report on ' awareness aabout cancer in pakistan' · pdf filepurpose a questionnaire...

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Awareness About Cancer in Pakistan,4th Feb 2013,NAYS Survey | http://www.nays.com.pk/nays-survey/

SUMMARY

Cancer is a pathological condition in which a malignant tumor forms in the body which later

may lead to metastasis. Even after cancer treatment and recovery of patient, there are chances

of disease relapse. It is considered as second major cause of death after cardiovascular

diseases. Although it is rapidly increasing in developed countries but mortality rate due to

cancer is higher in developing countries. One of the major reasons behind that is lack of

awareness and late diagnosis. National Academy of Young Scientists (NAYS) Pakistan Survey

Team conducted a simple survey to know the awareness level of Pakistani population. For this

purpose a questionnaire was designed by NAYS Survey Team and data was collected by both,

online as well as manual survey form. Due to limited resources 1461 survey forms were

collected and 1209 were selected out of them for data Analysis. Results showed that people are

not fully aware about risk factors of cancer, most prevalent type of cancer in Pakistan and how

many cancer hospitals are working in Pakistan. There is no trend of regular medical checkup

neither in rural nor urban areas. In addition to this, many efforts are needed to make people

aware of cancer especially in rural areas as people there are less aware as compared to urban

population. Health ministry, cancer hospitals and research centers, and media should play its

role in order to spread the awareness.

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About Authors:

• Shehar Bano

Project Coordinator of NAYS Survey

MS Scholar at Atta-ur- Rahman School of Applied Biosciences (ASAB)/NUST

Islamabad, Pakistan

[email protected]

• Syeda Mehpara Farhat

In charge Report Writing Team of NAYS Survey

PhD Scholar at Atta-ur- Rahman School of Applied Biosciences (ASAB)/NUST

Islamabad, Pakistan

• Sania Arif

NAYS Survey Data Analysis Team Member

BS Student at Atta-ur- Rahman School of Applied Biosciences (ASAB)/NUST

Islamabad, Pakistan

• Muhammad Mushtaq

NAYS Survey Data Analysis Team Member

M.phil Statistics

Junior RO at Allama Iqbal Open University, Islamabad

Visiting Lecturer at University for Arid Agriculture, Rawalpindi

• Munnum Zafar

NAYS Survey Data Investigation Team Member

M.Sc Student at University of Karachi

• Faiza Khurshid


M. Phil Scholar at University of Agriculture, Faisalabad

• Muhammad Moosa Abro


BS from University of Sindh, Jamshoro

• Aftab Ahmad

President NAYS

PhD Scholar at School of Biological Sciences (SBS)/PU

Lahore, Pakistan

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CONTENTS

Acknowledgements iv

Introduction 1

Methodology 3

Results 5

Discussion 14

Conclusion & Future Prospects 15

References 16

Appendix 19

iv


ACKNOWLEDGEMENTS:

I bow in deep reverence to Almighty Allah, the most merciful and compassionate, the

Omnipotent, most Benevolent and Bounteous. He is who enabled me and bestowed upon me

His countless Blessings to complete this survey.

A survey can never be successful by the efforts of a single person. So I am thankful to all those

persons who play their role in spreading this questionnaire, and all those who fill it. Specially

the members of NAYS Survey Data Investigation Team (Raseen Tariq, Sumaira Mubarak, Hafiz

Muhammad Saqib Mushtaq, Khalid Iqbal and Muhammad Salman Haider Qurshi) who played

their remarkable role in collecting data. I am also thankful to Ammara Khalid who helped in

designing questionnaire and in collecting data, and Sara Arif who design cover page for this

report. I am specially thankful to the patron of NAYS, Dr. Anwar Naseem who encouraged us to

conduct this survey.

Shehar Bano

Project Coordinator of NAYS Survey


1

INTRODUCTION:

Cancer is the term to describe a

pathological condition when cells of the

body start uncontrolled growth. Cancer is a

very ancient disease and records for the

ailment are found throughout the history

and it is also evidently found in fossil bones

and Egyptian mummies. The oldest cancer

description dates back to 3000 BC in Egypt

although in this record word cancer was not

used. The origin of word cancer is credited

to Hippocrates (370-460 BC). He used the

word Carcinos and carcinoma, the Greek

word for crab, to describe the finger like

projections from cancer. After Hippocrats a

Roman physician Celsus (28-50 BC)

translated this Greek word in cancer, the

Latin word for cancer (cancer.org, Feinberg

et al., 2006).

