There is no second opinion that cancer is assuming endemic proportions in the country and the numbers are alarming. In the absence of a National Cancer Registry, there are no accurate figures but estimates abound and come from different entities in both the private and the public sectors.

According to some estimates, between 150,000 and 300,000 new individuals are diagnosed with cancer every year in the country and a large number of them are not curable because of the advance stage of the disease they are suffering from. If we go by the cancer assessment mission report of the International Atomic Energy Agency (IAEA) released in 2016, 150,000 new cases of cancer are emerging in Pakistan every year. This figure was 140,000 in 2015 as reported by the Ministry of National Health Services, Regulations and Coordination (NHSRC).

Keeping in view the gravity of the situation, one is compelled to look at the structure of cancer awareness, diagnosis and treatment facilities available in the country. This analysis is important because late or no diagnosis of cancer, especially breast cancer, are the major reasons of high casualty rate among patients. If diagnosed in time, the chances of cure and survival are high otherwise not.

There are a few full-fledge cancer hospitals like Shaukat Khanum Memorial Cancer Hospital that provide all services under one roof whereas others offer limited facilities. To name a few, there are: Shifa International Hospital, Islamabad; Northwest General Hospital and Research Centre, Peshawar; Ziauddin Cancer Hospital, Ziauddin University Karachi; Baitul Sukoon Cancer Hospital Karachi; and The Cancer Foundation Hospital, Karachi.

In the government sector, there are oncology departments in government hospitals at tehsil and district levels managed by provinces but the general perception is that they are using outdated radiation machines that do more harm than good to the patients. For example, if a new radiation machine takes a minute to complete a therapy an outdated one would take 8 to 10 minutes exposing the patient to harmful radiation. Unfortunately, the government is cash-strapped and not in a position to install new radiation machines costing tens of millions of rupees. An example of this neglect is the oncology department at Jinnah Hospital, Lahore, where there has been no oncologist for the last two years.

Ghulam Mustafa, a spokesman of Pakistan Atomic Energy Commission (PAEC), points out that keeping in view the difficulties faced by cancer patients the commission has set up 18 hospitals throughout the country and is in the process of establishing more. At the moment a hospital is under construction in Gilgit that will cater to the needs of patients in this remote area.

"No plan can work till the time awareness about breast cancer is incorporated in curriculum and included in the mandate of health facilities even at the level of Basic Health Units (BHUs) and Rural Health Centres (RHCs)," says Dr Ashraf Nizami, former president of Pakistan Medical Association.

Mustafa says their vision is to establish a cancer hospital after every 100 kilometers in the country so that the population around it can get easier access to these. He says every year one million

cancer patients out of the total 1.8 million benefit from these facilities, and the best part is that PAEC hospitals take patients regardless of the stage their disease is. "There are no refusals at all."

Though he does not mention any names, he seems to be referring to other cancer hospitals that do not accommodate patients who are suffering from advance stages of cancer. A good news, however, is that the government has given Rs 30 billion to PAEC for upgrade of existing hospitals and maintenance of equipment.

He tells The News on Sunday that they have funds from Bait ul Maal and philanthropists which are spent on the treatment of deserving patients since it is a very costly process. Extreme care is taken to ensure these funds are available only to those who cannot afford the treatment otherwise, he adds.

Mustafa says there are mobile breast care clinics as well, established by the PAEC, that help them arrange monthly or fortnightly visits and camps in remote areas for awareness and screening purposes. During these trips, experts deliver lectures and distribute awareness material regarding breast cancer prevention, detection and treatment among women.

Dr Ashraf Nizami, a former president of Pakistan Medical Association and current head of its international committee, thinks no plan can work until awareness about breast cancer is incorporated in curriculum and included in the mandate of health facilities even at the level of Basic Health Units (BHUs) and Rural Health Centres (RHCs). No doubt the staff of BHUs and RHCs cannot be provided costly equipment to diagnose and treat cancer but they can at least be trained to tell people about the disease and its symptoms. Unfortunately, he says, talking about breast cancer has become a taboo in the society which should not have been the case. Once the symptoms are identified, the patient can be convinced to approach a facility and get tested, he adds.

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The shortage of oncologists in the country and dependence on expensive imported medicines are two other issues that need to be taken care of. Oncologist Dr Riaz Rahman says there are around 120 oncologists in Pakistan which is too small a number. The reason, he points out, is that a medical practitioner does not want to give up but in case of cancer the morbidity rates are high. "This is a discouraging factor."

Besides, he says, it is almost impossible for oncologists to practice privately because cancer treatment is equipment-dependent, and very expensive. Most doctors cannot afford it and have to establish properly equipped private clinics.

Similarly, he says, it is time to produce cancer medicines locally because the imported or smuggled ones are too expensive. Citing an example, he says, an imported injection priced at Rs 100,000 in Pakistan is being produced in India at less than one-tenth of this amount. Dr.Rahman says a group of businessmen in Sialkot plan to start producing cancer drugs in Pakistan and is in touch with the cancer hospital he is associated with.

The writer is a staff member and can be reached at shahzada.irfan@gmail.com