Are we preparing for alarming cancer surge?

Recent World Health Organisation (WHO) data indicates an 8% rise in cancer-related deaths and an 11% increase in cases in Bangladesh in 2022 compared to 2018. By 2050, WHO projects a more than doubling of cancer cases in the country from the 2022 figures.

As cancer cases surge, concerns mount about the nation's ability to address diagnosis, treatment, and support.

Health experts said the existing cancer facilities in the country remain insufficient. Prevention, early detection of cancer and the establishment of advanced facilities are key to addressing this growing health crisis.

Prof Dr Golam Mohiuddin Faruque, the president of the Bangladesh Cancer Society (BCS) and a proponent of the Union for International Cancer Control, told The Business Standard, "The surge in cases can be attributed to various factors such as lifestyle choices, obesity, smoking, insufficient physical activity, and a growing reliance on fast food." 

"A more accurate diagnosis facilitated by modern medical facilities is another reason for the case rise. With our average life expectancy on the rise, the incidence of cancer is likely to increase in the future," he added.

Amid rising cancer cases, Bangladesh is observing World Cancer Day today with the theme "Close the care gap."

According to the Bangladesh Cancer Society, there are approximately 13 to 15 lakh cancer patients in the country.

Some 1.56 lakh new cancer patients are diagnosed in Bangladesh each year while 1.08 lakh people die from cancer, according to the Global Cancer Observatory's 2020 data.

Cancer specialists noted a slight improvement in treatment facilities due to the increasing number of patients. Various advanced equipment, including PET-CT scans and Linac machines, is now available in different cancer centres. The country has also diversified treatments, introduced bone marrow transplants, and commenced local manufacturing of cancer drugs, leading to cost reductions.

A decade or two ago, the absence of PET-CT scan machines was evident, but now the country has multiple sophisticated machines. Despite these strides, the current infrastructure remains inadequate for the population of 18 crores, said Dr Golam Mohiuddin Faruque.

The National Institute of Cancer Research and Hospital (NICRH) is the country's only comprehensive cancer facility with lower diagnosis and treatment costs than private hospitals. However, persistent equipment issues hinder essential treatment for many impoverished patients.

Presently, at the NICRH, four out of six radiotherapy machines are completely non-functional, and even the remaining two face intermittent issues. Additionally, the MRI and CT scan machines are out of order, and the hospital lacks a functioning X-ray machine. The persistent equipment issues hinder the conduct of crucial tests for cancer diagnosis, including biopsies.

When asked, NICRH Director Prof Dr Nizamul Haque said, "Efforts are underway to fix the malfunctioning equipment. Two radiotherapy machines have been acquired, and an additional two are set to be procured from the Directorate General of Health Services.

Oncologists said if cancer is identified in its early stages, patients can typically recover within 6-8 months of treatment, followed by a five-year follow-up. However, for economically disadvantaged patients in Bangladesh, obtaining a date for radiotherapy or chemotherapy in government hospitals after diagnosis often takes 5-6 months.

The PET-CT scan test is essential for determining the presence and extent of cancer in the body. Such scans are only conducted in seven hospitals across the country, and their cost is prohibitively high in private hospitals. At Bangabandhu Sheikh Mujib Medical University, the test is priced at Tk25,000, but patients often endure a waiting period of 2 to 6 months for this test.

Treatment cost

A study published in 2023 by the Bangladesh Institute of Development Studies (BIDS) indicates that, on average, Tk5.47 lakh is spent on the treatment of a cancer patient in Bangladesh. This cost ranges from a minimum of Tk81,000 to a maximum of Tk25 lakh per person, with medications being the most expensive component.

According to CancerRounds, India's first comprehensive cancer care website, the average cost of cancer treatment in India varies between 2,50,000 Indian rupees and 20,00,000 rupees.

Golam Mohiuddin Faruque said the cost of cancer treatment in Bangladesh's government hospitals is comparatively lower due to subsidies. Private hospitals, in contrast, are 20 times more expensive. However, government hospitals need improved infrastructure and equipment to better serve the cancer treatment needs of economically disadvantaged patients.

"The government has initiated the establishment of cancer centres in eight divisional cities nationwide. These centres are expected to be operational within the next two years. In addition, focus should not only be on constructing cancer hospitals; equal emphasis should be placed on cancer prevention efforts," he added.

Why private investment is low in cancer hospitals 

According to WHO, there should be one integrated cancer treatment centre for every one million people. As per this criterion, Bangladesh would ideally need 170 such centres; however, the country currently has only 33. Furthermore, not all of these centres offer comprehensive cancer treatment services. 

When asked why private investment is relatively low in local cancer hospitals, Dr M A Shamim, chairman of the Labaid Cancer Hospital, told TBS that establishing cancer hospitals incurs costs two to three times higher than those of general hospitals. 

"The expenses include a substantial investment in specific equipment, such as a PET-CT scan machine priced between Tk15-20 crore and a Linac machine for radiotherapy costing Tk30-40 crore each. Additionally, considerable expenditures are attributed to employing well-compensated personnel for various treatments, including tumour boards. The limited investment is a consequence of the elevated costs associated with cancer care," he said.

Claiming that the cost of cancer treatment in Bangladesh is not higher than in India, he said, "Our patients opt for cancer treatment in India mainly due to a lack of trust. Previously, there was a lack of confidence in cardiac treatment, leading people to seek treatment in India. However, the scenario has changed, and individuals now undergo cardiac treatment within the country, reflecting a restored trust. The expectation is that confidence in domestic cancer treatment will also rise in the coming years."