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      Epidemiology of cancers in Lahore, Pakistan, 2010–2012: a cross-sectional study

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          Abstract

          Objectives

          To estimate the population-level cancer estimates for the Lahore district, which is part of the Punjab Cancer Registry (PCR), Pakistan. The average population per year of Lahore was estimated at 9.8 million in 2010–2012.

          Design

          A cross-sectional study.

          Setting

          The Registry has 19 collaborating centres in Lahore that report their data to the Central Office located within a tertiary care cancer treatment facility in Lahore, Pakistan.

          Participants

          Patients belonging to Lahore, of any age-group, and diagnosed with cancer in 2010–2012, were included in the study. They were followed up between July and October 2015 to determine their vital status.

          Outcome measures

          Summaries were generated for gender, the basis of diagnosis, diagnoses and deaths. The Age-Standardized Incidence Rates (ASIR) were computed per 100 000 population, by gender and cancer site. Five-year age categories were created from 0–4 until 70–74, followed by 75+ years. Death counts were reported by site.

          Results

          Between 2010 and 2012, in Lahore, a total of 15 840 new cancers were diagnosed in 43% male patients and 57% female patients; 93.5% were microscopically confirmed and 6.5% non-microscopically. In females, the ASIR was 105.1 and in males, it was 66.7. ASIRs of leading cancers among women were breast 47.6, ovary 4.9 and corpus uteri 3.6, whereas among men they were prostate 6.4, bladder 5.0, and trachea, bronchus and lung 4.6. A total of 5134 deaths were recorded.

          Conclusions

          In Lahore, the ASIR was higher in women than in men. Among women and men, breast cancer and prostate cancer, respectively, were the leading cancer types. These estimates can be used for health promotion and policymaking in the region.

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          Most cited references7

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          Epidemiology of cervical cancer with special focus on India

          Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. This paper attempts to review the available knowledge regarding the epidemiology and pattern of cervical cancer; types of HPV (human papilloma virus) prevalent among cervical cancer patients and among women in general, high-risk groups such as commercial sex workers, and HIV (human immunodeficiency virus)-positive women; and the role of the national program on cancer in control efforts. The peak age of incidence of cervical cancer is 55–59 years, and a considerable proportion of women report in the late stages of disease. Specific types of oncogenic HPV-16, 18 have been identified in patients with cervical cancer. Other epidemiological risk factors are early age at marriage, multiple sexual partners, multiple pregnancies, poor genital hygiene, malnutrition, use of oral contraceptives, and lack of awareness. A multipronged approach is necessary which can target areas of high prevalence identified by registries with a combination of behavior change communication exercises and routine early screening with VIA. Sensitizing the people of the area, including menfolk, is necessary to increase uptake levels. Vaccination against types 16 and 18 can also be undertaken after taking into confidence all stakeholders, including the parents of adolescent girls. Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.
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            Cancer registration in developing countries: luxury or necessity?

            Differences in culture and resources between low-income and high-income countries have resulted in unequal rights to health. In the past few decades, developing countries have had an increase in chronic-disease burden, including cancer. Cancer registries are urgently needed in developing countries because the cancer burden is usually poorly known. To fight this burden, the extent of the cancer must be known so that programmes for cancer control can be planned efficiently, not only to implement standards of care but also to define prevention strategies. In this Review, we advocate the need for availability of cancer data and discuss potential opportunities for hospital-based and population-based cancer registries to collaborate in providing these data in low-income countries.
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              Human papillomavirus infection in women with and without cervical cancer in Karachi, Pakistan

              Background: No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia. Methods: Cervical specimens were obtained from 899 married women aged 15–59 years from the general population of Karachi, Pakistan and from 91 locally diagnosed invasive cervical cancers (ICCs). HPV was detected using a GP5+/6+ PCR-based assay. Results: The prevalence of HPV in the general population was 2.8%, with no evidence of higher HPV prevalence in young women. The positivity of HPV was associated with women's lifetime number of sexual partners, but particularly with the age difference between spouses and other husbands' characteristics, such as extramarital sexual relationships and regular absence from home. The HPV16/18 accounted for 24 and 88% of HPV-positive women in the general population and ICC, respectively. Conclusion: Cervical cancer prevention policies should take into account the low HPV prevalence and low acceptability of gynaecological examination in this population.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2016
                28 June 2016
                : 6
                : 6
                : e011828
                Affiliations
                [1 ]Cancer Registry & Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
                [2 ]Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
                Author notes
                [Correspondence to ] Farhana Badar; farhana@ 123456skm.org.pk
                Article
                bmjopen-2016-011828
                10.1136/bmjopen-2016-011828
                4932289
                27354082
                cae565b4-58c1-4483-9310-9ddaed7723a4
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 8 March 2016
                : 2 June 2016
                : 6 June 2016
                Categories
                Public Health
                Research
                1506
                1724
                1692

                Medicine
                public health,epidemiology,oncology
                Medicine
                public health, epidemiology, oncology

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