There are many risk factors for

cancer including tobacco smoking, alcohol

consumption, particular infections like

Helicobacter pylori, Hepatitis B and C etc.

(Park et al., 2008). In addition sun/UV

exposure, environmental pollutants

particularly heavy metals and genetic

mutations can also be the risk factors for

cancer. Now a days it is also considered that

life style and diet can also be a threat for

cancer. Different types of cancers are

caused by genetic mutations in a cell and

currently about three hundred genes are

known as oncogenes, the genes that can

potentially cause cancer (Futreal et al.,

2004), and the cell may accumulate

different properties that can help in

uncontrolled growth of the cell (Cahill et al.,

1999). These alterations may include

evasion from normal growth control and

apoptotic pathway (Jorrit et al., 2006). In

addition to these mechanisms the tumor

cells require continuous supply of blood for

sustained growth and to escape from cell

death. For this purpose the tumor cells

cause the activation of endothelial cells to

form new blood vessels in the tumor cells, a

phenomenon known as angiogenesis (Jorrit

et al., 2006).

Many different kinds of cancer are

described. The most common types include

Carcinoma (cancer of lung, colon breast and

ovarian cancer), Sarcoma (Cancer of bones

and cartilage), Lymphoma (Cancer of lymph

nodes) and Leukemia (blood cancer). In

addition to these there are many other

kinds of cancer depending on the body part

affected by the cancer.

Cancer has become the leading

cause of disease worldwide and is ranked as

second cause of death, after cardiovascular

disease worldwide. According to WHO Lung

cancer is the most prevalent type of cancer

in males, causing death of 4.2 million men

and 23 % of cancer mortality worldwide,

while the breast cancer is the most

common cancer type in females, causing

death of 3.3 million women and 14 % of

cancer related deaths worldwide. While if

we talk about the most prevalent cancer by

country then prostate cancer is most

prevalent in males, affecting 111 countries,

and breast cancer in females, affecting 145

countries, worldwide (WHO 2012). Around

four-fifth of the world population reside in


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less developed countries of world (UN.

2009) and therefore 56 % of new cases of

cancer and 64 % of all deaths due to cancer

appear in less developed countries (WHO.

2011). Therefore cancer is considered to be

a serious health threat in Asian countries

(Mackay et al., 2006). Cancer has become

leading cause of death in Asian Pacific

countries (Park et al., 2008) with 3 million

new cancer cases and 2 million deaths in

Asia (Hanif et al., 2009).

Pakistan is seventh most populous

country in the world and political instability,

inflation and other insecurities cause rise in

the rate of different diseases, so is the case

with cancer. Contrary to the previous

decade when cervical cancer was the major

cause of death now breast cancer accounts

for highest morbidity and mortality rate in

female (Jemal et al., 2011). Overall cancer

incidence is about half that reported in

developed countries but the cancer related

mortality rate is almost similar. This can be

attributed to the late stage diagnosis and

limited access to quality treatment. The

precise number of mortality and number of

cancer cases in Pakistan are unknown (Hanif

et al., 2009). Keeping in view the lack of any

cancer registry database Karachi Cancer

Registry (KCR) was developed to determine

the prevalence of different cancer types in

Pakistan during the period of 2000-2008

(Bhurgri et al., 2006 a). According to this

database, female cancer accounted for

51.8% and male cancer for 48.1 %. In this

database, in males head and neck cancer

was found to be the most prevalent cancer

type accounting for 32.6 % of total cancer

cases and lung cancer was found to be the

second most prevalent cancer type

accounting for 15 % of cancer cases,

followed by Cancer of gastrointestinal tract

(6.9 %), lymphoma (6.1 %), and least

prevalent was bone and soft tissue cancer

(4.9 %). The data for cancer prevalence in

females was in accordance with the trend

found worldwide i.e. breast cancer was

reported to be the most prevalent cancer

type accounting for 38.2 % cases. This was

followed by head & neck (15.1%), cervical

(5.5%), ovarian (4.9%) and GIT cancer

(4.9%) respectively (Hanif et al., 2009).

