Prevalence Of Childhood Leukemia Rising In Pak, Over 8,000 New Cases Annually Reported

Wraa Noor Haider

Islamabad: Pakistan is a densely populated, low-income country with an estimated 21 million people. The general population’s lack of awareness, unhygienic lifestyles and poor sanitary conditions in populated areas are the main causes of the country’s endemic prevalence of various communicable and non-communicable diseases.

Studies on the prevalence and incidence of cancer in Pakistan are very few. Previously, there were just two cancer registers located in Karachi and Lahore; and recently in 2015, the Pakistan Health Research Council (PHRC) in Islamabad developed a National Cancer Registry.

According to Classified Child Specialist Dr Imran Chaudhary, “The leading causes of death for children are malnutrition and infectious diseases in Pakistan. Better diagnostic facilities have led to establishing that cancer is a significant cause of morbidity and mortality in children. Available data indicates that childhood cancer accounts for 10 per cent of all reported cancer cases in 2017.”

There is no sure-fire way to prevent leukaemia from developing in host children because there are no identified risk factors for the disease: Child Specialist Dr Imran Chaudhary

Dr Imran explained that the age standardised ratio for cancer in females is slightly higher (172/100,000) than males (145/100000), adding that “recently, Pakistan has seen 150,000 new cases of cancer, with 60–80% of people dying from their illnesses. Annually, between 7000 and 7500 children are diagnosed with cancer in the country.”

Leukemia is a broad term for cancer of the blood cells. The type of leukaemia is determined by the type of blood cell that develops into cancer and how rapidly or slowly it grows. Although it occurs most frequently in adults over the age of 55but it is also the most prevalent cancer in children below the age of 15.

According to Karachi Cancer Registry, leukaemia is the most common oncological disease in children which accounts for 31 per cent of cases.

PIMS Child Specialist Dr Tariq said, “Presently, about 8,000to 10,000 new cases of leukemia are reported every year in Pakistan according to World Health Organization (WHO) statistics.”

“Children between the ages of one and 10 are more vulnerable to this disease. Acute lymphoblastic leukaemia (ALL), which is most prevalent in children 2-8 years old, is the most frequent kind of leukaemia in children. The majority of cases of acute myeloid leukemia (AML) happen in children under the age of 2 and teenagers are the second most prevalent type of childhood leukaemia,” he added.

Approximately 15 to 20% risks of relapse due to delayed diagnosis, delayed therapy and the absence of favourable prognostic factors: Child Specialist Dr Tariq

Most childhood leukemias have an unknown specific cause, “While the exact aetiology of the disease– or any cancer for that matter– is still unclear, there are a number of risk factors that have been identified, such as radiation exposure, prior cancer treatment and being older than 65,” stated Dr Imran Chaudhary.

In order to determine the specific genetic and environmental factors which are considered to contribute to leukaemia as well as what causes bone marrow cells to mutate, Dr Imran explained that researchers are evaluating certain combinations of a genetic predisposition, down syndrome, Human T-lymphotropic virus (HTLV), Human immunodeficiency virus (HIV), exposure to petrochemicals, such as benzene, extensive exposure to artificial ionizing radiation, alkylating chemotherapy agents used to treat other types of cancer, tobacco use, and use of certain hair dyes.

Dr Tariq explained that paediatric leukaemia risk can be increased in children with certain genetic disorders such as Down syndrome, Bloom syndrome, Klinefelter syndrome, and Fanconi anaemia.

Symptoms Vs Prevention

According to Dr Tariq, the bone marrow, which produces new blood cells, is where leukaemia first manifests itself. Leukemia symptoms are frequently caused by problems in the bone marrow. As a result, it may cause Thrombocytopenia (low blood platelet count), Anaemia (low red blood cell count) and Leukopenia (low white blood cell count).A shortage of platelets may lead to easy bruising or bleeding; anaemia may contribute to weakness, fatigue or shortness of breath; and lack of normal white blood cells can lead to infection and fever.

“Other main symptoms include bone or joint pain, anorexia, abdominal swelling in the form of enlarged liver or spleen which may cause loss of appetite and weight loss, and lymphadenopathy – swelling of lymph nodes,” Dr Tariq further added.

