Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
Government of Nepal
Nepal Health Research Council Ramshah Path, Kathmandu
Population Based Cancer Registriesat Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018
Nepal Health Research Council (NHRC)Ramshah Path, Kathmandu, NepalTel : +977 1 4254220Fax : +977 1 4262469E-mail : [email protected] Website : www.nhrc.gov.np
Report of Population Based Cancer Registries atKathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha,
Mohattari, West Rukum and East Rukum Districts, Nepal, 2018
Published by Government of Nepal
Nepal Health Research Council
Report of Population Based Cancer Registries atKathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum
Districts, Nepal, 2018
List of authors/contributors: Anjani Kumar Jha, Sandhya Chapagain, Meghnath Dhimal, Ranjeeta Subedi, Uma Kafle, Chanda Thakur, Kopila Khadka, Atul Budukh, Rajesh Dikshit
Suggested citation: Jha AK, Chapagain S, Dhimal M, Subedi R, Kafle U, Thakur C, Khadka K, Budukh A, Dikshit R. Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018. Nepal Health Research Council, Government of Nepal. 2020.
The burden of Non Communicable Disease is increasing globally. Currently, Nepal is also facing increasing double burden Non
communicable disease like other developing countries. The major NCDs like cardiovascular disease, cancer, diabetes and chron-
ic respiratory diseases are increasing in recent years. Cancer has become one of the major public health issues in Nepal which
demands huge investment for prevention and treatment. It is reported as fifth leading cause of death in Nepal. In this context
population based evidence of cancer is the primary need of government of Nepal in order to develop country specific strategies
and programs to prevent, control and treat the diseases.
Population Based Cancer Registry has been established by Nepal Health Research Council since January 1, 2018 in close col-
laboration with Ministry of Health and Population (MoHP), WHO country office Nepal and International Agency for Research
on Cancer (IARC) Regional Hub, Mumbai. The main aim of the registry is generating evidence on cancer incidence, mortality,
pattern and trends in Nepal. The findings of the study will help in the development of cancer control strategy as per the need
of the country. It also helps in providing the information regarding the geographical variation in the pattern of cancer which
eventually helps the national, provincial and local governments to plan and develop targeted interventions to control cancer. It
will serve as a basis in developing evidence based cancer control and prevention programs for the policy makers and planners.
I would like to take this opportunity to thank all who have supported and contributed in establishing the registry and generating
the evidence. I express my sincere gratitude to the support of MoHP, technical assistance of IARC, Regional Hub and WHO Coun-
try Office for Nepal. I am very thankful to BP Koirala Memorial Cancer Hospital, Chitwan for their strong support and collabora-
tion to continue the Population based cancer registry in Nepal. I extend my thankfulness to all the hospitals, hospice, ayurvedic
centers, pathology laboratories, social security and nursing division, civil registration, local bodies like municipalities, DHOs/
DPHOs, Health posts, ward offices and community leaders in helping us in providing the data. Finally, I appreciate NHRC team
members for their continuous effort in making registry successful and providing such a valuable evidence to the country.
Prof. Dr. Anjani Kumar Jha
Chairman
Nepal Health Research Council
Preface
Contribution in Population Based Cancer Registry in Nepal
Steering Committee Members
Name Organization Designation
Chief Health Coordination Division, Ministry of Health and Population Chairperson
Prof Dr. Anjani Kumar Jha Executive Chairperson, Nepal Health Research Council Advisor
Dr. Md. Khurshid Alam Hyder
Public Health Administrator, WHO Country Office for Nepal Member
Prof. Dr. Gehanath Baral Gynae Oncologist, Paropakar Maternity & Women’s Hospital Member
Dr. Rajeev Kumar Deo Medical Oncologist, Birendra Military Hospital Member
Mr. Praladh Kumar Karki Ministry of Federal Affairs and Local Development Member
Under secretaryDirector
Ministry of Health and Population B.P Koirala Memorial Cancer Hospital
Member Member
Director Bir Hospital Member
Director Tribhuvan University Teaching Hospital Member
Director Civil Service Hospital Member
Director Patan Hospital Member
Director Bhaktapur Cancer Hospital Member
Director Kanti Children Hospital Member
Director Nepal Cancer Hospital & Research Center Member
Director Department of Civil Registration Member
Dr. Sandhya Chapagain Radiation Oncologist, Bir Hospital Member cum Secretary
Technical Working Group (TWG) Members
Name of Individual Name of Organization Position in Registry
Prof. Dr. Anjani Kumar Jha Radiation Oncologist and Executive Chairperson, NHRC Registry Coordinator/Director
Mr. Sudhakar Jayaram CEO, Medicity Hospital Advisor
Dr. Sandhya Chapagain Radiation Oncologist, NAMS, Bir Hospital Member
Dr. Meghnath Dhimal Chief Research Section, NHRC Member
Dr. Rajendra Kumar B.C Research Advisor (Consultant), NHRC Member
Dr. Amita Pradhan Consultant (Biostatistician), NHRC Member
Mr. Paban Kumar Ghimire National Professional Officer, WHO, Country Office for Nepal Member
Representative Social Security and Nursing Division, Department of Health Services
Member
Ms. Jyoti Mishra Medical Record Officer, Grande International Hospital Member
Representative HMIS Division, Management Division Member
Representative Civil Registration Section Member
Representative NCD and Mental Health Section, EDCD Member
Dr. Hari Prasad Dhakal Pathologist, Nepal Cancer Hospital & Research Center Member
Dr. Sameer Neupane Pathologist, Civil Service Hospital Member
Dr. Murari Man Shrestha Medical Epidemiologist, Nepal Cancer Hospital & Research Center
Member
Ms. Ranjeeta Subedi Research Officer, NHRC Member
Principal Investigator/Co- Investigators
Name Role Designation
Prof. Dr. Anjani Kumar Jha Principal Investigator Executive Chairperson, NHRC
Dr. Sandhya Chapagain Co- Investigator Radiation Oncologist
Dr. Meghnath Dhimal Co- Investigator Chief, Research Section
Ms. Ranjeeta Subedi Co-Investigator Research Officer
International Collaboration Team, India
Name Name of the Organization
Dr. Rajesh Dikshit IARC, Regional Hub, Tata Memorial Hospital, Mumbai, India
Dr. Atul Budukh IARC, Regional Hub, Tata Memorial Hospital, Mumbai, India
Ms. Sonali Bagal IARC, Regional Hub, Tata Memorial Hospital, Mumbai, India
Ms. Suchita Yadav IARC, Regional Hub, Tata Memorial Hospital, Mumbai, India
Ms. Shraddha Shinde IARC, Regional Hub, Tata Memorial Hospital, Mumbai, India
Population Based Cancer Registry Staff
Name Designation
Ranjeeta Subedi Research Officer/ Focal Person
Uma Kafle Program Officer
Chanda Thakur Program Officer
Kopila Khadka Program Officer
Simran Sapkota Research Assistant
Kabita Chaudhary Data Manager
Monika Yadav Research Assistant
