Nepal Health Research Council (NHRC) has published a new report on Cancer Incidence and Mortality Rate in Selected Districts of Nepal in 2019 (Kathmandu, Lalitpur, Bhaktapur, Siraha, Saptari, Dhanusha, Mahottari, Rukum East and Rukum West Districts).

Executive summary

Background
Nepal Health Research Council (NHRC) is a national apical body of Government of Nepal (GoN) established for the promoting scientific studies and quality health research in the country. NHRC has Started Population-based Cancer Registry (PBCR) since January 2018. The registry sites were divided into urban, semi-urban and rural regions respectively to understand the cancer burden. The registry sites were Kathmandu valley registry, Siraha, Saptari, Dhanusha and Mahottari registry (SSDM) and Rukum registry (East Rukum and West Rukum). The registry covers 21% of the total estimated population of Nepal where estimation done on the basis of population growth rate from 2001 to 2011 census period. Kathmandu valley cancer registry situated in Bagmati province covers the population of Kathmandu, Bhaktapur and Lalitpur districts. Similarly, SSDM covers Siraha, Saptari, Dhanusha and Mahottari districts of Madhesh province and Rukum Registry includes Rukum East and Rukum West district of Lumbini province and Karnali province respectively. The objective of PBCR is to generate evidence on cancer incidence, mortality, patterns and trends of cancer burden in the selected geographical regions of the country. Furthermore, the registry has been working to enhance Nepal’s national capacity for strengthening sustainable PBCRs in Nepal. The NHRC has collaborated with the Ministry of Health and Population (MoHP), WHO, Nepal and International Agency for Research on Cancer (IARC) for promoting the quality of registry in Nepal. To retrieve the data related to cancer cases, the council has worked in collaboration with health facilities related to diagnosis and treatment of the same.

Population Covered
According to Central Bureau of Statistics (CBS) Nepal; the total estimated population of Nepal for the year 2019 was 29,704,501. The PBCR covers 21% of the total population which is approximately 6,249,770. The Kathmandu valley registry had covered an estimated population of 3,151,205. Similarly, registries in SSDM (including four districts) and Rukum (Rukum East and Rukum West) had covered a population of over 2,872,760 and 225,805 respectively.

Registration Methodology
The registrations were done through community and health-facility based approach involving direct and indirect methods of data collection. In Kathmandu valley, PBCR focused mostly on health-facilities based approach (hospitals, diagnostic facilities, pathology laboratories, Ayurveda and other alternative treatment centers, and social security section) for data collection through direct and indirect methods.

The PBCRs in SSDM and Rukum primarily collected data through direct method where identification of the case was done with the help of the doctor in charge, health co- coordinators, female community health volunteers (FCHVs), ward chairpersons and community leaders. After identifying the cases, detailed information was taken either from the patient or his/her family. The same approach was followed in urban areas with low incidence for better data coverage. Quality control was done once data was collected from numerous sources. CanReg5 software was used for data analysis after data entry.

Findings
In 2019, PBCR had studied altogether 12,336 cancer cases. Out of them, the number of new cases and death cases registered in the year 2019 were 3,295 and 1,427 respectively. The Kathmandu valley registry registered 2,019 new cases (937 males and 1,082 females). The crude incidence rate (CR) and age adjusted incidence rate (AAR) for males was 57.5 and 86.7 per 100,000 population, for females it was, 71.0 and 90.8 per 100,000 population, respectively. Similarly, Kathmandu valley registry registered a total of 847 death cases (445 were males and 402 females). The crude mortality rate and age adjusted mortality rates in the Kathmandu Valley among males was 27.3 and 42.2 per 100,000 population, and in females, It was 26.4 and 34.3 per 100,000 population, respectively. The Bhaktapur district recorded the highest incidence (109.2 and 105.7 per 100,000) and mortality rate (58 per 100,000 and 42.1 per 100,000 population) for both males and females in Nepal among all registry sites.

The SSDM registry recorded 1,188 new cancers (579 males and 609 females) and 533 deaths (291 males and 242 females). The crude incidence rate and age adjusted incidence rate was found 41.9 and 47.8 per 100,000 population, for males, and in females, it was 40.8 and 49 per 100,000 population, respectively. Similarly, the crude mortality rate and age adjusted mortality rate in SSDM (combined) for males was 21.1 and 24 per 100,000 population, and in females, it was 16.2 and 19.9 per 100,000 population, respectively. The highest cancer incidence was noticed in Saptari district (54 per 100,000 population for males) and Siraha District (53.1 per 100,000 population for females).

The Rukum registry which represents the rural population, recorded 88 new cancer cases (43 males and 45 females) and 47 deaths (23 males and 24 females). The crude incidence rate and age adjusted incidence rates (AAR) was 42.7 and 52.5 per 100,000 population for males and in females, it was 35.93 and 47.3 per 100,000 population respectively.

The crude mortality rate and age adjusted mortality rate in Rukum registry was 22.9 and 27.6 per 100,000 population in males, whereas in females, it was 19.2 and 25.5 per 100,000 population, respectively. West Rukum recorded the highest age adjusted incidence rate (Males- 58.1 per 100,000 population, Females- 50.5 per 100,000 population).

As compared to 2018 there was slight reduction in the percentage of unknown primary cases (Males from 4.5% to 3.2%, Females- 3.2% to 2.6%). The highest number of unknown primary cases (7.42% males and 5.74% females) was recorded in SSDM registry, this could be attributed to the fact that data collection mostly relied on verbal information (31.5%) during community visits.

The quality of data depends more on availability of clinical and pathological information of tumors which can be represented as the registered % of cases with microscopic verification. In Kathmandu valley 91.7% cases registered with microscopic verification, however in SSDM and Rukum registry, it was found 51.6% and 60.2% respectively.