Cancer Registration in Pakistan

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Cancer Registration in Pakistan

By Dr. Farhana Badar
Sr. Biostatistician & Cancer Epidemiologist
Cancer Registry & Clinical Data Management
Shaukat Khanum Memorial Cancer Hospital & Research Center

Pakistan is a populous country with nearly 18.5 million inhabitants, according to the estimates provided by the Population Census Organization of the Government of Pakistan. Cancer registration has been a low priority due to multiple reasons and until recently, the Karachi Cancer Registry (KCR) was the only recognized population-based cancer registry in the country representing Karachi South district of Pakistan that accounts for less than 1% of the total population of the country. The dynamic director of the KCR, Dr Yasmin Bhurgri, died about two years ago and one hopes that her work will be continued. Over the years, some other cancer treatment facilities have attempted to promote cancer registration in the region. One such center is the Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC), Lahore, Pakistan, which has a hospital-based cancer registry now functioning for about 19 years. This registry is the only one of its type in the country following international standards on cancer registration and medical coding and using the classification system introduced by the World Health Organization. Data from SKMCH & RC has been used by hospital professionals to provide estimates for childhood cancers in Lahore district. This is based on the premise given by Valsecchi and Steliarova-Foucher, that hospital-based cancer registries in developing countries are likely to record a large proportion of pediatric cases because the care units are rare and specialized, thus attracting many patients who are diagnosed or referred to them.
To ascertain reliable cancer statistics from within Lahore and Punjab, a collaborative population-based cancer registry called the Punjab Cancer Registry was set up in Lahore, nearly nine years ago. The Registry has 36 members from 18 collaborating centers in Lahore district. Members include both government and private hospitals and laboratories. All of these centers report their data to the Central Office of the Registry located on the premises of SKMCH & RC. The details related to the Registry can be accessed by visiting its website http://punjabcancerregistry.org.pk/. The data collection form that has been refined over the years, is in compliance with the standards set by the International Agency for Research on Cancer (IARC), a sub-office of the World Health Organization. Until recently, only the cases belonging to Lahore district were being studied. There are plans to expand this effort to other adjoining districts as Kasur, Sheikhupura, Nankana Sahb, and Faisalabad. The plan is also to expand the coverage to include more districts of Punjab in due course of time. It is worth mentioning that data from Lahore district, for the time period between 2008 and 2010, has been reported to IARC. The data has been used by IARC to provide cancer estimates for Pakistan in its latest release ‘Globocan 2012’, which can be accessed by visiting their official website: http://globocan.iarc.fr/. According to the estimates, in Pakistan, in the year 2012, the total number of cancer cases and deaths recorded in both genders combined was 148,041 and 101,113; among men it was 63,451 and 48,449; and among women, it was 84,590 and 52,664, respectively. The annual age-standardized incidence rate of cancer among men was 96/100,000 and among women, it was 127.7/100,000. The commonest cancers among men were: i) lip and oral cavity cancers 10.5, ii) lung cancer 9.8, and iii) prostate cancer and non-Hodgkin’s lymphoma each 5.3, and among women: i) breast cancer 50.3, ii) lip and oral cavity cancers 9.1, and iii) cervix uteri cancer 7.9, per 100,000.
National registries are difficult to set up and maintain in large countries and even in the United States, their national cancer registry, the ‘Surveillance, Epidemiology, and End Results Program’ covers only 28% of the population of the country and the figure varies from time to time. Setting-up district-wise or province-wise population-based cancer registries by professionals of various institutes seems to be the way forward in the area of cancer registration in the country.