Cancer in Pakistan

By:

Muniba Bashir, Naila Shoaib & Arifa Ashraf

Cancer is one of the major health issues in Pakistan, which is a low to medium resource country, as classified by WHO. About 148,000 new cancer cases are reported, and almost 100,000 die due to cancer per annum [1].

Resource restriction put high technology methods beyond the scope of Pakistan today. In order to prevent and control cancers, there is need to establish the National Cancer Registry. To date, we do not have any National Cancer Registry which can provide the true nature of problem to formulate health policy. Only some regional cancer registries are there [1]. One of these, the Punjab Cancer Registry is Lahore based. It was established in 2005 and was awarded Associate Mentor status by the International Association of Cancer Registries in 2011 [2]. Other registry is the Karachi Cancer Registry (KCR) data has acquired 9 years stability (1995-2003) for Karachi South [3]. The computerized cancer registry of the Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH&RC), Lahore, Pakistan, is another data system designed for collection, management, and analysis of detailed data on patients registered at the facility. Every year, the registry generates cancer statistics according to sex, age, demographic area, topography, morphology, stage, grade, etc [4]. Ministry of NHSRC has designated PHRC (Pakistan Health Research Council) to establish a cancer registry by affiliating all major public and private sector hospitals of the country[1].

The overview of cancer epidemiology in Pakistan can be obtained from GLOBOCAN 2018, which shows the epidemiology of all cancer types worldwide. There were 18.07 million reported new cases and 9.5 million reported deaths of cancer in 2018 worldwide. According to this, Asia has the highest incidence rate (48.4%), the death rate (57.3%), and five years prevalence (39.7%) in both males and females worldwide [5].

The data from GLOBOCAN also estimated for different countries and regions. This is based on data collected by IARC (International Agency for Research on Cancer) and other local registries in each country [6]. The data showed incidence cases, mortality cases, and five years prevalent cases of cancer in the Pakistani population in 2018. Almost 1, 73, 937 new cases appeared in the Pakistani population in 2018. Among these, 81, 298 cases were in the male population, and 92, 639 cases were in the female population. Lip and oral cavity (n=12924, 15.9%), lung (n=7933, 9.8%), oesophagus (n=4713, 5.8%), prostate (n=4552, 5.6%), and leukemia (n=4264, 5.2%) are the top five cancers in male population.  Breast (n=34066, 36.8%), lip and oral cavity (n=5957, 6.4%), cervix uteri (n=5601, 6%), ovary (n=4504, 4.9%), and oesophagus (n=3240, 3.5%) are the top five cancers in female population. The estimated death cases were 118442 in the overall whole Pakistani population in 2018.  The major cancers that caused death are breast (n=17158, 14.5%), lip and oral cavity (n=13351, 11.3%), lung (n=9260, 7.8%), oesophagus (n=7555, 6.5%) and leukemia (n=4945, 4.2%). Moreover, these were the top five prevalent cancers of 5 years in all age groups of Pakistani population. Thus, breast cancer remained the most frequently diagnosed cancer in Pakistan. This is also responsible for more deat and prevalent cases caused by cancer [5]. Some other cancers that are also prevalent in the Pakistani population are shown in the table given below.

 

 

Cancer

New Cases Deaths Prevalence
Number (%) Number (%) Number Prop.
Non-Hodgkin lymphoma 5876 3.4 4818 4.1 12089 6.02
Cervix uteri 5601 3.2 3861 3.3 11659 11.94
Bladder 4610 2.7 2614 2.2 9298 4.63
Prostate 4552 2.6 3417 2.9 7400 7.17
Ovary 4502 2.6 3326 2.8 9047 9.26
Liver 4381 2.5 4222 3.6 3786 1.89
Larynx 4365 2.5 2442 2.1 8550 4.26
Brain, nervous system 4299 2.5 4033 3.4 8855 4.41
Stomach 4154 2.4 3923 3.3 5286 2.63
Gallbladder 3312 1.9 2189 1.8 4011 2.00
Colon 3017 1.7 2181 1.8 5208 2.59
Corpus uteri 2881 1.7 1139 0.96 6349 6.50
Rectum 2839 1.6 2430 2.1 5022 2.50
Hypopharynx 2378 1.4 873 0.74 2778 1.38
Kidney 2209 1.3 1329 1.1 4102 2.04

