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Based on a citizen’s report, a house-to-house survey was conducted in Talwandi Sabo and Chamkaur Sahib Community Development Blocks in Bathinda and Roop Nagar District respectively in Punjab state located in a northern part of India to identify the number of existing cancer cases, and the number of cancer deaths that occurred in the last 10 years. Age adjusted prevalence of confirmed cancer cases per 100,000 population was 125 (107/85315) in Talwandi Sabo and 72 (71/97928) in Chamkaur Sahib. Cancer of female reproductive system, i.e., breast, uterus/cervix and ovary were more common in Talwandi sabo whereas cancer of blood and lymphatic system, esophagus, and bones were more common in Chamkaur Sahib. Cancer deaths per 100,000 populations per year were 52 in Talwandi Sabo compared to 30 at Chamkaur Sahib. A comparison of the characteristics of randomly selected individuals, from the villages where a cancer case existed or death due to cancer had occurred in last 2 years, revealed that involvement in cultivation, pesticide use, alcohol consumption and smoking were more common in Talwandi Sabo as compared to Chamkaur Sahib. Limited studies show that in drinking water the levels of heavy metals such as As, Cd, Cr, Se, Hg were generally higher, and pesticides such as heptachlor, ethion, and chloropyrifos were also higher in samples of drinking water, vegetables, and blood in Talwandi Sabo as compared to Chamkaur Sahib. As multiple factors were responsible for significantly higher prevalence of cancer cases in Talwandi Sabo, therefore, a multi-pronged strategy to discourage the indiscriminate use of pesticides, tobacco and alcohol needs to be adopted for cancer prevention, and a cancer registry should be set up for elucidation of the role of pesticides and heavy metals in the etiology of cancer in this area. Full article