Cervical Cancer in Afganistan

Introduction

A landlocked and mountainous country located within South Asia and Central Asia, Afghanistan is bordering China, Pakistan, Iran, Turkmenistan, Uzbekistan, and Tajikistan. Apart from the physical connection with these countries, there lies a deep ethnic connection between Afghanistan and the before-mentioned countries. A country with an estimated population about 32.5 million, Afghanistan is ranked 41st most populous nation around the globe.1 The average age of Afghans is 18.4 years, which shows high growth rate of the population (2.32%). Similarly, studies show a high birth rate of 38.57/100,000 population, and death rate of 13.89 /100,000 population. Altogether these factors contribute to a low life expectancy rate of 51 years.2 Healthcare spent in Afghanistan is nearly 8.5% of the gross domestic product.

Suffering from civil war, Afghanistan loses a huge number of its population due to cancer that is much higher than the rates of the loss of lives in the war annually. Cancer is huge burden on the shoulders of the government that needs a perpetual and passionate fight to reduce the cancer incidents in Afghanistan. The main cause of the unavailability of integrated cancer prevention in Afghanistan is the lack of public awareness among the commoners. The masses have no or very little knowledge about the preventive measures of cancer that contributes to the high rates of cancer incidents in Afghanistan. The deficiency of cancer policy and the lack of robust cancer registries at national level is another stumbling block. At the public primary healthcare level, the screening for early detection of breast, cervical, and colorectal and other cancers is not normally accessible. Moreover, there is no standard radiotherapy or chemotherapy and other treatments existing in Afghanistan for which the patients are obliged to travel for these services to the neighboring countries. Although in the past, there existed some cancer facilities (a cancer treatment center was established in the late 60s—within Ali Abad Hospital Kabul), the unfortunate four decades have led to unintended demolition of most cancer treatment facilities.3

In Afghanistan, approximately 20,000 people are diagnosed with cancer annually and 15,000 among these patients die in the same year.45 According the report published by the World Health Organization in 2014, the top cancer sites that were diagnosed in our women were breast, stomach, and cervix uteri.16 Our age-standardized death rate due to cervical cancer is 7% (https://reliefweb.int/report/world/ensure-universal-access-sexual-and-reproductive-health-and-reproductive-rights).7 A retrospective cross-sectional study between October 2015 and December 2017 included 1,025 patients—403 (39.3%) male and 622 (60.7%) female.8 The age range was 20 to 70 years. Common cancers in females included those of breast (45.8%), esophagus (12.5%), colorectum (4.8%), ovary (3.8%), and cervix uteri (1.9%).

A cancer survey that was conducted by Afghanistan Cancer Foundation in our country involved a sample of 2,38,491 (1,21,192 females and 1,17,299 males).9 The common cancers in females are breast cancer, gastric cancer, leukemia, liver cancer, esophageal cancer, cervix cancer, and brain tumors. According to the survey, breast cancer, gastric cancer, and leukemia are the three major cancers. Human papillomavirus (HPV) vaccination has not been introduced in Afghanistan yet. A high number of Afghani women have no access to cervical screening. To implement cervical cancer control in Afghanistan, we need to launch a public awareness program in tandem with a national cervical screening program. Unfortunately, our strict religious and cultural societies make it quite difficult to implement HPV vaccination program.

Conclusions

People of Afghanistan have limited access to knowledge regarding their healthcare needs. This is applicable to cancers, and particularly to women's cancers. Prevention and management of cervical cancer remain an unmet need. There is delay in patients seeking medical help as well as additional delay in commencement of treatment. In 2018, total number of patients with cancers were 19,450 of which 14,746 were not expected to survive.