National Cancer Registry of Pakistan: First Comprehensive Report of Cancer Statistics 2015-2019.

OBJECTIVE: To compile a comprehensive national cancer registry report of Pakistan by merging and analysing cancer registration data received from major functional cancer registries in various parts of Pakistan. STUDY DESIGN: Observational study. Place and Duration of the Study: Health Research Institute (HRI), National Institutes of Health (NIH), Islamabad, from 2015-2019. METHODOLOGY: Data from major cancer registries which included 'Punjab Cancer Registry (PCR), 'Karachi Cancer Registry (KCR)', 'Pakistan Atomic Energy Commission (PAEC) Cancer Registry', Armed Forces Institute of Pathology (AFIP) Cancer Registry, Nishtar Medical University Hospital Multan (NMH), and Shifa International Hospital, Islamabad (SIH) registries were pooled, cleared, and analysed at HRI. RESULTS: A total of 269,707 cancer cases were analysed. Gender-wise 46.7% were males and 53.61% were females. As per province-wise distribution, 45.13% of cases were from Punjab, 26.83% from Sindh, 16.46% from Khyber Pakhtunkhwa (KP), and 3.52% from Baluchistan. Both genders combined, 'breast cancer' 57633 (21.4%) was the most common cancer. In males, the top-5 cancers in order of frequency/percenatages were 'oral' 14477 (11.6%), 'liver' 8398 (6.73%), colorectal 8024 (6.43%), 'lung' 7547 (6.05%) and 'prostate' 7322 (5.87% cancers). In females, causes of the top-5-cancers included 'breast' 56250 (38.8%), 'ovary' 8823 (6.09%), 'oral' 7195 (4.97%), 'cervix' 6043 (4.17%), and 'colorectal' 4860 (3.36%) cancers. In children 'Leukemia' 1626 (14.50%) and in adolescents 'Bone' 880 (14%) were the leading malignancies. CONCLUSION: Breast cancer is the most common cancer in females touching epidemic proportions while 'oral cancer' which is the leading cancer in males ranks third in frequency in females. Like 'oral cancer' which shows a strong correlation with chewing, other common cancers in Pakistan including liver cancer, lung cancer, and cervical cancer are also largely preventable as showed a strong correlation with hepatitis B and C, smoking, and high-risk human papillomavirus. KEY WORDS: National Cancer Registry, Health Research Institute - NIH, Islamabad, Pakistan.

Arsenic Exposure in Children through Drinking Water in Different Districts of Sindh, Pakistan.

A cross sectional study has been conducted during 2007-2010 for the assessment of arsenic (As) contamination in drinking water, and its impact on the health of local public belongs to five districts of Sindh, Pakistan. The toxic risk assessment of As in different areas of Sindh province based upon its concentration in drinking water and scalp hair of boys and girls of age group 5-10 and 11-15 years. The total and inorganic As species in drinking water samples of four districts Hyderabad, Sukkur, Naushehro Firoze, Nawab shah, and Dadu were determined by advance pre-concentration methodologies. The resulting data indicated that the dominant inorganic As species in municipal treated (Hyaderabad) and hand pumps (Sukkur, Naushehro Firoze, Nawab shah and Dadu) water samples were arsenate (As(V)) and arsenite (As(III)), respectively. The total As concentrations in hand pumps water samples of Dadu district were 6.0- to 35-fold higher than the World Health Organization permissible limit of (10 µg/L) for drinking water. Whereas, total As in hand pump water samples of Sukkur, Naushehro Firoze, and Nawab shah were found in the range of 26.0-98.2, 18.0-50.6, and 52.3-85.2 µg/L, respectively. However, municipal treated water samples of Hyderabad were within recommended level (As <10 µg/L). The content of total As in children of both genders and age group belonging to Sukkur, Naushehro Firoze, Nawab shah, and Dadu was found to be significantly high as compared to those children residing in Hyderabad district. The Pearson coefficient of correlation r values between As levels in hand pump water and scalp hair samples of children belonging to Sukkur, Naushehro Firoze, Nawab shah, and Dadu were observed in the range of 0.65-0.75, 0.75-0.82, 0.80-0.90, and 0.95-0.98, respectively. The results of As toxicity risk assessment based on hazard quotient indicated that Dadu district has high carcinogenic exposure risk for children. Moreover, it is concluded that the children consuming groundwater of Sukkur, Naushehro Firoze, Nawab shah, and Dadu districts of Sindh, Pakistan were at risk of chronic As toxicity in future.