Office Address:Nepal Health Research Council Ramshah Path Kathmandu, Nepal P O Box: 7626Phone no: 977-1-4254220Fax: 977-1-4262469/9771-1-4268284Email: [email protected]/[email protected]
Table of Contents
1. Background ............................................................................................................................... 1
2. Population Covered ..................................................................................................................... 1
3. Area Covered ............................................................................................................................. 2
4. Cancer Incidence and Mortality ....................................................................................................... 3
5. Cancer Incidence by Sex ............................................................................................................... 4
6. Leading Cancer Sites .................................................................................................................... 6
7. Comparison of Cancer Incidence Rate with Other Neighboring Registries ....................................................16
8. Comparison of Leading Sites with Other Neighboring Registries ................................................................18
9. Cancer Mortality ........................................................................................................................24
10. Highlights ................................................................................................................................26
11. Recommendations ......................................................................................................................27
12. References ...............................................................................................................................28
13. Acknowledgements .....................................................................................................................29
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 1
Nepal Health Research Council (NHRC) has started Population Based Cancer Registry (PBCR) since January 2018 in close collaboration with Ministry of Health and Populations and with technical support from WHO Country Office for Nepal and International Agency for Research on Cancer (IARC). Currently, three PBCRs have been established in 9 districts out of 77 districts of the country. They are Kathmandu, Bhaktapur and Lalitpur districts in Bagmati Province (PBCR representing of hill region), Siraha, Saptari, Dhanusha and Mohattari in Province no. 2 (PBCR representing of low land terai region), and East and West Rukum in Province no. 5 and Karnali Province (PBCR representing mountain region). The objective of the registry is to generate evidence on cancer incidence, patterns and trends and mortality related to cancer in the given territory and defined population, and to enhance national capacity for sustainable PBCR in the country. The registry data are useful to plan cancer control activities as well as to strengthen cancer care services by the government of Nepal.
PoPulation Covered
With three registry sites, PBCR Nepal cover all urban/rural municipalities of nine districts of Nepal which include Kathmandu, Bhaktapur, lalitpur, Siraha, Saptari, Dhanusha, Mahottari, East Rukum and West Rukum with an estimated population of covering 20.27% population of Nepal according to the census 2011. The Kathmandu Valley registry is an urban registry, Siraha, Saptari, Dhanusha and Mohattari (SSDM) Registry a semi urban registry and Rukum registry is predominantly rural registry. For the purpose of analysis, the population has been estimated for 2018 on the basis of population of 2001 and 2011. The estimated population distribution of 2018 is shown in table below
Cancer Registry Province Area Population% of population Covered
of Nepal
PBCR Kathmandu valley
Bagmati Urban
3071932
10.48%Kathmandu 2165764
Lalitpur 551083
Bhaktapur 355085
PBCR Siraha, Saptari, Dhanusha and Mahottari (SSDM)
2 Semi Urban
2846036
9.71%Siraha 680249
Saptari 683194
Dhanusha 807858
Mohattari 674734
PBCR Rukum 5 and
KarnaliRural 221376 0.75%
Total 5940105 20.27%
BaCkground
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 20182
area Covered
Kathmandu District Lalitpur District Bhaktapur District
Rukum West District Rukum East District Siraha District
Saptari District Dhanusha District Mohattari District
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 3
CanCer inCidenCe and Mortality
Population Covered, Incidence Cases Registered and Incidence Rate by Sex:2018
Rukum Kathmandu Valley
Kathmandu District
Lalitpur District
Bhaktapur District SSDM Siraha
DistrictSaptari District
Dhanusha District
Mohattari District
Male
Average Population Covered 101530 1587691 1127450 279848 180393 1372101 321188 328124 397066 325723
Number of cases registered 44 999 630 222 147 564 166 175 120 103
AAR per 100000 59.1 95.3 90.4 101.3 112.5 47.1 59.1 58.7 35.8 37.0
Cumulative risk of getting the disease (0-74 age group)
1 in 15 1 in 8 1 in 9 1 in 8 1 in 7 1 in 20 1 in 15 1 in 15 1 in 29 1 in 25
Female
Average Population Covered 119846 1484241 1038314 271235 174691 1473935 359062 355070 410792 349011
Number of cases registered 43 1157 721 262 174 542 154 123 143 122
AAR per 100000 51.4 98.1 92.6 109.2 107.8 44.6 50.5 40.1 44.2 43.5
Cumulative risk of getting the disease (0-74 age group)
1 in 18 1 in 9 1 in 9 1 in 8 1 in 8 1 in 20 1 in 6 1 in 17 1 in 21 1 in 22
Population Covered, Death due to Cancer and Death Rate by Sex:2018
Rukum Kathmandu Valley
Kathmandu District
Lalitpur District
Bhaktapur District
SSDM Registry
Siraha District
Saptari District
Dhanusha District
Mohattari District
Male
Average Population Covered 101530 1587691 1127450 279848 180393 1372101 321188 328124 397066 325723
Number of cases registered 16 365 210 91 64 155 57 44 20 34
AAR per 100000 21.4 36.3 31.6 43.3 49.4 13.1 20.2 15.4 6.0 11.8
Cumulative risk of getting the disease (0-74 age group)
1 in 50 1 in 20 1 in 25 1 in 17 1 in 17 1 in 100 1 in 50 1 in 100 1 in 100
Female
Average Population Covered 119846 1484241 1038314 271235 174691 1473935 359062 355070 410792 349011
Number of cases registered 22 305 183 82 40 135 38 34 26 33
AAR per 100000 25.1 27 24.9 34.7 34.7 11.1 13.0 11.3 8.8 11.6
Cumulative risk of getting the disease (0-74 age group)
1 in 50 1 in 33 1 in 33 1 in 25 1 in 33 1 in 100 1 in 50 1 in 100 1 in 50
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 20184
CanCer inCidenCe By Sex
Cancer incidence rate varies according to geographical areas in Nepal. Among the three registries the Age Adjusted incidence Rate (AAR) and Mortality Rates were found higher in both male and female in Kathmandu valley followed by Rukum and SSDM. Though SSDM is semi urban area, the incidence and mortality rates are found to be lesser in SSDM than Rukum. The AAR and Age Adjusted Mortality Rate irrespective of sex and according to sex of the 3 registries are shown in figure below.
