Differences in cancer incidence and pattern between urban and rural Nepal: one-year experience from two population-based cancer registries

Subedi, Ranjeeta; Budukh, Atul; Chapagain, Sandhya; Gyawali, Bishal; Khadka, Kopila; Thakur, Chanda; Dahal, Uma; Dikshit, Rajesh; Jha, Anjani Kumar; Dhimal, Meghnath

doi:10.3332/ecancer.2021.1229

Cited by 10 publications

(12 citation statements)

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“…We observed a significant difference in the standardised rate ratios for the site-specific cancers for rural and urban patients. Similar observations have been reported from previous cancer registries of India, Nepal, China, and the United States (US) [ 14 , 19 , 33 , 40 ]. The significantly higher AAR for liver cancer in rural patients can be partially attributed to a greater prevalence of alcohol use in the rural Indian population.…”

Section: Discussionsupporting

confidence: 90%

“…Another study noted that the AAIR in urban Punjab PBCRs (Chandigarh and SAS Nagar) is almost twice that in rural PBCRs (Mansa and Sangrur) [ 19 ]. Similar trends are observed in Nepal, where the urban (Kathmandu) registry showed 1.6 times higher AAR among males and 1.9 times higher AAR among females in comparison to the rural (Rukum) registry [ 33 ]. Conversely, a study in China revealed significantly higher AAIR in rural men, primarily attributed to oesophageal cancer [ 14 ].…”

Section: Discussionsupporting

confidence: 75%

“…Several studies from India (cancer registries and case-control studies) have reported rural background as a risk factor for gallbladder cancer [ 44 , 47 ]. However, studies from countries such as Nepal [ 33 ] and Chile [ 48 ] have reported urban predominance for gallbladder cancer, which has been explained by the higher prevalence of gallstones, obesity, and hormone use in their urban regions [ 33 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

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Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

Khanna,

Sharma,

Budukh

et al. 2024

BMC Cancer

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Background Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. Methods This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. Conclusions Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

Khanna,

Sharma,

Budukh

et al. 2024

BMC Cancer

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“…The coverage of cervical cancer screening in Nepal is only 2.4%. The estimated coverage of cervical cancer screening in rural and urban Nepal is 2% and 4.7% respectively [13], [14]. While the national guidelines of screening for cervical cancer have prioritized VIA as the prime screening method at all levels of health care settings but still it has not been made easily accessible and has not intervened effectively.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with utilization of visual inspection with acetic acid in Nepal

Ramtel

Noh

Rampal

et al. 2022

IJPHS

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Visual inspection with acetic acid (VIA) is an optional cervical cancer screening method. National guideline of Nepal has emphasized using the VIA and intended to achieve at least a 50% screening rate by 2015 but the overall coverage is only 2.4% in 2019. A cross-sectional study was conducted to identify the factors associated with the utilization of VIA screening in Bagmati Province, Nepal. A convenience sample of 400 women aged 30 to 60 years was included in the study. A semi-structured questionnaire was used to elicit information on VIA test and factors associated with it. Awareness, economic status, socio-psychological beliefs, service availability and accessibility, perception on service providers’ performance were associated with low VIA use in the province. VIA screening was associated with socio-demographic variables (χ2=29.9; df=4; p=<0.001), knowledge factors (χ2=69.29; df=3; p=<0.001) and with the perception on service providers’ performance (χ2=433.82; df=6; p=<0.001). Service providers’ approach during the VIA screening mattered to the acceptance of this service. The disparity was observed in the knowledge of cervical cancer and screening by the women. Based on this, there is a need for massive improvement on the awareness of the community about cervical disease and screening services.

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“…Monitoring epidemiological trends in cancer through population-based cancer registries (PBCR) is important for cancer control, as it allows for the evaluation of the effectiveness of cancer screening programmes and the assessment of inequalities in cancer treatment, and supports the planning of cancer care services (Parkin 2008). In 2018, PBCR was introduced in Nepal in some districts, and although it was recently expanded, it still covers only 20% of the population (Gyawali et al 2020;Subedi et al 2020Subedi et al , 2021. The lack of a robust PBCR hinders not only the ability to assess cancer incidence and the impact of cancer in the country, but also makes the development of cancer management initiatives more difficult.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review

Rademaker

Bhandary

Harder

2021

J Public Health (Berl.)

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Aim Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality. Methods Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively. Results The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening. Conclusion Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.

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Differences in cancer incidence and pattern between urban and rural Nepal: one-year experience from two population-based cancer registries

Cited by 10 publications

References 16 publications

Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

Rural-urban disparity in cancer burden and care: findings from an Indian cancer registry

Factors associated with utilization of visual inspection with acetic acid in Nepal

Knowledge, awareness, attitudes and screening practices towards breast and cervical cancer among women in Nepal: a scoping review

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