Cancer: A Global Health Challenge with Local Realities

2026-02-04 - 00:06

Dr. Shazia Fatima Director General, NMO Directorate, PAEC HQ President, Women in Nuclear Pakistan Cancer is one of the most significant public health challenges worldwide. According to the World Health Organization (WHO), cancer is a leading cause of death globally, responsible for nearly 10 million deaths in 2020, accounting for about one in six of all deaths. The most commonly diagnosed cancers worldwide include breast, lung, colorectal, prostate, and stomach cancers, with lung cancer being the deadliest. A range of factors drives this burden, including tobacco use, unhealthy diets, physical inactivity, infections such as HPV and hepatitis, and environmental exposures like air pollution. Importantly, many cancers can be successfully treated if detected early and managed effectively. Global estimates from major cancer surveillance systems such as GLOBOCAN indicate that nearly 20 million new cancer cases were diagnosed worldwide in 2022, with 9.7 million deaths attributed to the disease. These numbers are projected to rise substantially, potentially reaching 35 million new cases annually by 2050. This expected increase is largely due to population growth, aging populations, and increasing exposure to cancer risk factors, particularly in low- and middle-income countries (LMICs). Global Patterns of Cancer Incidence A 2022 global map of age-standardized cancer incidence rates shows that the highest reported cancer rates occur in North America, Western Europe, Australia, and parts of Eastern Europe, where age-standardized incidence commonly exceeds 258 per 100,000 population. These regions benefit from broad screening programs and comprehensive cancer registries that enable early detection. Emerging economies in Latin America, East Asia, and Central Asia fall into intermediate incidence ranges, reflecting economic transitions and growing exposure to cancer risk factors. In contrast, many low-income regions, particularly in Sub-Saharan Africa and parts of South and Southeast Asia, show lower reported incidence, partly because of limited diagnostic capacity and incomplete reporting systems. The map also highlights areas with limited or absent cancer registry data. Overall, these patterns demonstrate that variations in reported cancer incidence reflect both genuine differences in disease burden and disparities in healthcare systems, surveillance, and early detection. The global distribution of cancer in 2022 also shows geographic variation in the most common cancer types. High-income regions such as North America, Europe, and Australia report higher incidence rates partly because of aging populations and strong detection systems, while many low-income regions show lower reported rates that often reflect underdiagnosis rather than a truly lower burden. Breast cancer is now the most frequently diagnosed cancer in the majority of countries worldwide, including Pakistan. Lung cancer remains dominant in parts of East Asia and Eastern Europe due to high tobacco use and air pollution. Prostate cancer is most common in several African and Caribbean countries, while cervical cancer remains a leading cancer in parts of Eastern and Southern Africa where screening and HPV vaccination coverage is limited. Colorectal cancer is prominent in more developed and transitioning economies, reflecting dietary and lifestyle changes. Stomach and liver cancers continue to be important in specific regions where infection-related risk factors remain prevalent. Together, these patterns show how cancer profiles are shaped by lifestyle, infections, health system capacity, and access to early detection — factors highly relevant for countries like Pakistan facing a mixed and evolving cancer burden. Disparities in Cancer Outcomes While high-income countries often have more robust healthcare infrastructure, early detection programs, and advanced treatment modalities, LMICs face stark disparities in access to quality cancer care. A large proportion of cancer deaths now occur in these countries, where weak health systems, limited diagnostic facilities, and financial barriers contribute to late presentation and poorer outcomes. In many settings, lack of awareness and absence of screening programs mean that cancers are frequently diagnosed at advanced stages, when treatment is less effective and more costly. Cancer Situation in Pakistan Pakistan, a populous South Asian country with over 259 million people, exemplifies the growing cancer challenge in a developing context. National estimates suggest that more than 180,000 new cancer cases occur annually in Pakistan. Around 80 percent of these patients receive treatment in specialized cancer centers operated by the Pakistan Atomic Energy Commission (PAEC), underscoring the central role of these facilities in national cancer care. Pakistan’s cancer profile reflects patterns seen in other LMICs. Breast cancer is the most frequently diagnosed cancer among women, followed by cancers of the lip and oral cavity, lung, and others. Risk factors such as tobacco use, dietary habits, infections like HPV, and environmental exposures contribute substantially to the disease burden. National data also point to a severe shortage of trained oncology specialists, with estimates suggesting fewer than 250 trained medical or radiation oncologists serving the entire country — an insufficient number for a population of this size. Challenges in Pakistan Pakistan faces multiple systemic challenges in cancer control. Many patients present at late stages of disease, which significantly reduces the chances of successful treatment. Access to comprehensive, population-based screening programs, especially for breast and cervical cancers, remains limited. Workforce constraints are also severe, with shortages of oncologists, pathologists, radiotherapists, and medical physicists limiting the country’s ability to manage complex cancer cases. Financial barriers further compound the problem, as out-of-pocket costs for diagnosis and treatment can be unaffordable for large segments of the population, particularly when private sector care is required. These challenges highlight the urgent need for sustained policy action, stronger health systems, and