The database was good as

preliminary information and provided basic

knowledge about cancer prevalence in

Pakistan but consists of a sample

population from Sindh only. In addition to

KCR, National Cancer Control Program was

also developed since 1994. In addition a

trial database REGATE is also in progress at

oncology department of Mayo hospital to

determine the treatment outcomes of

gastric cancer (Akhtar, 2007). In addition to

these data bases 175 papers are available at

pakmedinet related to cancer and out of

these only seven related to cancer

registration in Pakistan. In addition the data

for the cancer prevalence in different cities

is also present including data from Quetta

(Bhurgri et al., 2002 b), Karachi (Bhurgri et

al., 2000; 2002a), Hyderabad (Bhurgri et al.,

2005 a), Punjab (Aziz et al., 2003), and

Rawalpindi (Jamal et al., 2006b). Moreover

some papers are published to report the

prevalence of certain types of cancer for

example head and neck (Bhurgri et al.,


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2006b), esophagus (Bhurgri et al., 2004b),

oral cavity and pharynx (Bhurgri et al., 1998;

2003a; Bhurgri, 2005 b), gastrointestinal

tumours (Mehdi, 1998), breast (Bhurgri et

al., 2007), lung (Badar et al., 2006 c; Bhurgri

et al., 2006b), non-Hodgkin’s lymphoma

(Bhurgri et al., 2005 c), Hodgkin's

lymphoma (Siddiqui et al., 2006), ocular

malignancies (Bhurgri et al., 2003b),

retinoblastomas (Bhurgri et al., 2004a),

rhabdomyosarcomas (Bhurgri et al., 2004c)

and childhood malignancies (Jamal et al.,

2006a). However in spite of the presence of

this data the accurate number of cancer

related mortalities cannot be estimated at

national level.

In Pakistan the number of reported

cancer cases is also on rise and it is

estimated that only in Lahore district about

3000 cancer patients are presented to

cancer hospitals (Akhtar, 2007). In spite of

availability of all the treatments for cancer,

i.e. Surgery, radiation therapy and

chemotherapy, at different hospitals (Table:

1 in Appendix) People don’t seek for

medical consultation this is mainly due to

the presence of many myths and fear of the

disease. It is also a common misconception

that biopsy, which is necessary for the

diagnosis of the cancer, will cause a spread

of the suspected tumor (Ansari et al., 2011).

As a result when the health physician is

contacted disease is at very advanced stage

and becomes incurable.

Therefore there is a need to assess cancer

prevalence in whole Pakistan and to

determine the level of awareness among

common public. The survey was conducted

to determine the awareness level of people

about cancer in Pakistan and to provide

basic information for the policy makers to

devise health care policies accordingly.

METHODOLOGY:

Cross sectional study design was

used to know the basic awareness level of

Pakistani population about cancer. Data

was collected by National Academy of

Young Scientists (NAYS) Survey team during

year 2012. The setting was a representative

of Pakistani population sample. Sample

comprises of 1209 subjects. For this

purpose a simple online questionnaire was

created by NAYS Survey Team by using

Google documents that was sent to all the

members of NAYS by email. Beside online

data collection, manual data collection was

also done by members of NAYS Survey

team. SPSS 17 and Microsoft Excel 2007

were used for generating frequency tables,

cross tabulations and graphs.

Survey forms of 1209 respondents

out of 1461 respondents were selected for

final analysis. Demographic data summery

shows that females were 52.0% while males

were 48.0%. Maximum respondents

(72.0%) of the sample belong to the age

group 16-25, and province of Punjab

(54.4%). Regarding residential and socio-

economic status majority of them belonged

to urban areas (61.2%) and students

(72.8%) respectively. And regarding

education most of them have completed

their graduation (28.3%) and the study

discipline of majority was science (80.2%).


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Summery of Demographic data is shown in Table: 1.