95.7
54.8 45.7
31.2 23
12
0.0
20.0
40.0
60.0
80.0
100.0
120.0
Kathmandu Valley Rukum Registry SSDM Registry
AAR
per
100,
000
Incidence
Mortality
Figure 1. Age Standard Incidence and Mortality Rates in both Sexes in Three Registries of Nepal.
95.3
59.1
47.1
98.1
51.4 44.6
0
20
40
60
80
100
120
Kathmandu Valley Rukum Registry SSDM Registry
Male
Female
AAR p
er 1
00,0
00
Figure 2. Comparisons of Age Standard Incidence Rates by Sex in Three Registries of Nepal.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 5
Looking at all the districts within the three registries separately, higher incidence rate is found in urban areas and lower incidence rate is found in semi urban and rural areas. Among all registry sites, the highest cancer burden is found in Bhaktapur district among males and females both and lowest burden is found in Dhanusha District for males and among females the incidence rate is lowest in Saptari district. The figure shows the rate of cancer incidence in various districts of Nepal.
112.5101.3
90.4
59.1 59.1 58.7
37 35.8
0
20
40
60
80
100
120
AARp
er10
0,000
Figure 3. Comparison of Age Standard Incidence Rates in Males in the Districts of Nepal.
109.2 107.8
92.6
51.4 50.544.2 43.5 40.1
0
20
40
60
80
100
120
AAR
per1
00,0
00
Figure 4. Comparison of Age Standard Incidence Rates in Females in the Districts of Nepal.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 20186
leading CanCer SiteS
Lung cancer is the leading cancer site in male with AAR 18.1 in Kathmandu valley followed by stomach, urinary bladder, gall bladder and NHL. Similarly, breast cancer is the top most leading site for female in Kathmandu Valley followed by lungs and cervix as second and third leading sites respectively. Gall bladder cancer ranks fourth leading cancer in both male and female of Kathmandu Valley. Interestingly, ovary cancer is among the top fifth leading cancer site in Females.
4.2
5.5
5.7
8.5
18.1
0 5 10 15 20
Non-Hodgkinlymphoma
Gallbladder
Urinary Bladder
Stomach
Lungs
AAR per 100,000
Figure 5. Leading Cancer Sites in Males, Kathmandu Valley.
5.5
7.4
8.7
10.4
21.5
0 5 10 15 20 25
Ovary
Gallbladder
Cervix uteri
Lungs
Breast
AAR per 100,000
Figure 6. Leading Cancer Sites in Female, Kathmandu Valley.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 7
In Kathmandu district, the top five leading cancer sites in male are as similar as with Kathmandu valley where lung is the top most followed by stomach, urinary bladder, gall bladder and Non- Hodgkin's Lymphoma . The most common site in female of Kathmandu district is the breast where the cervix and lung cancer ranks as second and third leading site respectively with little difference in AAR.
4.1
5.8
6.8
7.8
15.3
0 5 10 15 20
Non-Hodgkin lymphoma
Gallbladder
Urinary Bladder
Stomach
Lungs
AAR per 100,000
Figure 7. Leading Cancer Sites in Male, Kathmandu District.
5.5
6.2
8.5
8.9
21.1
0 5 10 15 20 25
Gallbladder
Ovary
Lungs
Cervix uteri
Breast
AAR per 100,000
Figure 8. Leading Cancer Sites in Females, Kathmandu District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 20188
As similar with other district, lung cancer ranks as first cancer site with highest AAR in Lalitpur district followed by stomach and gall bladder in second and third position respectively. Contrast to the other registry sites larynx and colon are the fifth common sites in males. Similarly, in female breast cancer is first leading site in females of Lalitpur district followed by lungs, gall bladder, cervix and thyroid cancer as second to fifth leading site respectively.
4.3
4.3
4.7
5
8.5
23.7
0 5 10 15 20 25
Colon
Larynx
Non-Hodgkin lymphoma
Gallbladder
Stomach
Lungs
AAR per 100,000
Figure 9. Leading Cancer Sites in Males, Lalitpur District.
5.9
10.5
11.5
17.9
21.1
0 5 10 15 20 25
Thyroid
Cervix uteri
Gallbladder
Lungs
Breast
AAR per 100,000
Figure 10. Leading Cancer Sites in Female, Lalitpur District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 9
Lung is the commonest site of cancer in males of Bhaktapur district followed by stomach cancer. Surprisingly, unlike Kathmandu and Lalitpur districts, the cancers of mouth and larynx are more common in Bhaktapur district. In female the leading sites were breast, gallbladder, lungs, thyroid and NHL. In contrast to other two districts, the AAR of cervix uteri in females in Bhaktapur district has been found low, not even in the top five.
5.9
6.1
7
11.6
23.4
0 5 10 15 20 25
Larynx
Urinay Bladder
Mouth
Stomach
Lungs
AAR per 100,000
Figure 11. Leading Cancer Sites in Males, Bhaktapur District.
4.9
5.9
8.2
10.2
24.9
0 5 10 15 20 25 30
Non-Hodgkinlymphoma
Thyroid
Lungs
Gallbladder
Breast
AAR per 100,000
Figure 12. Leading Cancer Sites in Females, Bhaktapur District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201810
The leading site in males in Rukum is lungs followed by stomach, thyroid, prostate and gallbladder. In females, the most common site is cervix uteri followed by lungs, uterus, ovary and breast.
2.9
3.0
4.2
7.3
13.2
0 2 4 6 8 10 12 14
Gallbladder
Prostate
Thyroid
Stomach
Lungs
AAR per 100,000
Figure 13. Leading Cancer Sites in Males, Rukum District.
2.7
3.2
3.9
5.2
13.2
0 2 4 6 8 10 12 14
Breast
Ovary
Uterus
Lungs
Cervix uteri
AAR per 100,000
Figure 14. Leading Cancer Sites in Females, Rukum District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 11
In SSDM, the leading sites of cancer in male in 2018 were mouth, lungs, gallbladder, liver and stomach. In female breast, cervix uteri, gallbladder, lungs and stomach were the leading sites. The top five leading sites in male and female is presented in figure below.
