National Cancer Registries in Bangladesh and Social Determinants of Health: Challenging Cancer Disparities

Dear Editor,

Cancer epidemiology is essential for LMICs as it provides data on cancer incidence, mortality, and risk factors, guiding resource allocation and policy decisions. It is crucial in low- and middle-income countries (LMICs) due to the rapidly increasing burden of cancer and the limited healthcare infrastructure to address it. In 2022, there were nearly 20 million new cancer cases globally with 9.7 million cancer-related deaths. The cancer burden is projected to sharply rise in LMICs, where a 142% increase is expected, leading to over 2 million new cases by 2050—more than double the 0.8 million cases recorded in 2022. Nearly 70% of global cancer deaths occur in LMICs, where access to early detection, treatment, and palliative care remains inadequate. ¹ Many of these countries, including Bangladesh, face a double burden of disease, as they continue to grapple with infectious diseases while also experiencing a surge in non-communicable diseases (NCDs) like cancer. The projected increase in cancer cases in LMICs by 2050 threatens to overwhelm already fragile healthcare systems, exacerbating global health disparities. Limited access to early detection and treatment in LMICs contributes to higher mortality rates, making cancer a regional crisis as well as a global public health challenge. Addressing cancer disparities in these regions is therefore crucial for reducing the overall global cancer burden and ensuring equitable healthcare access worldwide.

In 2022, Bangladesh faced a significant cancer burden, with a total population of 167 885, 680 and 167 256 reported cancer cases, resulting in 116 598 cancer deaths. The most common cancers in 2022 included upper gastrointestinal tract followed by lung and breast cancer, reflecting its serious impact on public health. Oral cancer showed notable incidence and mortality, while cervical cancer was particularly prevalent among women. Esophageal cancer had the highest incidence and mortality rate, especially among men, along with lung cancer, which also contributed significantly to mortality. ¹ Additionally, there were 258 368 total premature deaths from non-communicable diseases (NCDs), with a notable percentage attributed to cancer (∼26%), highlighting the substantial impact of the disease on overall health in the country. ²

Cancer registries are essential tools for understanding the burden of cancer and informing public health policies. In Bangladesh, the lack of a centralized, population-based cancer registry or national cancer registry has hindered the country’s ability to comprehensively address cancer disparities. The available data from the National Institute of Cancer Research and Hospital (NICRH) registry, which began in 2015, highlights several concerning trends. ² The NICRH report published in 2022 reveals that late-stage diagnoses dominate, with 77% of patients untreated before reaching the NICRH. Additionally, the report underscores significant regional disparities in access to cancer care. A histopathology-based cancer registry in the premier medical university has been established through an informal network among pathologists working at different government and private sectors which also collects tissue and paraffin blocks from patients. ³ These findings underscore the urgent need for a robust, population-based cancer registry (PBCR) in Bangladesh to identify national trends and address inequalities. ⁴

Linking cancer registry data with social determinants of health (SDOH) data can provide a more comprehensive understanding of the factors contributing to cancer disparities in Bangladesh. SDOH, such as poverty, education, and access to healthcare, play a crucial role in shaping cancer incidence, treatment, and survival outcomes. ⁵ By integrating SDOH data with cancer registry information, policymakers and public health professionals can develop targeted interventions to address the root causes of these disparities. Despite the challenges, several countries have successfully linked cancer registries with SDOH data. The Surveillance, Epidemiology, and End Results (SEER) program in the United States collaborates with several organizations such as Center for disease control (CDC) to accumulate cancer incidence and survival data. These efforts have yielded valuable insights and informed the development of evidence-based strategies to reduce cancer disparities. ⁶

In the absence of a coordinated effort or comprehensive database, anecdotal evidence suggests that the current cancer landscape in Bangladesh is characterized by deep inequality in cancer management. ⁷ The Bangladeshi government and relevant stakeholders should prioritize the establishment of a comprehensive population-based cancer registry, which can subsequently be linked to SDOH data. This approach will not only enhance our understanding of the cancer burden but also guide the formulation of effective policies and interventions to address the social, economic, and environmental factors that contribute to cancer disparities in Bangladesh.