Bangladesh severely unequipped to treat cancer

As the country observes World Cancer Day along with the rest of the world today, medical experts say there is no national registry here to keep record of patients diagnosed with cancer, despite a recommendation made by World Health Organisation (WHO) in 2014. According to a WHO study published that same year, around 59% of the deaths in Bangladesh are caused by non-communicable diseases (NCD), 10% of which are caused by cancer. In addition, the top 20 causes of death include four types of cancer: oral, oesophageal, cervical and breast. The study was conducted from 2000 to 2012. Oncologists believe that there are currently around 1.5 million cancer patients in Bangladesh. Around 250,000 people are diagnosed with cancer while around 150,000 die from cancer every year. “It is very difficult to say how many cancer patients are receiving treatment around the country, or have gone abroad for treatment, as we do not have a national cancer registry,” said Dr Mafizur Rahman, associate professor of radiation oncology at National Institute of Cancer Research and Hospital (NICRH) in Dhaka. There is a general lack of awareness regarding cancer as well, he said. “Cancer is 95% curable if it is identified at the early stage, but majority of our patients are at the advanced stage when they are diagnosed,” Mafiz told the Dhaka Tribune. Cancer-related death is on the rise in the country; the International Agency for Research (IARC) on Cancer estimates that cancer will cause 13% of annual deaths in Bangladesh by 2030, rising from 7.5% in 2005. Yet, the health care authorities have not taken any measures to develop a proper cancer treatment system in the country. “With our existing capacity around the country, we can provide treatment to less than 10% of cancer patients,” Dr Mafizur Rahman told the Dhaka Tribune.A shocking example of inadequacySpeaking to the Dhaka Tribune, family members of a number of cancer patients in Dhaka expressed a lack of confidence in the country’s cancer treatment facilities and said they would rather go abroad. But those who cannot afford to go abroad have a hard time getting access to the local facilities too, as there is a small number of cancer treatment facilities in the country. Among them, the Dhaka-based hospitals, especially the NICRH, receive more patients than they can provide treatment to, said Dr Mafizur Rahman. According to the annual bulletin of the Ministry of Health and Family Affairs in 2015, the NICRH provided treatment to 201,195 outdoor, 4,493 emergency, and 4,057 indoor cancer patients in 2014. Sources said nearly 1,000 cancer patients come to the NICRH for radiotherapy every day where the hospital can provide radiotherapy to 450-500 patients at best. Dhaka Medical College Hospital gets some 200 cancer patients for radiotherapy every day, but it has the capacity to provide radiotherapy to 80 patients, said Swapan Bandopadhyay, associate professor at the hospital’s radiotherapy department. Bangladesh has only 16 cancer treatment centres, nine of which are government facilities and the others private.

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According to WHO, Bangladesh should have at least 160 treatment centres considering its population. The South Asian Journal of Cancer says Bangladesh needs at least 300 radiotherapy machines. But the country has only 27 such machines, of which 12 are outdated and often break down, hindering the treatment process, according to sources. The rest of the machines are equipped with advanced technology, but eight of them are owned by private hospitals and are therefore out of reach of poor patients. “The radiotherapy machines are old and need to be replaced, and the government needs to establish cancer treatment centres in all government medical colleges with skilled manpower, infrastructure, equipment and adequate support,” Mafiz said.Screening process for cervical, breast cancersThe United Nations Population Fund (UNFPA) is assisting the Ministry of Health and Family Welfare to run cervical and breast cancer screening programmes around the country, UNFPA Communication Officer Asma Akter told the Dhaka Tribune. The programme is being coordinated by the department of obstetrics and gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU). According to the annual bulletin of the Directorate General of Health Services, at least 363 screening centres have been set up around the country since 2004. The screening centres have conducted a total of 886,490 visual inspection with acetic acid (VIA) tests to diagnose cervical cancer, 5% of which came positive. The centres also ran a total of 808,042 clinical breast exams to diagnose breast cancer from 2007 to 2014, 1.5% of which came positive.