IT has been a long time coming. Finally, Pakistan is set to create a national cancer registry after President Asif Ali Zardari signed into law a bill reorganising the National Institutes of Health. The NIH will now be tasked with maintaining a central database of cancer cases. The hope is that this registry will provide a clear picture of the country’s true cancer burden. At present, the numbers are guesswork. The Global Cancer Observatory recorded 178,388 cases in Pakistan in 2020, but these were largely based on the Punjab Cancer Registry, which covers only parts of Lahore and central Punjab. Extrapolating from such a narrow base to a country of 240m people is a recipe for undercounting. Official figures almost certainly underestimate the problem. The result is that health policy is crafted in the dark, treatment capacity is misallocated and awareness campaigns are scattershot. A functioning national registry could change this. By recording confirmed cases, deaths, recoveries and demographic data — such as age, gender and location — policymakers will have a sharper tool for designing prevention programmes and allocating resources. Researchers will gain access to a dataset that can identify patterns — whether in lifestyle, environment or genetics — that raise cancer risk. International donors and research bodies, long wary of our patchy data, may be more willing to invest in programmes once the scale of the problem is better understood.

But registries are only as good as the systems that feed them. Previous attempts at a national registry failed for lack of resources and institutional coordination. Pakistan’s health infrastructure is fragmented, underfunded and overly reliant on ad hoc donor projects. Rural areas, where medical records are sparse, will be particularly difficult to capture. Ensuring patient privacy, as the bill promises, will also be vital to maintaining public trust. The registry, in short, is a necessary but insufficient reform. It will provide the map. But maps are useless without vehicles to traverse them — and without leaders willing to steer those vehicles towards meaningful progress. Pakistan must pair this initiative with stronger cancer screening programmes, more oncology centres outside big cities and expanded palliative care. Cancer is rising sharply in low- and middle-income countries. Without investment in treatment and prevention, Pakistan risks turning this new database into nothing more than a bleak national roll-call.

Published in Dawn, September 9th, 2025