Table 1: Demographic Data Summary

Frequency Percent Valid

Percent

Cumulative

Percent

Gender

Valid Male 580 48.0 48.0 48.0

Female 629 52.0 52.0 100.0

Total 1209 100.0 100.0

Age

Valid 16 – 25 872 72.1 72.1 72.1

26 – 35 226 18.7 18.7 90.8

36 – 45 67 5.5 5.5 96.4

46 – 55 38 3.1 3.1 99.5

>55 6 .5 .5 100.0

Total 1209 100.0 100.0

Province

Valid Punjab 658 54.4 54.4 54.4

Sind 405 33.5 33.5 87.9

Khyber

Pakhtonkhwa 88 7.3 7.3 95.2

Baluchistan 38 3.1 3.1 98.3

Gilgit baltistan 12 1.0 1.0 99.3

Azad Jammu and

Kashmir 8 .7 .7 100.0

Total 1209 100.0 100.0

Residential Status

Valid Urban 740 61.2 61.2 61.2

Rural 469 38.8 38.8 100.0

Total 1209 100.0 100.0

Socio – Economic Status

Valid Student 880 72.8 72.8 72.8

Employee 287 23.7 23.7 96.5

Un-employed 42 3.5 3.5 100.0

Total 1209 100.0 100.0

Discipline


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Valid Science 970 80.2 80.2 80.2

Arts 239 19.8 19.8 100.0

Total 1209 100.0 100.0

Education Level

Valid Under Matric 46 3.8 3.8 3.8

Matric 99 8.2 8.2 12.0

F.A/ F.Sc. 191 15.8 15.8 27.8

B.A/ B.Sc. 342 28.3 28.3 56.1

B.A.( hons)/ B.Sc.

(hons)/ M.Sc. 282 23.3 23.3 79.4

MS/ M.Phil 194 16.0 16.0 95.5

PhD 29 2.4 2.4 97.8

Others 26 2.2 2.2 100.0

Total 1209 100.0 100.0

RESULTS:

Very basic questions were asked to

keep the questionnaire short and simple so

that maximum people can respond but due

to very limited resources sample size is not

very large. Cross tabulation was done on

various bases like provinces, education

level, age, gender, socio-economic status

and discipline but here only most

appropriate cross tabulations have shown.

Results show that 49.0% people never go

for regular medical checkups (Fig: 1). Even

majority of the population did not go for

regular medical check ups until they get ill,

so it was found that some people confused

the regular medical checkup with the one

when they got ill. Regular medical checkup

is a necessary measure for the timely

cancer diagnosis. When cross tabulation

was done on the basis of residential status,

it was found that majority of the both urban

and rural population never go for regular

medical checkups (Fig. 1a). And same

results were found when cross tabulation

was done on the basis of gender (Fig. 1b).


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Fig. 1. How frequently people go for Regular Medical checkup

Fig. 1a. Residential Status * How frequently people go for Regular Medical Checkup

* = Cross Tabulation


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Fig. 1b. Gender * How frequently people go for Regular Medical Checkup

Results show that according to the

sample’s opinion cancer is more prevalent

in Pakistani women than in Pakistani men

(Fig. 2). When cross tabulation was done on

the basis of residential status it was found

that although majority of both populations

is aware that cancer is more prevalent in

females but urban population is more

aware as a difference of 17% was found

(Fig. 2a). When cross tabulation was done

on gender base than it was found that in

males there is a mix perception about the

prevalence of cancer in Pakistani population

regarding gender but most of the females

know that it is most prevalent among them

(Fig. 2b) as 68.0% females said that cancer

is more prevalent among females. While

Less than 25% subjects said that they do not

know about prevalence of cancer in

Pakistan regarding gender.

Fig. 2. Sample’s opinion about prevalence of cancer in Pakistan regarding gender


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Fig. 2a. Residential Status * Sample’s opinion about prevalence of cancer in Pakistan

regarding gender

Fig. 2b. Gender * Sample’s opinion about prevalence of cancer in Pakistan regarding gender

Results showed that according to

sample’s opinion most prevalent type of

cancer in Pakistani population is Breast

cancer (41.0%), and second to it is Blood

cancer (20 %) and then Lungs cancer (16%)

(Fig. 3). Other type of cancers included

ovary and prostrate, skin, esophagus,

throat, colorectal, head and neck cancer.

When cross tabulation was done on the

basis of residential status, it was found that

both urban and rural population consider

that Breast cancer is most prevalent type of


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cancer but regarding second most common

type of cancer rural population thought that

it is blood cancer (29.0%), while urban

population thought that it is Lung cancer

(22.0%) (Fig: 3a). When it was cross

tabulated on the basis of gender than it was

found that majority of the females are sure

about breast cancer that it is most

prevalent but in males a mix response was

found about the most common type of

cancer in Pakistan. As same size of sample

(28.0%) opted breast cancer and blood

cancer as most prevalent cancer in Pakistan.

