 2024, up from 39,521 in 2021 ~ a 7 per cent increase. Despite this upward trend, Punjab ranks 14th among Indian states in total cancer cases and 24th in cases per lakh population, indicating a lower incidence rate compared to states like Mizoram and Tripura where pesticides usage is negligible as per data from Government of India. However, high pesticide usage does not inherently translate to higher cancer rates. Cancer is influenced by multiple factors like genetics, lifestyle, and environment, with no clear correlation to pesticide usage. For instance, Meghalaya, an organic state with negligible pesticide use, has a high age-standardized cancer rate of 153.3, surpassing Punjab, which consumes 5,391 MT of pesticides annually but has only 0.13 per cent cancer cases.

Maharashtra, the highest pesticide consumer (13,303 MT), reports just 0.10 per cent cancer incidence, lower than Kerala (0.17 per cent), which consumes only 1,375 MT. Similarly, organic states like Meghalaya (0.09 per cent) and Sikkim (0.07 per cent) show cancer rates comparable to pesticide-consuming states, underscoring the multifactorial nature of the disease. The Central Ground Water Board (CGWB) Report (2014) on “Water Quality Issues and Challenges in Punjab” analyzed water samples from Faridkot, Bathinda, Mansa, Ferozepur, Muktsar, and Moga districts in the Malwa Region.

The findings revealed that no pesticide or organochlorine pesticide residues were detected in the water samples from these locations. India’s pesticide registration process is comprehensive and robust. Pesticides undergo thorough evaluation across various safety parameters, including genotoxic and carcinogenic properties.

Any pesticide found to be genotoxic (DNA-reactive) or carcinogenic is not registered for use in the country. Pesticides are only approved after a detailed risk assessment, in accordance with the Insecticides Act and the Food Safety and Standards Act of India (FSSAI). Cancer does not have a single cause. Various factors, such as older age, personal or family history of cancer, alcohol and tobacco use, unhealthy diet, exposure to asbestos, arsenic, uranium, and other heavy metals, and sun exposure, are all linked to cancer development. According to WHO-Globocan & FAOSTAT, 2020 (accessed on 23 August 2023), genetics also plays a crucial role, with mutations in specific genes like BRCA1 and BRCA2 increasing susceptibility to certain cancers, such as breast and ovarian cancer.

Lifestyle choices, including smoking, poor diet, and lack of physical activity, are major contributors to lung, colorectal, and liver cancer. Environmental exposures, such as carcinogens like asbestos, UV radiation, and pollution, also elevate cancer risk. For example, prolonged sun exposure can lead to skin cancer, while industrial chemicals can increase the risk of lung cancer. Dr. Kurt Straif, Head of the IARC Monographs Section, stated, “We now know that outdoor air pollution is not only a major risk to health in general, but also a leading environmental cause of cancer deaths.” The International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, has classified outdoor air pollution as carcinogenic to humans.

* Countries such as the United States, Australia, and many European nations, which have some of the most stringent regulations on pesticide use, consistently report much higher cancer incidence rates. For instance, according to the Global Cancer Observatory (GLOBOCAN), the age-standardized cancer incidence rate in the United States stands at over 300 cases per 100,000 people, whereas India’s rate is significantly lower, around 100 cases per 100,000 people.

* In Australia, one of the strictest countries in regulating pesticides, cancer incidence rates are among the highest in the world, largely due to lifestyle factors such as tobacco use, high alcohol consumption, poor dietary patterns, and exposure to ultraviolet radiation. Similarly, European nations like Denmark and Belgium, also rank among the highest globally in cancer incidence.

* This data underscores that cancer is a multifactorial disease influenced by genetics, lifestyle choices, and environmental exposures, rather than simply pesticide consumption. The narrative blaming pesticides for cancer in agricultural regions overlooks critical factors like tobacco use, dietary deficiencies, outdoor air pollution and delayed medical interventions, which are proven major contributors to the disease.

By focusing on these primary drivers, rather than vilifying pesticides, public health efforts can be more effectively directed toward reducing the global cancer burden. The narrative around the Bathinda-Bikaner Cancer Train gained traction due to selective reporting and a lack of public awareness. While pesticides are often vilified, it is essential to understand their role in ensuring food security for a growing population. Misleading claims not only tarnish the reputation of hardworking farmers but also divert attention from real issues, such as early detection and improved cancer treatment facilities. The book emphasizes the importance of data-driven conclusions.

The myth that pesticides are the primary cause of cancer in Punjab not only stigmatizes farmers but also hinders meaningful policy interventions. Here are some steps we must take: Raise Awareness: Public health campaigns should focus on lifestyle changes, such as reducing tobacco use, promoting healthy diets, and encouraging regular screenings. Support Farmers: Farmers are often vilified without evidence. A balanced perspective is needed to support their essential role in feeding the nation while promoting safe agricultural practices. Invest in Research and Healthcare: More resources should be allocated to studying cancer patterns and expanding healthcare facilities in rural areas.

“The Bathinda-Bikaner Cancer Train is not a testament to pesticides causing cancer, but rather a reflection of the need for better healthcare infrastructure and awareness. If a myth is repeated enough times, it may eventually be perceived as truth, leading people to believe it. It’s time we focus on actionable solutions and confront the truth, rather than letting myths shape perceptions.” As we debunk the biggest confusion, let’s honor the truth and work collectively to create a healthier and better-informed society

(The writer is former Additional Director-General, Ministry of Health and Family Welfare, and author of Cancer Chronicles: Debunking Myths about Cancer. Anyone wishing to receive a copy of the book can get a soft copy free of cost. Interested individuals can write to the author at kanungo294@gmail.com)