 Some of the major risk factors that can increase the chance of cancer incidence are smoking, physical inactivity, unhealthy diet, biological infections, and exposure to toxins. Obesity is a major risk factor in the development of breast cancer [7]. These risk factors can be prevented by adopting necessary measures and a healthy lifestyle [8].

Primary prevention in the form of diet control (in the case of colon, breast, gastric cancers), checks on preservatives, dyes, and pesticides; protection from occupational hazards (in lung, pleural, peritoneum, skin, eye, scrotum, liver, lymphatic, haematopoietic malignancies), control of biological agents (as hepatitis B vaccination – for liver cancer, H.pylori treatment – for gastric cancer and MALToma, avoidance of aspergillus contamination – for oral cavity and liver) and solar UV protection (eye and skin cancers) will help in the control of half the malignancies [9]. Early detection of cancers of accessible sites could be warranted for oral, cervical, and breast cancer. In females, this could help target 47.6% (approximately half) the malignancies and in men, 13% of the total [10]. Self-examination of the oral cavity and breast, physician breast examination and cytology-based screening for high-risk cervical cancer populations should be established. Establishment of equitable pain control and a palliative care network throughout the country is essential as more than 70% of cancer patients report in very advanced stages of malignancy [11].  Furthermore, the eradication of smoking habits could reduce 43.7% of the malignancies in males and 17.8% in females [10].

Cancer control activities should focus primarily on education to improve awareness. This can be targeted by increasing public health education using mass education and media influence as well as by healthcare providers [11].

Ms. Muniba Bashir (munibabashir27@gmail.com),Ms. Naila Shoaib (naila123946@gmail.com), and Ms. Arifa Ashraf (arifaashraf100@gmail.com) have recently completed their MS/MPhil from CBL-MMG.

References

  1. Pakistan Health Research Council (PHRC). Available from: https://phrc.org.pk/cancer-registry.html.
  2. Idrees, R., et al., Cancer prevalence in Pakistan: meta-analysis of various published studies to determine variation in cancer figures resulting from marked population heterogeneity in different parts of the country. World journal of surgical oncology, 2018. 16(1): p. 129.
  3. Bhurgri, Y., Karachi Cancer Registry Data–implications for the National Cancer Control Program of Pakistan. Asian Pac J Cancer Prev, 2004. 5(1): p. 77-82.
  4. Mahmood, S., R. Faraz, and A. Yousaf, Annual cancer registry report-2016, of the Shaukat Khanum Memorial Cancer Hospital & Research Center. 2016, Pakistan.
  5. Bray, F., et al., Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 2018. 68(6): p. 394-424.
  6. Sarwar, M.R. and A. Saqib, Cancer prevalence, incidence and mortality rates in Pakistan in 2012. Cogent Medicine, 2017. 4(1): p. 1288773.
  7. Malik, S.S., et al., Survival analysis of breast cancer patients with different treatments: A multi-centric clinicopathological study. JPMA, 2019. 69: p. 976-980.
  8. Lewandowska, A.M., et al., Environmental risk factors for cancer – review paper. Ann Agric Environ Med, 2019. 26(1): p. 1-7.
  9. Hirayama, T., Diet and cancer. Nutrition and Cancer, 1979. 1(3): p. 67-81.
  10. Bhurgri, Y., Karachi Cancer Registry Data–implications for the National Cancer Control Program of Pakistan. Asian Pacific journal of cancer prevention : APJCP, 2004. 5(1): p. 77-82.
  11. Institute, U.N.C. and W.H. Organization, The economics of tobacco and tobacco control. National Cancer Institute tobacco control monograph 21. 2016, US Department of Health and Human Services, National Institutes of Health .

 

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