ISLAMABAD: Breast cancer remains the most common cancer in both women and men in Pakistan followed by cancer of the head and neck, large bowel, liver and lungs, the National Cancer Registry (NCR) at the National Institute of Health (NIH), Islamabad, said Friday.
In its first analysis of cancer cases in the country between 2015 and 2019, the NCR said a total of 269,707 cases are analysed with 46.7pc males and 53.61pc females. As per provincewide distribution, 45.13pc of cases are from Punjab, 26.83pc from Sindh, 16.46 from Khyber Pakhtunkhwa (KP) and 3.52pc from Balochistan. Both genders combined, breast cancer is the most common cancer followed by cancers of oral, large bowel, liver and lungs.
In males, the top-five cancers in order of frequency are oral, liver, large bowel, lung and prostate. In females, the top-5 cancers included breast, ovary, oral, cervix and large bowel. In children, leukemia (blood cancer) and in adolescents bone-related cancers are the leading malignancies.
The NCR report said all functional cancer registries of Pakistan, including Pakistan Atomic Energy Commission (PAEC), Punjab Cancer Registry, Karachi Cancer Registry, Multan Cancer Registry, Armed Forces Institute of Pathology (AFIP) Cancer Registry and Shifa International Hospital Cancer Registry, contributed to this national effort. The report confirms breast cancer is a very frequent cancer in Pakistan, one of the highest in Asia. It is quite commonly seen in young women, and diagnosis in their 30s is not uncommon. “It seems both genetic and environmental factors must be playing a significant role. In the absence of any breast screening programme, over and above social taboo to share with family, results in late diagnosis. This is the major cause of breast cancer-related deaths in Pakistan,” the NCR report said.
In males, oral cancer is most common in Pakistan, according to the study results. In contrast to breast cancer, oral cancer is largely preventable cancer as over 3/4 of patients diagnosed with this cancer are habitual consumers of paan, Chalia (Betel Nut) and Gutka. Other risk factors may include smoking, poor oral hygiene and undernutrition. Another rampant habit in some population segments of Karachi, as well as KP and Balochistan, is the use of Naswar.
Another common preventable cancer is liver cancer, which is associated with a very high death rate with survival usually counted in months than years at the time of diagnosis. This is largely due to a very high prevalence of Hepatitis B & C in Pakistan. A revelation in this report is the unprecedented rise in large bowel cancer – the third most common if both genders combined. Again, both genetic and lifestyle factors seem to be playing havoc.
In addition, over the last 2-3 decades, a paradigm shift is seen in dietary habits with an exponential increase in the consumption of fast foods. Keeping in mind the very huge young population of Pakistan, there is increasing demand for this food. Fast food/junk food is stipulated to be a major contributor of large bowel cancer.
Lung cancer, another largely preventable cancer, seems to have slightly reduced in the last couple of decades, listed as the fourth most common in males (in the report) from 1st or 2nd most common cancer a couple of decades ago. This is still a major health-related cause of morbidity and mortality.
One reason is the major shift in Sindh province towards smokeless tobacco for various reasons, which include better social acceptability compared to smoking. This along with the easy and relatively cheaper availability of chewing alternatives has largely given way to chewing as a more attractive form of addiction. Esophageal (tube which connects throat with stomach) cancer is particularly highly prevalent in both genders in KP and Balochistan.
Very similar prevalence is reported from Afghanistan and Iran. This may be largely attributed to their lifestyle, which includes excessive hot beverage intake, excessive consumption of red meat, including salted preserved meat, and little consumption of vegetables and fruits. In view of growing cancer cases, the NCR steering committee has recommended that the lawmakers legislate cancer as a mandatory reportable event like many infectious diseases. This will bring Pakistan at par with minimal dataset requirements as expected by international agencies with age-standardised incidence rates. The medical/scientific community is encouraged to undertake further studies to determine risk factors associated with different types of cancers.