16 May 2004	Sunday	25 Rabi-ul-Awwal 1425

ISLAMABAD, May 15: As many as 79,400 cases of cancer ranging from head and neck tumours to prostrate, breast and colon-rectum cancers are reported every year in Pakistan , said a National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion.

The National Action Plan, which was launched last Wednesday, said more than 60 per cent of the new cancer cases occurred in the under-developed parts of the world.

Presently, cancer is known to be the second most common cause of death in the developed countries and evidence points to the emergence of a similar trend in the developing countries. Though a national data on Pakistan is not available, statistics from Karachi Cancer Registry indicate that cancer has been on the rise.

The action plan said, scientific evidence showed that at least one-third of the annually occurring cancers could be prevented and mentioned institutional studies carried out at the Pakistan institute of medical sciences (Pims) which suggested that the frequency of leukaemia was the highest followed by the central nervous system tumours (CNS) and lymphomas.

A pathology-based study at Agha Khan University Hospital (AKUH) showed that within solid tumours, lymphoma was the commonest, followed by the CNS tumours.

The action plan has asked the government to set up cancer registries, which should conform to the CI5 standards (cancer incidence in five continents). Currently, the only registry that conforms to CI5 standards is the Karachi South Cancer Registry.

Referring to tobacco, the action plan said it was the single largest preventable risk factor for cancer, accounting for 30 per cent of the cancer-related deaths in the developing countries.

Similarly, diet, physical activity, overweight and obesity have been described as preventable risk factors for cardiovascular diseases (CVDs) and cancer.

The plan has also mentioned about the use of areca nut that leads to the cancer of the oral cavity adding that in Pakistan the use of areca nut was quite common, though it was not grown in Pakistan and imported from Indonesia and India.

During its transportation, it is likely to be contaminated with aspergillus and other biological contaminations and therefore could be carcinogenic.

Within Pakistan, areca nut imports, distribution and retailing is not regulated despite clear evidence of its association with cancer.

The action plan has asked the government to enact laws to regulate its import and ensure that arriving consignments are not contaminated. In addition, awareness is also needed to educate people about its risk to cancer. However, presently there is no comprehensive health education initiative focused on cancer prevention and control, it said.

The plan said many industrial settings in Pakistan used chemical agents like aniline dyes, asbestos, benzene, uranium, chromium, vinyl chloride, which all were carcinogenic.

It said aniline dyes, known to cause cancer of the bladder, were used in printing presses, dyeing departments of textile industries, tanneries and industries incorporating dyeing treatments. Such industrial units are scattered all over the country.

Similarly, asbestos, known to be a causative agent for lung cancer is used principally in glass industries in Hassanabdal, Attock, Gadoon Amazai, Lahore and Karachi. It is also in use where fireproofing materials, insulators and auto- brakes are manufactured.

Several other industrial units involved in electroplating and construction of batteries and plastic stabilizers in Hattar, Karachi, Lahore and Gujranwala are potential sources of chromium exposure. In addition, several industrial plants manufacturing plastics in Gujranwala, Lahore, Faisalabad, Sialkot and Gadoon Amazai use vinyl chloride.

In such settings, risks to cancer need to be recognized and regulated so that exposure to those in contact with these agents and those inadvertently exposed to them, is minimized, the national action plan said.