Cancer in Bangladesh: a model for some problems and proposed solutions in the Third World

Bangladesh typifies Third World cancer problems. Soluble problems include 1) assessment: establishment of national and hospital-based cancer registries for factual assessment of incidence and prevalence rates, which are different from those in the West and commonly include cancers of the head and neck or oropharynx, lymphoma, bronchus, esophagus, uterine corpus and cervix, penis, and hepatocellular carcinoma. These facts have consequences for 2) primary prevention. Three common cancers may be preventable--bronchus (smoking), head and neck (alcohol, tobacco and betel nut chewing, smoking), and hepatocellular carcinoma (mold contamination of unrefrigerated stored grains, hepatitis B vaccination). Four common cancers are often amenable to definitive treatment if only they are subjected to 3) early detection. These are cancers of the oropharynx (leukoplakia), cervix uteri (Pap smear), breast (self-exam) and hepatocellular carcinoma (serum alpha-fetoprotein levels). In addition, an analgesic plan at all levels of health care delivery might be instituted. These are practical, low-technology, and cheap and might result in the relief of much misery.