2.1
2.3
2.8
3.9
6.3
0 1 2 3 4 5 6 7
Stomach
Liver
Gallbladder
Lungs
Mouth
AAR per 100,000
Figure 15. Leading Cancer Sites in Males, Siraha, Saptari, Dhanusha and Mohattari District.
1.7
3.7
4.8
8.7
8.9
0 2 4 6 8 10
Stomach
Lungs
Gallbladder
Cervix uteri
Breast
AAR per 100,000
Figure 16. Leading Cancer Sites in Females, Siraha, Saptari, Dhanusha and Mohattari District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201812
Lung cancer ranks among the first leading cancer site in male population of Siraha district followed by liver, mouth, gall bladder in second, third and fourth position respectively. Surprisingly, cancer of brain and nervous system ranks among fifth leading site in this population. The incidence rate of breast cancer is the highest among the female population of Siraha district followed by cervix, lungs, gall bladder and ovary second to fifth common site respectively.
2.9
3.6
3.7
4.0
8.0
0 2 4 6 8 10
Brain and Nervous system
Gallbladder
Mouth
Liver
Lungs
AAR per 100,000
Figure 17. Leading Cancer Sites in Males, Siraha District.
2.3
4.8
5.4
10.2
10.9
0 2 4 6 8 10 12
Ovary
Gallbladder
Lungs
Cervix uteri
Breast
AAR per 100,000
Figure 18. Leading Cancer Sites in Females, Siraha District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 13
The commonest sites in Males in Saptari district in 2018 were mouth, lungs, liver, gallbladder and rectum. The leading sites in Saptari were similar to Siraha district. Similarly in females the top leading sites were cervix uteri, breast, gallbladder, mouth, lungs and liver as described in figure below.
2.5
2.8
3.2
3.4
9.9
0 2 4 6 8 10 12
Rectum
Gallbladder
Liver
Lungs
Mouth
AAR per 100,000
Figure 19. Leading Cancer Sites in Males, Saptari District.
1.7
2.6
3.3
3.3
5.6
6.3
0 1 2 3 4 5 6 7
Liver
Lungs
Mouth
Gallbladder
Breast
Cervix uteri
AAR Per 100,000
Figure 20. Leading Cancer Sites in Females, Saptari District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201814
The most common site of cancer in male population of Dhanusha district is mouth followed by cancer of stomach, gall bladder, tongue and bladder.Compared to other districts the incidence of Lungs cancer in males was low in Dhanusha district. In females the leading sites were breast, gallbladder, cervix uteri, lungs and stomach given in figure below.
1.6
1.9
2.7
3.5
6.2
0 1 2 3 4 5 6 7
Bladder
Tongue
Gallbladder
Stomach
Mouth
AAR per 100,000
Figure 21. Leading Cancer Sites in Males, Dhanusha District.
1.8
3.7
6.4
7.4
10.2
0 2 4 6 8 10 12
Stomach
Lungs
Cervix uteri
Gallbladder
Breast
AAR per 100,000
Figure 22. Leading Cancer Sites in Females, Dhanusha District.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 15
In Mohattari district, the leading sites in male in 2018 were mouth, lungs, Non-Hodgkins Lymphoma, small intestine and tongue.Unlike Siraha, Saptari and Dhanusha districts, the incidence of Non-Hodgkins lymphoma was more in Mohattari. In female the leading sites were cervix uteri, breast, lungs, gallbladder, stomach, Liver and ovary similar to other districts.
2.2
2.3
2.6
3.7
5.2
0 1 2 3 4 5 6
Tongue
Smallintestine
Non-Hodgkinlymphoma
Lungs
Mouth
AAR per 100,000
Figure 23. Leading Cancer Sites in Males, Mohattari District.
1.1
1.1
1.7
3.4
3.4
9
12.4
0 2 4 6 8 10 12 14
Liver
Ovary
Stomach
Gallbladder
Lungs
Breast
Cervix uteri
AAR per 100,000
Figure 24. Leading Cancer Sites in Females, Mohattari.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201816
CoMPariSon of CanCer inCidenCe rate with other neighBoring regiStrieS
Cancer incidence in Males in the major cities of India and China such as Delhi, Chennai, Mumbai, Sanghai and Beijing are higher compared to of urban registries of Nepal. The incidence rate is higher in urban areas and lower in semi urban and rural areas compared to the estimated incidence rate of Nepal given by GLOBOCAN. The highest incidence is found in Bhaktapur and Lalitpur districts and lowest incidence is found in Dhanusha and Mahottari district of Nepal respectively. The incidence rates of semi urban and rural areas in Nepal are low however comparable to the incidence rates of rural areas of India like Sangrur and Mansa.
35.8
37.0
47.1
47.7
47.8
58.7
59.1
59.1
77.6
82.3
87.5
89.8
90.4
90.7
95.3
96.9
101.3
112.5
113.1
116.1
149.4
168.2
202.9
0 50 100 150 200 250
Dhanusa(2018)
Mahottari (2018)
SSD M R egistry (2018)
Mansa (2014)
Sangrur (2014)
Saptari (2018)
Rukum (2018)
Siraha (2018)
Pune (2012-2013)
SA S Nagar (2014)
Nepal (E stimate by GL OBOC A N, 2018)
India (E stimate by GL OBOC A N, 2018)
K athmandu (2018)
Sikkim State (2012-2014)
K athmanduV alley (2018)
C handigarh (2014)
L alitpur (2018)
Bhaktapur (2018)
Mumbai PBC R (2012)
C hennai (2012-2014)
Delhi (2012)
B ejing (2008-2012)
Shanghai (2008-2012)
AAR Per 100,000
Figure 25. Comparison of Age Adjusted Incidence Rate of All Sites with Other Neighboring Registries, Males.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 17
Similar for females, the cancer incidence in Nepal is less than the incidence rates of major cities of India and China. In Females, Nepal has lower cancer incidence rate compared to the estimated incidence rate of Nepal given by GLOBOCAN. The highest incidence rate is found in Lalitpur and Bhaktapur districts and lowest rate is found in Saptari and Mohattari districts of Nepal respectively.