And lungs cancer was considered as second

most common cancer in Pakistan by both

males (19.0%) and females (17.0%) (Fig. 3b).

Fig. 3. Sample’s opinion about most prevalent type of cancer in Pakistani population

Fig. 3a. Residential Status * Sample’s opinion about most prevalent type of cancer in

Pakistani population


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Fig. 3b. Gender * Sample’s opinion about most prevalent type of cancer in Pakistani

population

Sample was given seven different

options including Viruses, Chemicals,

Genetic defects (hereditary), Tobacco,

Alcohol, Food, and Sun exposure, to choose

as risk factors and results show that

majority of them (41.0%) choose all the

options (Fig. 4). When cross tabulation was

done on the basis of residential status than

it was found that majority of the urban

population (49.0%) choose all of the options

while majority of the rural population

(45.0%) choose any one of the options (Fig.

4a).

Fig. 4. Sample’s opinion about different Risk factors involved in cancer


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Fig. 4a. Residential Status * Sample’s opinion about different Risk factors involved in cancer

Results show that when sample was

asked about different available treatments

of cancer in Pakistan, majority of them

(48.0%) selected all the given treatments

(Fig. 5). When it was cross tabulated on the

basis of residential status, it was found that

majority of the urban population (60.0%)

choose all the treatments while majority of

rural population (30.0%) did not know

about this (Fig. 5a). When it was cross

tabulated on the basis of gender than it was

found that majority of both males (43.0%)

and females (53.0%) choose all the

treatments (Fig: 5b).

Fig. 5. Sample’s opinion about available cancer treatments in Pakistan


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Fig. 5a. Residential Status * Sample’s opinion about prevalence of cancer among different

genders in Pakistan

Fig. 5b. Gender * Sample’s opinion about prevalence of cancer among different genders in

Pakistan

Sample was also asked that, about

how many cancer hospitals they know in

Pakistan. Results show mix response but

majority of them (28.0%) don’t know about

cancer hospitals in Pakistan (Fig. 6). When it

was cross tabulated on the basis of


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residential status not a major difference

was found in rural or urban population,

majority of them either do not know about

cancer hospitals in Pakistan or know about

one or two cancer Hospitals (Fig. 6a).

Fig. 6. Pakistani sample population knows about how many Cancer Hospitals in Pakistan

Fig. 6a. Residential Status * Pakistani sample population knows about how many Cancer

Hospitals in Pakistan


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DISCUSSION:

The results of survey revealed that

mostly there is very low awareness level

about cancer among Pakistani people. Same

were the results obtained by Ali and Baig

(2006) in a study based on 281 individuals

about cancer awareness in Agha Khan

University, Karachi. Moreover in our study

results of cross tabulation on the basis of

residential status are mostly shown and it

was found that people of urban areas were

generally more aware about the cancer as

compared to the rural population. This

difference might be due to the difference of

literacy rate and access to better awareness

resources. As urban population have better

education facilities and are mostly more

educated than the people living in rural

areas. In a study about breast cancer

awareness from Karachi also showed that

individuals with higher education level were

more aware about the cancer and its risk

factors (Sobani et al., 2012). But these

results are in contradiction to those

obtained in a study about cancer awareness

in West Bengal which found no significant

difference in knowledge index in rural and

urban population (Ray and mandal, 2004).

In Pakistan it is a general

misconception that one should visit a

physician only in case of some ailment.

Therefore people consider regular health

checkup as unnecessary requirement. Many

cancers can be revealed on routine

checkups because in general population

there is lack of understanding about the

seriousness of cancer symptoms at initial

stages and this usually results cancer

diagnosis at late stages when the disease

becomes incurable (Bhurgari et al., 2008).

The results of our study showed that

the people were more aware about the

more cancer prevalence in female and were

also able to identify breast cancer as the

most prevalent cancer type in Pakistan.

