In the study population, 31.08% patients were Smokers, 15.99%  were Ex-smokers and rest were non-smokers, but all of them were exposed to Smoke due to wood – domestic Cooking practices at home due to traditional woody- smoky traditional Chullahs for most of the year. 65% patients used to have >4 cups of traditional Salty “Noon”-Butter tea and out of which 57(12.84%) patients had the habit of taking >10 cups of Noon tea per day. All the patients in the study group were non-Vegetarian having dietary habit of intake of Red- meat with fat intake of 1-3 /month in 16.45% patients, 1-2/week in 37.38% patients and 2-4/week in 31.08% patients. . Another important risk factor seen in this research study was the less intake of fresh fruits and vegetables, with 58.78% patients taking <1/week, 24.55% taking <4/week, and only 16.67% taking fresh fruits and vegetables >4/week. This was due to loss of air and road connectivity with other parts of the state and country, for 6 months (November-April) in harsh winter, forcing the population to eat excess of dry, raw food stuffs, stored meats, stored tinned food items, besides traditional spicy foods and pickles.

The high rates of gastro-esophageal cancer in Ladakh region is alarming and may be due to the fact that majority of the risk factors are prevalent in this region. Dietary habits, Smoking, H.Pylori infection, Genetic susceptibility etc. are widely studied. In Ladakh, the most important specific food habit is the consumption of large quantities of hot, salted, butter tea; locally known as “noon” tea or “ Gurgur” tea; which is made of local butter added to boiling water mixed with common salt(Nacl), Sodium bicarbonate(soda), milk and green tea leave extracts. The sodium bicarbonate (soda) and common salt (Nacl) are well-known irritants of gastric epithelium and have been considered as risk factor for gastric cancer. Salt-tea showed the formation of high amount of N-nitrosopipe-colic acid with several unidentified non-volatile N-nitroso compounds on nitrosation of green tea extracts, which all are irritants to the gastric mucosa. Ingestion of salt has been shown to increase gastritis and the carcinogenic effects of known gastric carcinogens such as N-methyl-N-nitro-N-nitrosoguanidine (MNNG). Salt is known to erode the mucosal barrier of the stomach, thereby leading to inflammation. Cultures whose diets are rich in salt and pickled foods, such as the Koreans and Japanese, exhibit higher rates of gastric cancer. Japanese immigrants to the United States who assimilated and adopted Western foods exhibited a substantially lower rate of gastric cancer relative to those who did not assimilate their diet.

High consumption of Red-Meat and fatty meal are another worrisome risk factors of the area, with all the cancer patients in this study taking the red-meat frequently and mostly taking >4/week, especially in the winter 6 months. Habit of taking barbecued meat was found to be prevalent in the Zanskar sub-region. Another important risk factor seen in this research was the less intake of fresh fruits and vegetables, with 58.78% patients taking <1/week, 24.55% taking <4/week, and only 16.67% taking fresh fruits and vegetables >4/week. All these traditional food habbits are the risk factors for Gastro-Esophageal and many other varieties of cancer. Preserved meats are rich in N-nitroso compounds, which can illicit similar effects in the body as already mentioned above. Grain-fed red meat is specially rich in saturated fats and low in protective fats such as omega-3 which contributes to its inflammatory processes and thus increases gastric cancer risk. Fruits and vegetables are rich in carotenoids, folate, phytochemicals and vitamin C, which help modulate xenobiotic metabolizing enzymes during digestion. They contain numerous antioxidants that prevent against metabolic damage. Case- control studies found that a higher intake of fruits and vegetables was associated with a 37% lower risk of gastric cancer. Fresh vegetables and fruits are considered to be probable protective factors and other food habbits like high rice intake, pickled food, spicy food, smoked, dried, salted meat, use of soda etc. are the significant dietary risk factors of cancer. Another risk-factor in Ladakh is the high colonization of H.Pylori in this population. H.Pylori is carcinogenic to humans based on epidemiological evidence. There is 2-3 fold increase in gastric cancer among individuals exposed compared to non-exposed ones. The Cag A gene of H.Pylori is the main virulence factor which is responsible for the development of gastric cancer through derangement of cellular architecture and signaling pathway. The prevalence of H.Pylori is high in India due to low socio-economic condition and poor hygiene. There might be complex interaction between dietary and life-style related factors, H.Pylori infection with certain strain types, in presence of genetic polymorphism, along with heightened inflammatory response that may produce a cascade of changes at molecular level and ultimately cancer cells of the stomach, and needs an in-depth research in future. H.Pylori strains from Ladakh are genetically distinct and possibly less virulent than the isolates from East-Asian countries, such as china and Japan where the prevalence of gastric cancer are very high.