0 50 100 150 200
Saptari (2018)Mahottari (2018)
Dhanusa (2018)SSDM Registry (2018)
Siraha (2018)Rukum (2018)
Sangrur (2014)Mansa (2014)
Pune (2012-2013)India (Estimate by GLOBOCAN 2018)
Kathmandu (2018)Kathmandu Valley (2018)
SAS Nagar (2014)Sikkim State (2012-2014)
Chandigarh (2014)Bhaktapur (2018)
Lalitpur (2018)Nepal (Estimate by GLOBOCAN, 2018)
Mumbai PBCR (2012)Banglore (2012)
Chennai (2012-2014)Delhi (2012)
Bejing (2008-2012)Shanghai (2008-2012)
AAR Per 100,000
Figure 26. Comparison of Age Adjusted Incidence Rate of All Sites with Other Neighboring Registries, Females.(Ref1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201818
CoMPariSon of leading SiteS with other neighBoring regiStrieS
0.7
1.2
2.6
3.4
1.1
3.7
3.87
6.74
2.4
5.4
4.3
4.24
4.88
6
5.2
16.3
8.5
4.9
10.4
8.2
17.9
22.7
19.3
1.8
2.1
3.4
3.7
3.7
3.9
6.88
7.77
7.8
8
10.5
11.6
11.69
12.4
13.2
14.4
15.3
17.2
18.1
23.4
23.7
37.9
38.6
0 5 10 15 20 25 30 35 40 45
Sangrur (2014)
Mansa (2014)
Saptari (2018)
Mahottari (2018)
Dhanusa (2018)
SSDM Registry(2018)
Pune (2012-2013)
Sikkim State (2012-2014)
SAS Nagar (2014)
Siraha (2018)
Chandigarh (2014)
Chennai (2012-2014)
Banglore (2012)
Mumbai PBCR (2012)
Rukum (2018)
Nepal (Estimate by GLOBOCAN,2018)
Kathmandu (2018)
Delhi (2012)
Kathmandu Valley (2018)
Bhaktapur (2018)
Lalitpur (2018)
Beijing (2008-2012)
Shanghai (2008-2012)
AAR per 100,000
Male
Female
Figure 27. Comparison of Cancer of Lungs with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 19
0.3
0.6
0.6
0.7
0.5
0.5
1.3
0.5
0.8
0.7
5.4
8.5
2.5
0.0
0.8
0.6
1.2
3.7
3.8
3.3
0.8
3.3
0.6
0.8
0.9
1.4
1.9
2.7
2.7
3.1
3.2
3.7
3.9
4.0
4.3
5.2
5.5
6.2
6.3
7.7
9.1
9.5
9.9
9.9
0.0 2.0 4.0 6.0 8.0 10.0 12.0
Sangrur (2014)
Shanghai (2008-2012)
Beijing (2008-2012)
Mansa (2014)
Lalitpur (2018)
Kathmandu (2018)
Rukum (2018)
Kathmandu Valley (2018)
SAS Nagar (2014)
Siraha (2018)
Banglore (2012)
Chennai (2012-2014)
Sikkim State (2012-2014)
Mahottari (2018)
Chandigarh (2014)
Dhanusa (2018)
SSDM Registry (2018)
Pune (2012-2013)
Mumbai (2012)
Delhi (2012)
Bhaktapur (2018)
Saptari (2018)
Male
Female
AAR per 100,000
Figure 28. Comparison of Cancer of Mouth with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201820
0.3
1
1.7
1.7
2.2
1
0.7
1.7
1.36
1.8
2.2
2.6
7.8
2.6
4.2
4.72
3.6
4.2
5.09
4.6
6.7
6.82
6.7
0.7
0.7
1.2
1.5
1.5
1.6
1.8
2.1
2.81
3.5
4.3
4.8
4.9
7.3
7.8
8.2
8.5
8.5
10.83
11.6
13.6
14.75
22.9
0 5 10 15 20 25
Sangrur (2014)
Mansa (2014)
Chandigarh (2014)
Mahottari (2018)
Siraha (2018)
Saptari (2018)
SAS Nagar (2014)
SSDM (2018)
Pune (2012-2013)
Dhanusa (2018)
Delhi (2012)
Mumbai PBCR (2012)
Nepal (Estimate by GLOBOCAN,2018)
Rukum (2018)
Kathmandu (2018)
Banglore (2012)
Lalitpur (2018)
Kathmandu Valley (2018)
Chennai (2012-2014)
Bhaktapur (2018)
Beijing (2008-2012)
Sikkim State (2012-2014)
Shanghai (2008-2012)
AAR per 100,000
Male
Female
Figure 29. Comparison of Cancer of Stomach with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 21
2.7
5.6
8.9
9
10.2
10.9
11.08
12.5
13.6
15
21.1
21.1
21.5
24.9
26.42
29.5
32.7
33.6
34.38
37.92
40.9
41
41.6
0 10 20 30 40 50
Rukum (2018)
Saptari (2018)
SSDM (2018)
Mahottari (2018)
Dhanusa (2018)
Siraha (2018)
Sikkim State (2012-2014)
Mansa (2014)
Sangrur (2014)
Nepal (Estimate by GLOBOCAN, 2018)
Kathmandu (2018)
Lalitpur (2018)
Kathmandu Valley (2018)
Bhaktapur (2018)
Pune (2012-2013)
SAS Nagar (2014)
Chandigarh (2014)
Mumbai PBCR (2012)
Banglore (2012)
Chennai (2012-2014)
Beijing (2008-2012)
Delhi (2012)
Shanghai (2008-2012)
AAR per 100,000
Figure 30. Comparison of Cancer of Breast with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201822
4.5
6.3
6.4
6.4
8.2
8.5
8.6
8.7
8.9
9
9
10
10.1
10.2
10.5
12.2
12.4
13.2
15.3
15.5
15.9
16.1
21.5
22
0 5 10 15 20 25
Bhaktapur (2018)
Saptari (2018)
Dhanusa (2018)
Shanghai (2008-2012)
Kathmandu Valley (2018)
Beijing (2008-2012)
Sangrur (2014)
SSDM Registry (2018)
Kathmandu (2018)
Mumbai (2012)
Pune (2012-2013)
SAS Nagar (2014)
Sikkim State (2012-2014)
Siraha (2018)
Lalitpur (2018)
Mansa (2014)
Mahottari (2018)
Rukum (2018)
Banglore (2012)
Delhi (2012)
Chennai (2012-2014)
Chandigarh (2014)
Nepal (Estimate by GLOBOCAN, 2018)
India (2012)
AAR Per 100,000
Figure 31. Comparison of Cancer Cervix with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 23
1.06
1.79
1.15
2.9
1.5
3.2
1.3
2.8
2.1
3
2.2
2.8
3.6
1.7
1.9
5.8
2.17
5.5
6
2.7
4.9
5
5.3
1.34
1.5
1.97
2.4
2.7
2.9
3
3.3
3.4
3.9
4.1
4.8
4.8
5.2
5.4
5.5
6.66
7.1
7.3
7.4
10.2
11.5
11.8
0 2 4 6 8 10 12 14
Pune (2012-2013)
Chennai (2012-2014)
Banglore (2012)
Rukum (2018)
Sangrur (2014)
Beijing (2008-2012)
Mansa (2014)
Saptari (2018)
Mahottari (2018)
Shanghai (2008-2012)
Mumbai PBCR (2012)
SSDM (2018)
Siraha (2018)
SAS Nagar (2014)
Chandigarh (2014)
Kathmandu (2018)
Sikkim State (2012-2014)
Kathmandu Valley (2018)
Nepal (Estimate by GLOBOCAN, 2018)
Dhanusa (2018)
Bhaktapur (2018)
Lalitpur (2018)
Delhi (2012)
AAR per 100,000
Female
Male
Figure 32. Comparison of Cancer of Gallbladder with Other Neighboring Registries.(Ref 1-8)
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201824
CanCer Mortality
Looking at Kathmandu Valley and SSDM registry, the Mortality Rates in males is higher than females in Kathmandu valley, whereas, in Rukum females have the higher mortality rates than males. There might be under reporting of the death cases. Government of Nepal is also facing challenges in recording the death cases as cancer. However, a combined effort is going on to capture as much mortality cases as possible. While comparing the three registries, the Age Standard Mortality Rates for both Males and Females are found to be higher in Kathmandu Valley followed by Rukum. The mortality rate in SSDM was low and the death cases might be under reported.
