Cancer burden epidemiological patterns and healthcare disparities across five major cancers in Pakistan

Abstract Cancer poses a substantial health burden in Pakistan, with breast, lip and oral cavity, lung, colorectal, and esophageal cancers leading in incidence and mortality. Breast cancer accounts for 30,682 new cases and 15,552 deaths, followed by lip and oral cavity cancer (15,915; 10,181), lung cancer (9,464; 8,307), colorectal cancer (9,447; 5,235), and esophageal cancer (9,289; 8,704). The persistently high mortality across these cancers reflects critical disparities, ranging from delayed diagnosis and demographic factors to inadequate treatment access and poor survival outcomes. This review analyzed the epidemiology of the five most prevalent cancers in Pakistan and identified disparities in diagnosis, demographics, risk factors, and healthcare access. A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar for English-language publications from 1990 to 2024, supplemented by GLOBOCAN data. The review highlighted how these inequities contribute to high incidence, delayed detection, and poor survival outcomes. Breast cancer disproportionately affects rural and low-income women, with delays in diagnosis and treatment due to stigma, limited awareness, and financial barriers. Oral cancer is more common in men due to tobacco use, while younger patients and rural populations face aggressive disease and late detection. Lung cancer mainly affects older men, with smoking, air pollution, and limited healthcare access contributing to advanced-stage diagnoses. Colorectal cancer shows delayed detection in older adults and aggressive forms in younger patients, compounded by poor screening and awareness. Esophageal cancer exhibits regional disparities, with rural areas experiencing more squamous cell carcinoma and late diagnosis, while urban populations show a rise in adenocarcinoma. Based on these disparities, targeted strategies were proposed for each cancer type, alongside broader measures to enhance early detection, improve healthcare access, and increase public awareness. Addressing these inequities is essential to reduce mortality and improve cancer outcomes across Pakistan.