Cross tabulation on the basis of gender

revealed that both genders consider that

cancer is more prevalent in them (Fig. 2b). It

was also revealed that females are much

familiar with the fact that breast cancer is

most common in them. As the prevalence

data also show that in Pakistan every ninth

woman is suffering from breast cancer and

moreover in Asia, Pakistan is on top

regarding breast cancer prevalence. Data

also showed that neither females nor males

are aware of the fact that head and neck

cancer is first most prevalent type of cancer

in males and second most prevalent type of

cancer in females of Pakistan (Fig. 3a) as

revealed by Hanif et al. in 2009. Rural and

Urban population were also unaware of this

fact (Fig. 3a). Regarding risk factors of

cancer most of the urban population was

able to identify all Viruses, Chemicals,

Genetic defects (hereditary), Tobacco,

Alcohol, Food, and Sun exposure as risk

factors of cancer while rural population

chose only one of the options which

revealed that rural population has less

awareness about cancer risk factors. Similar

results were obtained in a study on British

population which showed that females and

people with higher education level were


15

more aware about the risk factors (Wardle

et al., 2001).

Interestingly in our study mostly

people were well aware about the basic

cancer treatments available in Pakistan but

were not sure from where this treatment is

available. About the available cancer

treatments in Pakistan urban population

was 30 % more aware than the rural

population. In spite of the presence of 23

cancer hospitals in 12 different cities (Table

1) in Pakistan, in our survey collectively

about 67 % of the people either did not

know about any cancer hospital or knew

only one or two. Only 14% knew about the

presence of more than 5 cancer hospitals in

Pakistan. Collectively data revealed that

overall awareness level is not much high but

comparatively urban population and

females are more aware than rural

population and males.

CONCLUSION & FUTURE PROSPECTS:

The results of our survey show that

the level of awareness among general

public about cancer is insufficient and

people should be given awareness about

cancer prevention, risk factors, importance

of routine medical checkup for early

detection of any disease including cancer

and availability of cancer treatments.

Cancer awareness programs are needed

especially for rural population and

electronic and print media (radio, TV,

newspapers), cancer hospitals, and cancer

research centers can play a major role in

this regard. Proper data base is required at

National level and health ministry should

play its role in this regard. Screening tests

for most prevalent cancers like breast

cancer, head and neck cancer and lungs

cancer, should be available in the nearer

possible vicinity of the urban and rural

population and it should be compulsory for

the people to undergo that tests on regular

bases. In this way early diagnosis will be

possible and the life quality of the cancer

patients can be improved, their life span

can be longer and mortality rate can be

reduced. In addition environmental factors

responsible for cancer should be reduced

and such chemicals should be strictly

banned e.g. tobacco, alcohol and “naswar”

etc. Factories waste having carcinogens or

mutagens like heavy metals and asbestos

etc. should be properly wasted to make

sure that it is harmless for public. These are

some measures which can be taken to

reduce cancer. In addition such studies

should be conducted on larger scale and at

regular intervals.


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APPENDIX: Table 1: Major Cancer Care Hospitals in Pakistan

Karachi

• Cytogen Centre,

• Agha Khan University Hospital,

• Neurospinal & Medical Institute / NMI

• Baqai Institute Of Oncology

• Children Cancer Foundation

• Edhi Free Cancer Hospital

• KIRAN (Karachi Institute Of Radiotherapy & Nuclear Medicine)

• National Cancer Institute

• Rahat Kada

• AEMC Cancer Hospital

Lahore

• Inmol Hospital

• Shaukat Khnaum Memorial Hospital

• CENUM (Centre for Nuclear Medicine)

Peshawar

• IRNUM (Institute of Radiotherapy and nuclear medicine)

Abbotabad

• INOR (Institute of Nuclear Medicine Oncology and Radiotherapy)

Islamabad

• NORI (Nuclear Medicine, Oncology and Radiotherapy Institute)

Multan

• MINAR (Multan Institute of Cancer Medicine and Radiotherapy) Cancer Hospital

Jamshoro

• Nimra Cancer Hospital

Gujranwala

• GINUM (Gujranwala institute of nuclear medicine and radiotherapy)

Quetta

• CENAR (Center for Nuclear. Medicine and Radiotherapy)

Faisalabad

• PINUM (Punjab Institue of nuclear medicine) Cancer Hospital

Bahawalpur

• BINO (Bahawalpur Institute of nuclear medicine and Oncology)

Larkana

• LINAR (Larkana Institute of Nuclear Medicine and Radiotherapy)

report on ' awareness aabout cancer in pakistan' · pdf filepurpose a questionnaire...

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