36.3
21.4
13.1
27.0 25.1
11.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Kathmandu Valley Rukum Registry SSDM Registry
Male
Female
AAR p
er 1
00,0
00
Figure 33. Cancer Mortality by Sex in Three Registries of Nepal, 2018.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 25
Comparing all the districts separately within the three registries the mortality rates are highest in Lalitpur and Bhaktapur districts and lowest in Mohattari and Dhanusha districts respectively.
49.4
43.3
31.6
21.4 20.215.4
11.86
0
10
20
30
40
50
60
AAR
per1
00,0
00
Figure 34. Cancer Mortality in Males in Districts of Nepal, 2018.
34.7 34.7
25.1 24.9
13 11.6 11.38.8
0
5
10
15
20
25
30
35
40
AAR
per1
00,0
00
Figure 35. Cancer Mortality in Females in Districts of Nepal, 2018.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201826
highlightS
• The three Population Based Cancer Registry in Kathmandu Valley PBCR (Bagmati Province), in Siraha, Saptari, Dhanusha and Mohattari (SSDM) PBCR (Province No. 2) and Rukum PBCR (Province No. 5 and Karnali Province) covers 20.27% of the total population of Nepal and represents Urban, Semi-Urban and Rural areas of Nepal respectively.
• The Kathmandu Valley incidence rate is higher for males and lower for females than the GLOBOCAN estimated incidence rate for Nepal, however comparable with many of the urban registries in India
• In Rukum registry, cancer incidence rates are lower than the Kathmandu Valley Cancer registry, however it is comparable with other rural registries in India.
• In SSDM registry, incidence rates are lower compared to the urban and rural registries in Nepal and India. Though all the possible ways to capture the cases have been done, we might have missed the cases in SSDM registry. The reason might be due to the lack of cancer diagnosis and treatment facilities, patient travel to India for cancer treatment as most of the area of SSDM registry borders with India and we were not able to include the sources of India at the border side. Another reason might be low awareness level of the people, under diagnosis and fear of exposing themselves as having cancer because of stigma.
• Lungs cancer is high in all the geographical areas of Nepal, the AAR ranging from 2.6 to 23.7 per 100,000.
• Cervical cancer is high in rural part of Nepal but less in urban region. In urban area breast cancer is higher.
• Within Kathmandu Valley though lungs cancer is common, the rates of lungs cancer are much higher in Lalitpur and Bhaktapur compared to Kathmandu. Similarly in Bhaktapur district the cancer of mouth and larynx is more common in contrast to other 2 districts.
• Gallbladder and stomach cancer are found to be common in all the districts among both the sexes. Within the districts, the incidence rate of gallbladder is very high in Bhaktapur and Lalitpur district and comparable to the urban areas of India.
• In the SSDM the incidence of mouth cancer is the commonest among males which was not found as common in other two registry area in the hill and mountain.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 27
reCoMMendationS
1. We suggest and recommend Ministry of Health and Population (MoHP) to develop the National cancer control strategy which is an urgent and important need of the time.
2. Based on the findings of the PBCR data, intervention programs should be planned and launched in various regions of the country focusing on the special cancer site for that region. Concerned Provincial and local government authority should be engaged in planning and intervention of the programs.
3. Establishment of a separate cancer wing in the MoHP to look after all the issues related to cancer.
4. As Lung cancer is commonest in all the areas of Kathmandu valley, existing awareness program needs to be strengthen to encourage smoking/tobacco cessation. Information Technology (IT) based and community based interventions for “quit tobacco” is a good tool for this.
5. Kathmandu Valley and SSDM PBCR shows Breast cancer as the most common cancer in female, thus government of Nepal as well as concern authority should need to give priority for the breast cancer awareness,screening and early detection to reduce the future burden of breast cancer in Nepal.
6. In SSDM and Rukum, cervical cancer is the commonest in females. Cervical Cancer is one of the Cancer amenable for all level of prevention and is the priority of Nepal Government. Activities like awareness, screening, vaccination, prevention, early detection and treatment to be carried out in a systematic manner to cover the maximum population across the country.
7. Establishment of early detection centers are highly recommended in the semi urban and rural areas like SSDM and Rukum.
8. It is necessary to conduct the risk factors study of the common cancer like Lungs, head and neck, stomach, gallbladder, urinary bladder, colorectal cancer in order to strengthen cancer prevention strategies and activities.
9. Government should need to focus towards digitalization of uniform medical recording system with some mandatory variable in all government and private health facilities. This will help to minimize work duplicate and save both human and financial resources at nation level.
10. Death is one of the vital statistics, which is also linked with human development index of the country, however, collecting death information is quite challenging in Nepal. Thus government should need to give emphasis towards strengthening the death recording system including cause of death.
