Bridging the gap: Imagining a cancer-free Nepal

Embracing the theme ‘Close the Care Gap’, humanity marked World Cancer Day on Feb 4, sending a grim reminder to Nepal, which finds itself at a critical juncture in the fight against cancer. Cancer stands as a main cause of mortality worldwide, contributing to almost 10m deaths in the year 2020, equating to nearly one in six fatalities. The latest statistics reveal a sobering reality, emphasizing the need for heightened awareness, improved healthcare infrastructure and collaborative efforts to combat this stubborn disease.

Nepal’s cancer landscape

Nepal, which has a population of around 30m, reported 22,008 new cancer cases in 2022. Among these, 9,792 cases affected males, while 12,216 cases impacted females. This alarming figure highlights the widespread impact of cancer on individuals and communities. The age-standardized incidence rate of 81.6 underscores the urgency of addressing the factors contributing to the rising incidence of cancer.

Top cancers and their impact

The top three leading cancers in Nepal, categorized by gender, reveal distinct patterns in the prevalence of the disease. Among males, lung cancer takes the forefront, followed by stomach and lip, oral cavity cancers. In contrast, females grapple predominantly with breast cancer, followed by cervix uteri and lung cancers. When considering both sexes collectively, lung cancer maintains its prominence, with breast and cervix uteri cancers following closely. These statistics highlight the need for gender-specific awareness campaigns, early detection initiatives and targeted healthcare interventions to address the unique challenges posed by different types of cancer in both men and women. These cancers not only affect the physical well-being of individuals but also carry a substantial emotional and economic burden for individual families and the society.

Losses and lessons: 14,704 lives lost

Tragically, 14,704 lives were lost to cancer in 2022, with lung cancer claiming the top spot. The breakdown by gender reveals that 6,936 males and 7,768 females succumbed to the devastating impact of cancer. Among males, lung cancer stands as the leading cause of cancer-related deaths, accounting for a significant 15.6 percent of the mortality rate, whereas lung cancer holds the third position among females, contributing to 7.4 percent of cancer-related deaths. The age-standardized mortality rate of 55.3 signals the urgent need for comprehensive strategies to improve cancer care, early detection and treatment outcomes.

A complex tapestry

The risk factors for cancer and other non-communicable diseases encompass tobacco use, alcohol consumption, an unhealthy diet, physical inactivity and exposure to air pollution. A study on the burden and risk factors of cancer suggests that roughly 50 percent of global cancer deaths can potentially be prevented. It is crucial to distinguish risk factors such as smoking and alcohol use from others. Various research studies indicate that a significant 90 percent of lung cancers worldwide are attributable to smoking and tobacco consumption. Cigarette and tobacco smoke emit over seven thousand chemicals, including nicotine, tar, carbon monoxide, lead, benzopyrene, hydrogen cyanide, ammonia and nitrosamines. Among these compounds, a minimum of 250 are identified as harmful, with at least 69 of them having the potential to cause cancer. Studies have shown that smoking as well as smokeless tobacco causes mouth, lip, throat, lung and esophagus cancer apart from more than 25 fatal diseases like heart disease, chronic respiratory obstruction and asthma. Research has shown that tobacco causes 20 types of cancer. Smoking can cause cancer in any part of the body. Tobacco use causes cancer of the mouth and throat, esophagus, stomach, bowel, rectum, liver, pancreas, voicebox (throat), trachea, bronchus, kidney, bladder and uterus.

A cancer-free future

In the pursuit of a cancer-free future for Nepal, a multifaceted approach is essential, encompassing key initiatives that address prevention, early detection, treatment, and palliative care forming integral components. Acknowledging that 30-50 percent of cancers are preventable, emphasis is placed on lifestyle choices, including avoiding tobacco and alcohol, maintaining a healthy weight, regular physical activity and a balanced diet. Vaccination against viruses such as HPV and hepatitis B, especially for high-risk groups, adds a crucial layer to preventive measures. 

Early detection, facilitated through awareness, clinical evaluation and timely referrals, significantly enhances the chances of successful treatment and lower morbidity. Screening programs, though effective, require substantial resources. Tailored treatment incorporating surgery, radiotherapy and systemic therapy is pivotal in achieving therapeutic goals, including cure and prolonged life. However, the global availability of comprehensive treatment remains uneven, with disparities between high- and low-income countries. In advanced stages, palliative care becomes essential, emphasizing community-based strategies for pain relief. Access to oral morphine is emphasized to address moderate to severe cancer pain, impacting over 80 percent of terminal-phase patients. The integration of vaccination into this comprehensive framework underscores its role in reducing cancer risk, particularly for virus-related cancers.

As we observe World Cancer Day, the global community must heed Nepal’s call to action. Beyond the statistics lie human stories, families affected, and communities in need. It is imperative to unite in the fight against cancer, offering support, resources and expertise to strengthen Nepal’s healthcare system.