Epidemiology of Cancer in Pakistan

Dr. Owais Raza | Lecturer | Department of Community Health Sciences | Ziauddin University

Epidemiology – basics

• How many cancer cases/deaths are there? (per year, sex, age group etc.)

• Is cancer more frequent in some geographical area?

• What is the association between tobacco smoke and (lung) cancer?

• Should screening for prostate cancer be recommended?

• Does cancer prevention work?

The most common cancers worldwide

World cancer report, International Agency for Research on Cancer 2003

Cancer Epidemiology milestones

• Richard Doll and Austin Bradford Hill, 1964– Mortality in relation to smoking: ten years´

observations of British doctorsSmoker Non - smoker RR

Men

2.27 0.07 32

Women

0.22 0.03 7

BMJ 1: 1399-1410 & 1460-67

Cancer registration

• An important tool for epidemiologic cancer research

• there is consensus that functioning cancer registries form an important basis for research work in this field

• Around the world many local, regional and national cancer registries operate

• Pakistan ???

Biology of Cancer

• Many Diseases – One Disease Process• A disorder of cellular growth and differentiation• Phases in cancer development

• Health cells• Dysplasia• Carcinoma in situ• Localized cancer Stage I• Regional spread Stages II and III• Generalized disease Stage IV

Biology of Cancer

Rule of Thirds

Sociology of Cancer

• Cancer is a lifestyle disease• Carcinogens arise as a consequence of– Living conditions– Working conditions

Sociology of Cancer

• Conditions of living– Geographical and temporal variability– Habits tobacco – lung cancer– Diet tea – esophageal cancer

• Conditions of work– Environmental hazards• Viruses – liver cancer• UV radiation – skin cancer• Asbestos – lung cancer• Benzene – Blood cancer

•Data from the Karachi South Cancer Registry show that the Age Standardized

Incidence Rates (ASIR) for all cancers, except those of the urinary bladder and

skin, have increased as evidenced by ASIRs in 1998-2002 in comparison to data in

1995-97.

•The commonest Cancer sites amongst males in Pakistan are lungs, oral cavity

and larynx while the commonest Cancer sites amongst females are breast, oral

cavity and gall bladder. Amongst children, Leukemia are the most common group

in both genders, followed by lymphomas in males and malignancies of the brain

in females and vice versa for the third most common cancer. Malignancies of the

bone are the fourth most common group in both genders.

•Incidence rates of cancers of the breast and mouth in Karachi are one of the

highest in Asia.

Incidence Rate of Breast Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 0.6 1.0

Female 53.8 69.1

Incidence Rate of Cancer of mouth – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 15.6 22.5

Female 15.5 20.4

Incidence Rate of Lung Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 21.0 25.5

Female 2.9 4.2

Incidence Rate of Cancer of Larynx – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 8.8 11.8

Female 1.5 1.7

Incidence Rate of Urinary Bladder Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 9.0 9.9

Female 3.6 2.8

Incidence Rate of Skin Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 5.3 5.2

Female 5.8 5.6

Incidence Rate of Prostate Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 5.3 9.8

Incidence Rate of Colorectal Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 5.4 7.8

Female 5.5 5.2

Incidence Rate of Esophageal Cancer – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 6.5 6.3

Female 6.9 8.6

Incidence Rate of Lymphoma – by gender (1995 - 2002) / 100,000

95 – 97 98 – 02

Male 7.9 9.6

Female 4.4 7.2

Trends in Cancer Pattern

• Continuous monitoring system with comparable data is prerequisite

• Nationally representative data for Pakistan are lacking