Cancer is the leading cause of death globally, and is responsible for an estimated 9.6 million deaths in 2018. About 1 in 6 deaths is due to cancer. Approximately 70% of deaths from cancer occur in low- and middle-income countries. Around one third of deaths from cancer are due to the 5 leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use. (Read our article on cancer causing foods).
It is predicted that by 2030, the number of new cancer cases will mount to 21.7 million and 13 million sufferers of cancer will die owing to the growth and aging of the population (Bray, Jemal, Grey, Ferlay, & Forman, 2012). It is estimated that in future the burden of cancer will markedly rise due to the lifestyle adoption which are linked with increased risk of cancer i.e. smoking, physical inactivity, improper diet and a decreased number of pregnancies in economically developing countries (Bray & Møller, 2006). The cancers which are influenced by these factors include lung, breast, and colorectal cancers, and these are already abundant in economically transitioning countries. In case the preventive measures are not taken than the cancers which are widely present in Western countries will keep on rising in developing countries.
The most prevalent, frequently diagnosed and top most cause of cancer death in female population of Pakistan is breast cancer, having an estimated 5-year prevalence of 119,710 cases, 34,038 newly diagnosed cases and 16,232 deaths in 2012.Breast cancer encompasses almost 23% (25.1% worldwide) of all newly diagnosed cases of cancer and 16.1% (15% worldwide) of all deaths due to cancer among female population. The early stage of breast cancer can often be detected through mammography, where it can be cured and treated more effectively. On the other hand, mammography screening cannot be termed as an effective method. All breast cancers cannot be detected by a mammogram, and certain breast cancers which are screen-detected might have a poor prognosis. It might be possible that mammography may lead to false-positive results, over-diagnosis and over-treatment of some breast cancers. Despite these shortcomings, early detection via mammography may save lives and increases treatment options. DNA based genetic testing can also help early diagnose breast cancer and help doctors to better plan treatment for the patient.
Lip and oral cavity cancer is the second most prevalent, frequently diagnosed and leading cause of cancer death in Pakistan, with an estimated 5-year prevalence of 30,647 cases, 12,761 newly diagnosed cases and 7,266 deaths in 2012.
Main risk factors associated with the cancer of lip and oral cavity include tobacco smoke from cigarettes, cigars, or pipes; poor nutrition, drinking alcohol, betel quid and gutka; ultraviolet light, and HPV infection (American Cancer Society, 2016). The areas of the lips that come in contact with the pipe stem are prone to the risk of lip and oral cavity cancer.
Many people in Southeast Asia, South Asia (i.e. Pakistan), and certain other parts of the world chew betel quid, comprising of areca nut and lime wrapped in a betel leaf. Inhabitants of these areas also chew gutka which is made up of betel quid and tobacco. People consuming betel quid or gutka are more prone to the cancer of the oral cavity (American Cancer Society, 2016).
Lung cancer is the third most commonly diagnosed and leading cause of cancer death in Pakistan, with an estimated 6,800 (4.6%) new cases and 6,013 (5.9%) deaths occurring in 2012.
Indoor air pollution resulting from unventilated coal-fueled stoves and cooking fumes (International Agency for Research on Cancer, 2012b), contact with certain occupational and environmental cancer-causing agents like asbestos, radon, polycyclic aromatic hydrocarbons and arsenic also serve as risk factors for lung cancer (Fraumeni & Schottenfeld, 2006). Moreover, outdoor pollution is now also linked with lung cancer (Hamra et al., 2014).
Lung cancer is among those cancers which could be prevented. Majority of the lung cancers can be evaded through eliminating smoke initiation and promoting smoking cessation among the current smokers. For this purpose, an extensive tobacco control program is required which demands increasing the price of tobacco products through excise taxes, prohibiting smoking in public places and supply of tobacco to minors, banning the advertisement and promotion of tobacco, counter advertising and provision of treatment and counseling to the tobacco dependent people.
Colorectum cancer is the fourth most prevalent and fifth most commonly diagnosed cancer in Pakistan, with an estimated 5-year prevalence of 11,917 (3.5%) cases, 5,335 (3.6%) newly diagnosed cases and 3,903 (3.9%) deaths occurring in 2012.
Genetic testing may lead to the detection of colorectal polyps which can be removed before they turn in to a lethal cancerous form; moreover, cancer which is in early stage can also be detected through genetic screening which can be treated in a more successful way.
Non-Hodgkin lymphoma is the fourth most frequently diagnosed and fifth leading cause of cancer death in Pakistan. An estimated 5,964 new cases of non-hodgkin lymphoma and 4,374 deaths occurred in Pakistan in 2012.
The risk factors for lymphoma are not clearly recognized; however, most of them are linked with an altered immune function. The risk of non-hodgkin lymphoma rises many folds in individuals who use immune suppressive agents for preventing organ transplant rejection, the people who are sufferers of severe autoimmune conditions, and in the individuals who are infected with human immunodeficiency virus, hepatitis C virus and human T-cell leukemia virus type I. Non-hodgkin lymphoma can be termed as an acquired immune deficiency syndrome (AIDS)- defining illness, whose risk is 60 times more in the sufferers of AIDS as compared to the general healthy population (Beral, Peterman, Berkelman, & Jaffe, 1991).
There are other forms of cancer too which are highly prevalent in Pakistan. We need to introduce new medical interventions to detect it early for better treatment of patients.