ENVIRONMENTAL CARCINOGENESIS IN HARYANA, INDIA: A CRITICAL COMPREHENSIVE REVIEW OF CANCER SURVEILLANCE, MULTIEXPOSURE PATHWAYS, AND PREVENTION PRIORITIES

Abstract

Haryana combines rapid industrialisation, intensive agriculture, severe air pollution, groundwater stress, and uneven occupational and environmental regulation, creating a plausible setting for cumulative carcinogenic exposure. This critical comprehensive review integrates cancer surveillance, Haryana-specific environmental studies, institutional monitoring, mechanistic evidence, and international epidemiology while distinguishing hazard detection from demonstrated local causation. ICMR-NCRP estimates indicate that annual incident cancer cases increased from 29,219 in 2020 to 32,513 in 2024. The peer-reviewed Haryana Cancer Atlas analysis included 36,736 confirmed cancers diagnosed in 2016-2017 from 126 participating centres, supplemented by eligible records from 28 hospital-based cancer registries, and identified substantial district and site-specific variation. The broader administrative atlas reported 42,699 records from 149 sources, illustrating why analytic and administrative totals should not be conflated. Rohtak had the highest male all-site age-adjusted incidence rate (143.9 per 100,000), whereas Gurugram had the highest female rate (108.2); high head-and-neck cancer rates among men and district variation in breast, lung, prostate, and cervical cancer require targeted surveillance but do not establish environmental causation. Groundwater monitoring identified nitrate, fluoride, arsenic, and uranium exceedances, while pesticide residues, industrial mixtures, ambient particulate matter, combustion emissions, and workplace exposures create additional prevention priorities. The strongest causal evidence relevant to Haryana concerns outdoor air pollution, benzene, inorganic arsenic, hexavalent chromium, cadmium, and selected occupational exposures; pesticide evidence remains compound- and outcome-specific, and uranium requires cautious interpretation because its drinking-water guideline primarily reflects chemical nephrotoxicity. The review proposes a transparent evidence hierarchy, an eco-oncology framework, districtcluster research priorities, and an implementation roadmap centred on sustained population-based cancer registration, historical exposure reconstruction, safe water, clean air, pesticide stewardship, and worker protection. Haryana offers a transferable model for environmentalcancer surveillance in rapidly industrialising, agriculturally intensive, data-constrained regions.