Cancer poses an increasing and damaging public health challenge in Bangladesh, necessitating improved methods for understanding and combating the disease. Although there are several existing hospital-based registries, including the one at the National Institute of Cancer Research and Hospital (NICRH), Bangladesh lacks a centralised or national cancer registry.

Broadly, registries are of two types: hospital-based and centralised or national registries. A hospital-based cancer registry (HBCR) collects cancer data from a specific hospital or network of hospitals. Ideally, it focuses on detailed clinical information about patients treated there, aiming to improve care and support local research. However, the data does not represent the broader population, and maintaining the registry can require significant resources.

In contrast, a national cancer registry (NCR) gathers cancer data from multiple healthcare facilities across the country. This registry provides a comprehensive view of cancer trends and helps in public health planning. Although it may lack the detailed clinical data found in HBCRs, it offers insights into national patterns. However, both registries serve important but different roles in cancer management and research.

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The NICRH started a hospital-based registry in 2015. According to its report, patients with late-stage diagnoses are the majority, with 77 percent untreated before reaching the institute. The report highlights regional disparities in access to cancer care. However, lack of a comprehensive population-based cancer registry limits expansive national insights. This significantly hampers our ability to identify cancer incidence, prevalent types, and mortality rates across the country. A national registry would enable healthcare professionals and policymakers to gather critical data on patient demographics, cancer diagnoses, treatment details, and geographic distribution. This information is vital for planning effective prevention strategies, early detection initiatives, and tailored treatment options. Understanding cancer trends would also help identify high-risk populations and regions that require targeted interventions.

However, there are challenges to implementing an NCR. Financial constraints and inadequate healthcare infrastructure can hinder both the establishment and maintenance of an effective registry. Besides, variability in reporting methods across healthcare facilities and a lack of trained personnel can lead to inconsistencies and inaccuracies in the data. Also, since access to healthcare services varies significantly between urban and rural areas, it may result in underreporting of cases in less accessible regions. Cultural stigma associated with cancer, along with limited awareness about the importance of cancer registration, may also deter individuals from participating in the registry. Thus, it is critical to ensure the confidentiality and security of sensitive health information and build public trust in the system.

We can take lessons from Sri Lanka's National Cancer Registry (NCR), established in 1985. It is considered one of the most successful cancer registries among developing countries. Besides, Sri Lanka faces challenges similar to Bangladesh's, such as limited resources, inadequate healthcare infrastructure, and cultural stigma associated with cancer, as well as a high burden of cancer with a significant proportion of cases being diagnosed at an advanced stage.

Key differences between the two countries include Sri Lanka's strong government commitment to cancer control, high data quality and standardisation, strong partnerships with international organisations, public awareness and education initiatives, and long-term sustainability of measures. Bangladesh can learn from Sri Lanka's example by prioritising cancer control, allocating sufficient resources to the registry, improving data quality, establishing partnerships, implementing public awareness campaigns, and ensuring the long-term sustainability of programmes.

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Securing strong government support and establishing a clear policy framework are essential first steps. Building partnerships with NGOs and international organisations can provide both technical assistance and funding, while utilising technology for data collection can streamline processes and enhance accuracy. Additionally, implementing training programmes for healthcare professionals and conducting public awareness campaigns can promote the registry's importance and encouraging participation.

Since establishing and maintaining a national cancer registry requires significant funding, Bangladesh can explore several funding models to ensure the long-term viability of the registry. These models can ensure a sustainable and robust NCR that supports cancer control and patient outcomes in the country. First, government funding through allocating a dedicated budget for the NCR can ensure a stable funding source for the registry's operations and development. Second, collaboration with international organisations, such as the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), to secure funding and technical assistance can be explored. Third, applying for research grants from local and international funding agencies can be an option to support specific projects and initiatives within the registry. Lastly, a cost-recovery model can be implemented, such as charging for data analysis and research services, to generate revenue and support the registry's operations.

Establishing a national cancer registry is crucial for advancing cancer control in Bangladesh. While challenges are considerable, the potential benefits for public health are significant. By investing in this system, Bangladesh can improve its understanding of cancer incidence, enhance treatment outcomes, remove the vast disparity in cancer management, and ultimately save numerous lives. A well-implemented registry will not only contribute to better cancer care but also foster a healthier future for the nation.

Jabed Iqbal MD, PhD is vice-chair of research in the pathology academic programme at Duke NUS SingHealth, and senior consultant in the Department of Anatomical Pathology at Singapore General Hospital in Singapore. He can be reached at jabed.iqbal@singhealth.com.sg. 

Views expressed in this article are the author's own. 

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