Dr. Shahid Aziz
Assistant Professor & PhD Supervisor
Institute of Allied Health Sciences,
Wah Medical College, Wah Cantt, Pakistan.
sazizgc@gmail.com
Gastric cancer represents a significant yet under-recognized health burden in Pakistan, with one of the highest mortality-to-incidence ratios globally. In 2022, the country recorded 5,968 new cases and 5,093 deaths, ranking gastric cancer as the ninth most commonly diagnosed cancer and the eighth leading cause of cancer-related mortality. The mortality-to-incidence ratio of 0.85 underscores the fact that nearly as many Pakistanis die from the disease each year as are diagnosed, reflecting widespread late detection and limited access to effective treatment.
The elevated fatality burden is largely attributable to three overlapping determinants. First, Helicobacter pylori infection—a class 1 carcinogen and the primary cause of non-cardia gastric cancer—remains highly prevalent in Pakistan, driven by overcrowding and inadequate sanitation. While the infection is a major cause of cancer, it is both preventable and treatable through low-cost antibiotic regimens. Second, dietary patterns exacerbate the risk. Average daily salt consumption in Pakistan stands at 8–9 grams, far exceeding the World Health Organization’s recommended limit of 5 grams. Excessive salt intake damages the stomach lining, potentiates H. pylori–related injury, and contributes to both gastric cancer and cardiovascular disease. Third, the widespread use of tobacco further increases disease burden. More than 19 percent of Pakistani adults use tobacco products, a factor strongly associated with higher cancer risk and poorer survival outcomes.
Clinical data reinforce the gravity of the situation. Hospital-based studies consistently show patients presenting with advanced disease and limited survival. The absence of a fully functional national cancer registry restricts the availability of comprehensive, population-based data, complicating policy planning and evaluation. Regionally, gastric cancer is a leading cause of gastrointestinal cancer mortality in Eastern Mediterranean countries, situating Pakistan within a broader high-burden landscape.
Evidence from international programs demonstrates that the disease can be prevented and controlled. Large-scale Helicobacter pylori “test-and-treat” initiatives in Japan and Taiwan have reduced gastric cancer incidence by almost 50 percent without major antibiotic resistance concerns. Likewise, nationwide salt-reduction strategies and rigorous tobacco control measures—including higher taxation, smoke-free laws, and cessation services—have been proven to lower population-wide risk and improve survival outcomes.
A coordinated and well-resourced national strategy is urgently required. The Ministry of National Health Services, in collaboration with provincial health departments, must lead the development of a National H. pylori Control Program integrated into primary healthcare. This would involve the issuance of standardized treatment guidelines, the subsidization of diagnostic tests such as urea breath or stool antigen tests, and the assurance of antibiotic availability. At the same time, comprehensive food policy reforms are needed, including mandatory sodium limits for processed foods, front-of-pack warning labels, and sustained public awareness campaigns on the health risks of excessive salt intake. Strengthened tobacco control measures—such as consistent enforcement of existing laws, annual increases in excise taxes, and the establishment of free cessation services—are also essential.
Equally critical is investment in healthcare capacity. This includes training gastroenterologists and surgeons, expanding access to diagnostic endoscopy and curative surgery, and implementing standardized referral pathways to ensure that patients with alarm symptoms are promptly evaluated. Finally, the establishment of a population-based national cancer registry must be prioritized, as reliable and timely data are indispensable for measuring disease burden, monitoring outcomes, and guiding resource allocation.
While structural reforms are essential, individuals can also take immediate steps to reduce their risk. These include seeking testing and treatment for H. pylori, reducing dietary salt intake, avoiding tobacco, and seeking prompt medical attention for alarm symptoms such as unexplained weight loss, persistent vomiting, gastrointestinal bleeding, or anemia. Early intervention significantly increases the chances of survival.
Gastric cancer does not need to remain Pakistan’s silent killer. The disease burden is driven primarily by a preventable infection, modifiable dietary habits, and widespread tobacco use, compounded by systemic challenges of late diagnosis and limited treatment access. With evidence-based strategies, political commitment, and data-driven policymaking, Pakistan has the opportunity to substantially reduce incidence and mortality and to safeguard the health of future generations.
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