11. Cancer survival studies to be undertaken. Similarly, it is recommended to do a cross sectional survey in order to check the completeness of registry data especially in the SSDM districts.
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201828
referenCeS
1. IARC/WHO; IACR: 2019 – CI5 XI: Cancer Incidence by Five Continents CI5 Volume XI, Lyon, France.
2. National Cancer Registry Program- Indian Council of Medical Research : Three year report of PBCR 2012-2014, Bangalore 2016
3. Chandigarh Population-Based Cancer Registry Report: (2014) – Tata Memorial Center, Mumbai and Post Graduate Institute of Medical Education and Research (PGI), Chandigarh, India.
4. Mansa Population-Based Cancer Registry Report: (2014) – Tata Memorial Center, Mumbai and Post Graduate Institute of Medical Education and Research (PGI), Chandigarh, India.
5. Sangrur Population-Based Cancer Registry Report: (2014) – Tata Memorial Center, Mumbai and Post Graduate Institute of Medical Education and Research (PGI), Chandigarh, India.
6. SAS Nagar Population-Based Cancer Registry Report: (2014) – Tata Memorial Center, Mumbai and Post Graduate Institute of Medical Education and Research (PGI), Chandigarh, India.
7. Cancer Incidence and Mortality Greater Mumbai: (2012) - Mumbai Cancer Registry, Mumbai, India
8. Global Cancer Observatory (GLOBOCAN). Cancer Today, Data Visualization for Exploring the Global Cancer Burden in 2018. International Agency for Research on Cancer Lyon, France. 2018; Available on http://gco.iarc.fr/
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 29
aCknowledgeMentS
We would like to express our special thanks to Secretaries and Division Chiefs of Ministry of Health and Population, Government of Nepal for their valuable support and encouragement for establishing Population Based Cancer Registry in Nepal. We would like to thank Dr. Bhola Ram Shrestha, former chief of then Curative Division, MoHP for his support and guidance during the initiation of registry. Our sincere gratitude goes to International Agency for Research on Cancer (IARC), France and IARC Regional Hub, Mumbai for their dedicated technical support in operating PBCR in Nepal. We are also thankful to Government of Nepal for financial support and WHO Nepal Country Office Nepal for the technical and partial financial support to initiate PBCR in Nepal.
The Nepal Health Research Council, Nepal thankfully acknowledges the support, coordination and collaborations rendered by the following hospitals, laboratories, local authorities and othercancer treatment centers for establishing PBCR in Nepal.
Alka Hospital, Lalitpur Annapurna Neurological Institute and Allied Science, Kathamandu
Dr. Suman Thapa, ENT Surgeon Dr. Sharad Gajurel
Mrs. Rojina Maharjan, Administrator
Miss Sabina Rajthala, Medical Recorder Bhaktapur Cancer Hospital, Bhaktapur
Dr. Rishikesh Narayan Shrestha, Medical Director
B & B Hospital, Lalitpur Dr. Ajay Jha, Oncologist
Dr. Roshani Shrestha, Oncologist Mr. Rajaram Tajale, Administrator
Dr. Reena Baidhya, Pathologist Mr. Jaganath Bhurtel, Account Section
Miss. Jeforsana Naveen Tamrakar, Nurse Mr. Prem Sujakhu, Medical Record Section
B.P Koirala Institute of Health Sciences, Sunsari B.P Koirala Memorial Cancer Hospital, Chitwan
Dr. Paricha Upadhyay, Pathologist Dr. Bijay Chandra Acharya, Director
Mr. Dharinidhar Baral, Assistant Professor Dr. Nirmal Lamichhane, Surgeon, Deputy Director
Mr. Sunil Parajuli, Officer, Medical Record Section Dr. Shivaji Poudel, Oncologist
Dr. Rajan Raj Bhatta, Pathologist
B.P. Smriti Samudayak Hospital, Kathmandu Er. Ibrahim Ansari, IT Department
Dr. Ramila Gurung Mrs. Bimala Sharma, Nurse
Mrs. Pabitra Bhusal
Birat Medical College and Teaching Hospital, Biratnagar Mr. Pravin Jha, Medical Record
Dr. Mrinalini Singh, Pathologist
Dr. Santosh Upadhyaya Kafle, Pathologist Birendra Millitary Hospital, Kathmandu
Dr. Sunil Parajuli, Community Medicine Dr. Rajeev Kumar Deo, Oncologist
Dr. Kavita Karmacharya, Pathologist
Civil Service Hospital, Kathmandu Mr. Chandra B Shrestha
Dr. Dirga Raj RC, Director
Dr. Simit Sapkota, Oncologist
Dr. Subash Pandit, Oncologist Divya Ayurvedic Aausadhalaya, Kathmandu
Dr. Jitendra Pariyar, Gyane Oncologist
Dr. Samir Neupane, Pathologist Golden Hospital, Biratnagar
Mr. Sudeep Dahal, Medical Record Section Dr Dinesh Khadka, Pathologist
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201830
Ms. Prastuti Dahal
Grande International Hospital, Kathmandu Green City Hospital, Kathmandu
Mrs. Jyoti Jha, Medical Record Section Dr. Romeo Kashakar, Surgical Oncologist
Miss Durga Rijal, Medical Record Section Mr. Chuna Shrestha, Oncology OPD
Miss Ramina Shrestha, Medical Record Section
Hospice Nepal, Lalitpur
Mr. Ganesh Koirala and Team
Kanti Children Hospital, Kathmandu
Dr. Ganesh K. Rai, Former Director Kantipur Hospital and Team
Mrs. Nirmala Shah, Nurse
Miss Pooja Dhakal, Nurse Kathmandu Medical Collage Teaching Hospital, Kathmandu
Medical Record Team Dr. Mukunda Raj Joshi, Director
Dr. Sailesh Pradhan, Pathologist
Kathmandu Cancer Centre, Bhaktapur Mrs. Ranjana Chhetri and Nursing Department
Mr. Rakesh Jha Miss Pooja Shrestha, Medical Record Section
Mr.Aasaram Prajapati
Mr. Mithun Neupane Koshi Zonal Hospital, Morang
