National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan

Abstract

Background Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. Objective To estimate the burden of cervical cancer in Pakistan using available data sources. Methods We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. Results A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995–1997 ASIR = 6.81, 1998–2002 ASIR = 7.47, and 2017–2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015–2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. Conclusion The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.

Nurses and doctors ‘s awareness and knowledge towards treatment and care of cervical cancer patients: a cross-sectional study

“…Cervical cancer burden estimate for Pakistan has been limited and regional. WHO disease burden estimate from Pakistan is based on the data from the neighboring countries and limited data from Pakistan [ 20 ]. Pakistan has an estimated cervical cancer burden that exceeds the WHO target [ 20 ].…”

“…WHO disease burden estimate from Pakistan is based on the data from the neighboring countries and limited data from Pakistan [ 20 ]. Pakistan has an estimated cervical cancer burden that exceeds the WHO target [ 20 ]. According to data retrieved from major hospitals of Pakistan, 7.06 (95% CI = 5.98–10.01) is age standardized incidence rates (ASIR) for cervical cancer with an estimated new case of 6166 per year [ 20 ].…”

“…Pakistan has an estimated cervical cancer burden that exceeds the WHO target [ 20 ]. According to data retrieved from major hospitals of Pakistan, 7.06 (95% CI = 5.98–10.01) is age standardized incidence rates (ASIR) for cervical cancer with an estimated new case of 6166 per year [ 20 ]. The exact situation of cervical cancer is not known in Pakistan because of social stigma and its ignorance in term of screening and prevention [ 21 ].…”

“…The exact situation of cervical cancer is not known in Pakistan because of social stigma and its ignorance in term of screening and prevention [ 21 ]. It has been reported that only 5% of women in Pakistan are aware of cervical cancer screening furthermore only 2.5% had Pap smear test once in a lifetime [ 20 ]. Lack of screening practices, poor knowledge about disease, unavailability of Pap smear test and lack of follow-up increases the disease burden in Pakistan [ 21 ].…”

Inadequate cervical cancer testing facilities in Pakistan: a major public health concern

“…The country’s health care infrastructure is insufficient, and resources are limited, which makes it challenging to establish adequate screening programs across the country. There is also a shortage of health care professionals, and the ones who are available, often lack the necessary training to conduct effective screening tests 11,13 .…”