expanded cancer care infrastructure. Cancer Diagnostic and Treatment Facilities in Pakistan Cancer diagnosis and treatment require a multidisciplinary approach, including radiology, pathology, nuclear medicine, surgery, medical oncology, and radiation oncology. In Pakistan, these services are provided through a mix of public, semi-public, and private institutions, although availability and quality vary significantly across regions. Approximately 40 hospitals in the country provide cancer management services in one form or another. Major providers include PAEC cancer hospitals, which form the backbone of publicly accessible cancer care, as well as specialized institutions such as Shaukat Khanum Memorial Cancer Hospital and Research Centre and Aga Khan University Hospital, both of which offer comprehensive oncology services including surgery, chemotherapy, radiotherapy, and research programs. Some university-affiliated and regional teaching hospitals also provide cancer care and training, though many are under-resourced compared to major tertiary centers. Despite these efforts, national capacity remains limited. Reports indicate that Pakistan has only around 27 dedicated cancer treatment centers, a number insufficient for the country’s high annual cancer incidence. Many facilities struggle to meet demand, particularly for advanced imaging, pathology services, and specialized treatments for complex cancers. However, the capacity of these facilities varies widely across regions. According to the Ministry of Planning and Development, Pakistan has a shortage of trained oncologists and other specialists critical for cancer care, with fewer than 250 qualified medical/radiation oncologists registered in Pakistan, and not all of them are serving in the country. Many regions outside major cities lack advanced diagnostic and therapeutic infrastructure, contributing to disparities in care access. Role of PAEC Cancer Hospitals in Combating Cancer in Pakistan The Pakistan Atomic Energy Commission has played a central role in Pakistan’s cancer response for over six decades. Under its healthcare mandate, PAEC has established a nationwide network of 21 Atomic Energy Cancer Hospitals that provide diagnostic and treatment services across the country. These hospitals have been instrumental in expanding affordable cancer care access for patients regardless of socio-economic status. PAEC’s hospital network treats more than 45,000 new cancer patients each year and performs approximately one million diagnostic and therapeutic procedures annually, illustrating its scale of contribution to national cancer care. The network spans all major provinces and regions, including Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, Gilgit-Baltistan, and Azad Jammu & Kashmir, improving geographic access to specialized cancer services. These hospitals are equipped with modern diagnostic and treatment technologies, including PET-CT and SPECT-CT imaging for accurate staging and monitoring, cyclotrons for producing radiopharmaceuticals used in nuclear medicine, linear accelerators and brachytherapy units for radiotherapy, and advanced techniques such as Intensity Modulated Radiation Therapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and CyberKnife. Comprehensive pathology and laboratory services further support accurate diagnosis and follow-up. Collectively, these capabilities place PAEC hospitals among the most technologically advanced public-sector cancer care providers in Pakistan. Beyond clinical services, PAEC invests heavily in training and capacity building. In collaboration with academic institutions such as the Pakistan Institute of Engineering and Applied Sciences (PIEAS), PAEC provides postgraduate training programs in nuclear medicine, oncology, radiology, and medical physics. These initiatives are essential for addressing national workforce shortages and ensuring sustainable expertise in specialized cancer care. Internationally, PAEC’s Nuclear Medicine, Oncology and Radiotherapy Institute (NORI) in Islamabad has been designated by the International Atomic Energy Agency as a “Rays of Hope Anchor Centre,” recognizing its excellence in cancer care, training, and research. This designation facilitates international collaboration and knowledge exchange with other countries. PAEC also conducts community outreach and awareness campaigns that promote early detection and educate the public about cancer prevention, an especially critical effort in settings where late presentation is common. Looking Forward: Strengthening Cancer Control in Pakistan While PAEC’s contributions are substantial, Pakistan’s overall cancer response requires a comprehensive, multi-sectoral approach that extends beyond treatment. Establishing a robust national cancer control policy and strengthening cancer registry systems are essential for tracking trends and guiding resource allocation. Expanding organized screening programs for breast, cervical, and colorectal cancers would enable earlier detection and better outcomes. Workforce development must be accelerated to train more oncologists, radiotherapists, pathologists, and oncology nurses. Preventive strategies, including tobacco control, promotion of healthy diets and physical activity, and vaccination against HPV and hepatitis, should be strengthened. At the same time, greater emphasis on local research and innovation is needed to better understand Pakistan’s cancer patterns and develop context-specific solutions. Conclusion Cancer remains a leading cause of death globally, with rising incidence and major disparities in access to quality care between high- and low-income countries. Pakistan faces a significant and growing cancer burden, compounded by limited resources, late diagnosis, and shortages of specialized personnel. In this context, the Pakistan Atomic Energy Commission’s network of cancer hospitals stands as a cornerstone of the national response, providing advanced diagnostics, modern treatment, professional training, and public outreach at a large scale. Continued investment in cancer infrastructure, workforce development, prevention strategies, and national policy frameworks will be essential to reduce the cancer burden and improve outcomes for patients across Pakistan.