Cancer registration in Pakistan: a dilemma that needs to be resolved.

Abstract

Dear Sir, National level cancer registration is nonexistent in Pakistan. Cancer statistics for Pakistan, as reported in the Globocan 2012 report published by the International Agency for Research on Cancer (IARC), are largely provided by the Punjab Cancer Registry (PCR)—the only provincial cancer registry in Pakistan. However, cancer statistics generated by the PCR are regional and not true representative of the whole country. Moreover, quality of these data has been stratified as category E (regional data rates) by the Globocan 2012 report, suggesting that the PCR data do not truly cover/represent cancer statistics in Pakistan. It is, therefore, extremely important to highlight the fact that a noticeable proportion of cancers in Pakistan are unregistered. This is an alarming situation requiring urgent response from all the stakeholders including Pakistani as well as international authorities. It is important to note that establishment of national level cancer registries demands huge logistical support including appropriate funds, human resource and political will amongst others. Nevertheless, and at least to begin with, several hospital-based registries could be initiated that can ultimately pool data to contribute toward provincial and subsequently national level cancer statistics. Indeed, there are several hospitals within the country that maintain their own records without contributing toward provincial and national statistics, probably because such forums are lacking in Pakistan. A successful model in Pakistan is the hospital-based cancer registry of the Shaukat Khanum Memorial Cancer and Research Centre, a major contributor of the PCR. Another example is the “currently-non-functional” Karachi Cancer Registry (KCR) that was founded by Dr. Yasmin Bhurguri. However, and after her death a couple of years ago, the KCR could not generate any further data. Several international examples also exist including the Surveillance, Epidemiology and End Results Program that is amongst the top research and funding priorities of the National Cancer Institute. In summary, there is a dire need that the government of Pakistan pays serious attention and allocates appropriate funding to establish hospital based, provincial as well as national level cancer registries. Moreover, international organizations such as the IARC and the Union for International Cancer Control should support Pakistan in this regard. Establishment of cancer statistics will not only provide incidence, prevalence, and mortality data, but will also allow the health care policy makers to devise appropriate screening and therapeutic strategies according to cancer burden in the country.