About 8,000to 10,000 new cases of paediatric leukemia are reported annually in Pakistan: WHO

“Although making lifestyle changes, such as giving up smoking, can lower the risk of many adult cancers; there is currently no known way to prevent the majority of childhood cancers. There is no sure-fire way to prevent leukaemia from developing in host children because there are no identified risk factors for the disease,” said Child Specialist Dr Chaudhary.

It is crucial to understand that, in the vast majority of cases, there is nothing that these kids or their parents could have done to prevent it because there are so few known environmental or lifestyle-related causes of paediatric leukaemia.

He also mentioned that parenting a child who has leukaemia requires knowing your child’s treatment plan, maintaining a positive outlook, set a routine, be patient and adaptable, and find a balance between overprotecting and overindulging your child.

Is Paediatric Leukemia Curable?

Child Specialist Dr Tariq further explained that its prognosis depends on the age, gender and type of leukemia. Children between the ages of 1 and 10 tend to have better cure rates. Children under 1 year old and those 10 years old or older are regarded as high-risk patients.

“Males have poor prognosis than females, and it occurs more frequently in men. The chromosomal structures also play a role; the Philadelphia chromosome (9;22) have a less favourable prognosis while syndrome chromosomes 10, 14 and 17 are more likely to be cured adding that it  also depends on the initial white blood cell (WBC) count; children who have very high WBC count (greater than 50,000 cells per cubic millimetre) has a poor prognosis and need more intensive treatment.

Abysmally, there are only 13 centres for childhood cancer care in Pakistan

According to Dr Tariq, “This illness is treatable. If the disease is identified early on, treatment is initiated promptly, and there are favourable prognostic variables present; 80–85% of patients, particularly children, recover from it. There are approximately 15 to 20% risks of relapse due to delayed diagnosis, delayed therapy and the absence of favourable prognostic factors.”

Dr Imran mentioned that chemotherapy is the main treatment for the majority of paediatric leukaemia. “High-dose chemotherapy paired with a stem cell transplant may be given to some kids with higher risk leukaemia.”

The emphasis should be on early diagnosis and suitable treatment since most paediatric cancers cannot be prevented. For the purpose of early detection of cancer, routine medical examinations must be performed every six to twelve months. One of the reasons that prompt cancer treatment for children is delayed because parents frequently try alternative medical treatments like spiritual healing instead of seeing an oncologist right away, which further delays curative therapy.

Pakistan’s Paediatric Cancer Survival Rate is Appalling

According to a report by the Children Cancer Foundation (CCF), Pakistan is one of the few developing nations whose success rate in curing its cancer-stricken children is among the lowest. Only 15 per cent of the children in Pakistan are cured, compared to up to 75 per cent of children in developed countries and 20 per cent of children in most developing nations.

There are few good-quality cancer treatment centres in Pakistan. Due to the lengthy hospital stays required for cancer treatment, the rate of abandonment is significant once a diagnosis or course of treatment has begun. Although the sick is offered free treatment, the impoverished cannot afford that. The government must step in and begin building state-of-the-art cancer treatment facilities at all major public hospitals.

With the aid of nuclear medicine and radiation oncology technology, the Pakistan Atomic Energy Commission (PAEC) has developed 18 medical facilities across the country.

The incidence rate of leukemia is 4.1% and mortality rate is 4.2% in Pakistan: WHO

According to the budget for the year 2022-23, government has allocated Rs12.65 billion for the health sector in Islamabad and Rawalpindi under the Public Sector Development Programme (PSDP). In the new budget, Rs.379.77 million have been proposed for Mother and Child Care Center Islamabad.

Furthermore, the government has dispensed Rs250 million in the budget for the proposed cancer hospital to be built in Islamabad, which will offer cutting-edge medical care to cancer sufferers.

Moreover, Rs900 million have been assigned for the cancer hospital of the PAEC in AJK. Also Rs1.795 billion has been allotted in the PSDP for the improvement of PAEC’s cancer hospital Kiran in Karachi.

As per UNICEF Pak Annual Report 2020, Pakistan’s health spending is still low when compared to the needs of its people. The World Health Organization recommends that health and nutrition expenditures should account for 5 per cent of GDP, yet only 1.1 per cent of GDP is spent on these areas.

To combat childhood cancer, there is an urgent need to raise public awareness of the condition. Due to a lack of awareness, the majority of paediatric cases in Pakistan go unreported and are not promptly diagnosed; this is a serious problem. The government must take initiatives to raise awareness of childhood cancer, early diagnosis, and treatment options.