Cancer prevalence in Pakistan: meta-analysis of various published studies to determine variation in cancer figures resulting from marked population heterogeneity in different parts of the country

Abstract

Background: Pakistan's population is ethnically diverse with distinct ethnic groups inhabiting various parts of the country. Cancer statistics obtained from specific regions populated by distinct ethnic groups may vary considerably. There is no national cancer registry. To determine whether there are indeed significant statistical differences in cancer incidence and prevalence, data was recorded from different parts of Pakistan based on the ethnic composition of the population in those parts.

Methods: Ten papers (original articles) on cancer incidence and prevalence in Pakistan published in the last two decades were selected from PubMed and Google Scholar. Meta-analysis of findings of these studies was performed using Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. χ²-based I² test was used for evaluating heterogeneity and Forest plots were generated for calculating unadjusted prevalence estimates. Oral, gastric, prostate, breast, and colorectal cancers were selected for meta-analysis. I² values of 75% or greater indicated high heterogeneity.

Results: All five types of cancer selected for meta-analysis (performed on studies carrying similar statistical weights) showed extremely high heterogeneity with I² values of 99.7% for oral cancer, 98.6% for prostate cancer, 98.3% for gastric cancer, 99.8% for breast cancer, and 85.4% for colorectal cancer. p values for all cancers were highly statistically significant.

Conclusions: Our findings show that the prevalence rates of different cancer types demonstrate marked variation in different studies depending on the place of origin of the study and dominant ethnic group in that region, and these variations are highly statistically significant. A national cancer registry needs to be established as soon as possible.

Keywords: Breast cancer; Cancer incidence; Cancer prevalence; Cancer registry; Colorectal cancer; Gastric cancer; Oral cancer; Pakistan; Population heterogeneity; Prostate cancer.

Fig. 1

Prevalence of oral cancer in Pakistan. Forest plot showing prevalence (%) estimates with 95% confidence intervals and weights allocated to each study based on sample size. The overall pooled prevalence estimate was 0.09 or 9%; I² = 99.7%: high heterogeneity; p value was significant (p = < 0.001)

Fig. 2

Prevalence of prostate cancer in Pakistan. Forest plot showing prevalence (%) estimates with 95% confidence intervals and weights allocated to each study based on sample size. The overall pooled prevalence estimate was 0.05 or 5%; I²= 98.6%: high heterogeneity; p value was significant (p = < 0.001)

Fig. 3

Prevalence of gastric cancer in Pakistan. Forest plot showing prevalence (%) estimates with 95% confidence intervals and weights allocated to each study based on sample size. The overall pooled prevalence estimate was 0.06 or 6%; I²= 98.3%: high heterogeneity; p value was statistically significant (p = < 0.001)

Fig. 4

Prevalence of breast cancer in Pakistan. Forest plot showing prevalence (%) estimates with 95% confidence intervals and weights allocated to each study based on sample size. The overall pooled prevalence estimate was 0.31 or 31%; I²= 99.8%: high heterogeneity; p value was statistically significant (p = < 0.001)

Fig. 5

Prevalence of colorectal cancer in Pakistan. Forest plot showing prevalence (%) estimates with 95% confidence intervals and weights allocated to each study based on sample size. The overall pooled prevalence estimate was 0.05 or 5%; I²= 85.4%: high heterogeneity; p value was statistically significant (p = < 0.001)