The risk factors involved in the rise of Colo-Rectal cancer in this region may be due to vanishing habit of high fiber ancestral diets like” Khulak” and “Pappa”, and increased westernization such as Obesity, Physical inactivity including less of agrico-farming activities in modern generation, heavy metal contamination of soil, food and water, use of pesticides, dyes and artificial coloring agents (like Tartazine), food adulteration, reuse of frying oils, increased intake of Killer foods (junk food, snacks, cold-drinks etc.) that are added with dangerous activities and adulterants. Even the milk and milk products in the market contain chemicals such as detergents (caustic soda). Artificial coloring agent or dyes like Tartazine has been found in many edibles, spices and condiments in the area. Tartazine metabolizes to Benzidine and 4-amino bi phenyl, listed under ‘known- carcinogenic’ category in 13th report on carcinogens by U.S Department of Health and Human Services. Many international studies have linked presence of Heavy Metals (potential carcinogen) in soils, vegetables, fruits and drinking water, to gastrointestinal cancers. All such trends are leading to a health catastrophe especially cancer in Ladakh. 

This study observed Liver cancer as the third most common cancer in the region (9.24%).The high incidence of Liver cancer in the region is due to the fact that the prevalence of Hepatitis B virus is very high in Ladakh region. In Kargil district, the prevalence of Hepatitis B infection is 7.86%-8.3%, where as its prevalence is 3.3-5.75 % in Leh, 1.2% in Srinagar and 2.4% in Jammu region of Jammu and Kashmir. In another research study by Dr Sajjad Hussain; “Hepato Cellular Carcinoma in High Altitude Kargil Ladakh: A Hepatitis B Virus High Endemic Zone”, published in renowned Clinical Surgery Journal; Chronic Hepatitis B infection was found to be one of the most important causes of Hepato-Cellular carcinoma (HCC) in Kargil Ladakh.

This study showed cancer of Gall bladder as the fifth most common finding in Kargil Ladakh and it was second most common cancer in females. It may be due to the fact that the prevalence of gall-stone disease, gastritis and gastro-esophageal reflux disease  are again very high in Ladakh Region due to inherited low transit time of intestine in the region, habit of high intake of fatty meal, spicy food and excess of  red meat at parties and at home.

This study observed Lung cancer as the second most common cancer in males in the region but eighth most common cancers in females, with M: F ratio of 7.6:1. This striking difference may be because of smoking pattern which was not seen even in a single female patient in our study. Use of Tobacco in the form of cigarette smoking, hukka and chewing were seen in 31.08% patients. Tobacco is an independent risk factor for Lung cancer, Stomach cancer and many other cancers while Alcohol may be carcinogenic to Esophagus, Cardia and Liver. International Agency for Research on Cancer (IARC) has reported that there is association between Tobacco use and smoke with cancer of Lung, oral-cavity, Pharynx, Esophagus, Larynx, Urinary Bladder, Ovary, Colon and Rectum. Tobacco related cancers contribute to two-thirds of all cancers, with three-fourths of cancers among men and more than half of cancers among women.

Alcohol use has been shown to increase the risk of gastric cancer, moderate alcohol consumption was shown to increase