We need a national cancer control policy very badly
The logistical support needed for cancer treatment in Bangladesh is inadequate. More skilled cancer professionals are required and a national cancer control policy has to be made as soon as possible
Worldwide cancer is the second major leading cause of mortality, with a global economic impact of $1.16 trillion. Despite a lower incidence of cancer in Low and Middle-Income Countries (LMICs) like Bangladesh, compared with high-income countries, the total cancer-related mortality in LMICs is significantly higher, especially in people younger than 65, causing an enormous impact on the economy through premature mortality and the lost productive years of life, compared to developed countries.
According to a latest World Health Organisation (WHO) report, there are around 1.5 million cancer patients in Bangladesh, with approximately 1,50,000 newly diagnosed and around 1,09,000 dying each year. Lung, oral cavity and stomach cancer are the most predominant among the male population and breast, cervix and oral cavity cancer are the top three cancers among females in our country.
However, the exact number of people suffering from cancer in the country is hard to tell as there is no population-based cancer registry. Presently, there are few hospital-based and specialised cancer registries in Bangladesh, with a very low coverage.
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The government took up a Tk2,500 crore project in 2019 to set up a full-fledged cancer centre in government medical college hospitals in the eight divisional cities. But one thing that must be addressed here is that treating cancer is not only based on the treatment, upgraded diagnostic facilities need to be established as well.
lthough we have had some recent advancement in treatment, which is mostly in the private sector, it is, however, expensive. National Institute of Cancer Research and Hospital (NICRH) is the country's only specialised government hospital for cancer treatment with a 500 bed capacity. Besides this, only nine government medical colleges and BSMMU have the logistics (radiotherapy setup) for cancer treatment.
According to the WHO guideline, we need to have around 170 radiotherapy units but we barely have 30. Patients wait in long queues for receiving essential cancer treatment, leading to treatment dropout and premature death.
The government took up a Tk2,500 crore project in 2019 to set up a full-fledged cancer centre in government medical college hospitals in the eight divisional cities. But one thing that must be addressed here is that treating cancer is not only based on the treatment, upgraded diagnostic facilities need to be established as well. Apart from logistics, we have a severe shortage in skilled manpower to deliver cancer care, which needs special attention too, in a reasonable time frame.
In Bangladesh, we still do not have any population-based cancer screening programme, not even a comprehensive hospital-based one. So, people usually come in with late stages of cancer, where curative treatment is not possible.
At present, there is a hospital-based cervical cancer screening programme in Bangladesh but we need more coverage. To achieve maximum benefit from screening programmes, the government should engage NGOs, civil society and other stakeholders as well.
Cancer control is not just about treatment. It needs equal emphasis on prevention too. There are few common risk factors that contribute to cancer: obesity, low level of physical activity, consumption of tobacco, betel nut, alcohol, air pollution, chemical-tainted food, lack of hygiene during menstruation, early marriage, etc.
Some level of awareness is seen among the urban population, but it is almost absent among rural people. We do not have an existing strategy for creating public awareness. Some NGOs are working here in dispersed ways, which too is very inadequate. A combination of public awareness about symptoms and access to seeking medical advice could improve cancer outcomes.
Because our out-pocket expenditure in health is so high, cancer treatment causes a huge financial burden to affected families and it reflects on national growth also. Lack of existing national health insurance policy is a major challenge to deliver equitable cancer treatment, eventually which constrains the achievement of SDGs.
To deliver a universal, quality-based and timely service, in line with the best that is currently available in the world, we need a national cancer control policy very badly. It is high time all the cancer programmes and stakeholders are brought under one umbrella and fight against cancer.
We need a national cancer control policy very badly.
Professor Dr. M A Hai is the President of Oncology Club.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.