Mrs. Laxmi Rijal Dr. Rogin Kathayat, Oncologist
Mr. Ajit Chaudhary, Administration
KIST Medical College and Teaching Hospital, lalitpur
Dr. Sushma Bhatta, Pathologist Mediquest Laboratory Pvt. Ltd, Lalitpur
Mrs. Tulasi Dahal, Medical Record Section Mr. Sunil Shrestha and Team
Mr. Naveen Gurung, It Section
MangalamDiagnaostic, Birgunj
NAMS, Bir Hospital, Kathmandu Dr. Amarnath Thakur
Dr. Bhupendra Kumar Basnet, Former Director
Dr. Bibek Acharya, Radiation Oncologist National Hospital and Cancer Research Center, Lalitpur
Dr. Bishnu D Paudel, Medical Oncologist Mr. Shyam Krishna Joshi, Founder
Dr. Prativa Bista, Pathologist Dr. Madan KumarPiya, Director
Miss Nika Maharjan, Nurse Mrs. Sanu Maiya Maharjan, Nurse
Miss Nagina Maharjan, Nurse Miss Sujata Pandit, Nurse
Mrs. Rekha Jha, Medical Record Section Mr. Ashim Chaudhary, Medical Record Section
National Medicare Hospital and Research Center, Kathmandu
Nepalgunj Medical College and Teaching Hospital Kolhapur and Nepalgunj
Dr. Pradeep Kumar Yadhav, Director Dr. Pragya Gautam Ghimire, Pathologist
Dr. Mamta Lakhey, Pathologist Mr.Tarak Malla, Medical Record Section
Mrs. Bimala Neupane, Nurse Mr.Ashok Dixit, Assistant Officer
Mrs. Meena Prajapati, Nurse
National Path Lab and Research Center, Dang
National Public Health Laboratory, Kathmandu Mr. Birendra Kumar Acharya, Branch Manager
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018 31
Dr. Runa Jha and Team
National Medical college, Birjung Nepal Cancer Hospital & Research Center, Lalitpur
Dr. Pramod Sarraf, Director Dr. Sudip Shrestha, Executive Director
Dr. Sabiya Yashmine, Academic Director Dr. Hari Prasad Dhakal, Pathologist
Prof. Dr. Anand Chaurasiya, Pathologist Dr. Murariman Shrestha, Medical Epidemiologist
Dr. Sanjay Shah, Pathologist Dr. Gisupnikha Prasiko Prasai, Radiation Oncologist
Mrs. Sabita Poudel, Nursing Supervisor
Mr. Pradeep Thakuri, IT Section
Nepal Medicity Hospital, Lalitpur Miss Sajina Maharjan, Medical record Department and Team
Dr. Sudakhar Jayram, CEO
Dr. Pankaj Barma, Oncologist Nepal Medical College Teaching Hospital, Kathmandu
Dr. Sabina Maharjan, Oncologist Dr. Rashmey Pun, Oncologist
Mr. Tribhuwan Singh, Medical Record Department Dr. Rita Mahaseth, Oncologist
Dr. Rakesh Pathak, Pathologist
Nepal Police Hospital, Kathmandu Mrs. Bimala, Medical Record Section
Bishnu Basnet, Medical Record Section Mrs. Juna Maya Karki, Nurse, Oncology OPD
Nobel Medical College and Teaching Hospital, Morang Norvic International Hospital, Kathmandu
Dr. Ram Hari Ghimire, Principal Dr. Bisharad Thapaliya, Physician
Dr. Prabesh Chaudhary, Pathologist Dr. Rajendra Baral, Oncologist
Dr. Neraj Nepal, Pathologist
Mr. Surendra Ghimire, Administration Patan Academy of Health Science, Lalitpur
Dr. Bishnu P. Sharma, Director
Om Hospital and Research Centre, Kathmandu Dr. Gyan Kayasta, Physician
Mrs. Kalpana Poudel, Matron Dr. Shivaraj K.C. Pathologist
Mrs. Sushila Rana, Nurse Officer Mrs. Gita Khanal, Nurse
Mrs. Meena Dawadi, Medical Record Section
Paropakar Maternity Hospital, Kathmandu Mr. Aswin K.C., Medical Record Section
Dr. Gehanath Baral, Gyane Oncologist Mr. Lok Bahadur Gurung, Administration
Dr. Karishma Malla, Pathologist
Mrs. Prava, Medical Record Section Sushil Koirala Prakhar Cancer Hospital, Banke
Dr. Bishwo Ram Poudel Oncologist
Samyak Diagnostic Pvt. Ltd. and Team, Kathmandu Ms. Ranjeeta Dhungana Nurse
Shechan Hospice and Team, Kathmandu TU Teaching Hospital, Kathmandu
Dr. Deepak Mahara, Former Director
Social Security and Nursing Division, DOHS Dr. Gita Sayami, Pathologist
Ms. Roshani Tui Tui Dr. Abhimanyu Jha, Pathologist
Mr. Prakash Ghimire Dr. Yogendra Prasad Singh, Surgeon
Dr. Anjan Shrestha, Pathologist
Thankot Hospice and Team, Kathmandu Mrs. Tulasi Pandey, Medical Record Section
Population Based Cancer Registries at Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 201832
The Max Foundation, Nepal UpendraDevkota Memorial National Institute of Neurological and Allied Science, Kathmandu
Mrs. SwetaAgrawal, Focal Person for Nepal Dr. MadhuDevkota, Director
Dr. Rajesh Pant, Pathologist
Vayodha Hospital and Team
Health Coordinator, Ward Chairperson, Ward Secretary, Health Post In charge, Female Community Health Volunteers of all the Urban/Rural Municipalities of Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari and Rukum districts.
Last but not the least all the field enumerators who have helped in collecting the data of cancer cases from the community
Dr. Pradeep Gyawali
Executive Chief
Nepal Health Research Council
Government of Nepal
Nepal Health Research Council Ramshah Path, Kathmandu
Population Based Cancer Registriesat Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018
Nepal Health Research Council (NHRC)Ramshah Path, Kathmandu, NepalTel : +977 1 4254220Fax : +977 1 4262469E-mail : [email protected] Website : www.nhrc.gov.np
Government of Nepal
Nepal Health Research Council Ramshah Path, Kathmandu
Population Based Cancer Registriesat Kathmandu, Bhaktapur, Lalitpur, Siraha, Saptari, Dhanusha, Mohattari, West Rukum and East Rukum Districts, Nepal, 2018
Nepal Health Research Council (NHRC)Ramshah Path, Kathmandu, NepalTel : +977 1 4254220Fax : +977 1 4262469E-mail : [email protected] Website : www.nhrc.gov.np