Central Asia

Nepal

At the INCTR Office at Scheer Hospital in Nepal, Dr Sankanarayanan (left) and colleagues assemble a culposcope provided by IARC to help detect cervical cancer.

In February, Dr Ian Magrath and Melissa Adde visited Nepal, where they met with Dr Sankaranayanan of the IARC and various collaborators to discuss joint studies (involving the IARC, INCTR and the Nepalese Cancer Relief Society) in population-based cancer registration and in the prevention and early detection of cervical cancer.

With respect to a population-based cancer registry, all agreed that this could be implemented at the BP Koirala Memorial Cancer Hospital (BPKMCH), a comprehensive cancer center supported by the government, located in Bharatpur in the Chitwan district in Eastern Nepal, 150 km from Kathmandu. The BPKMCH has steadily increased the number of new cancer patients cared for annually and is expected to see more than 2,000 new cases this year. Dr Sankaranayanan felt that a large proportion of the cancer cases in the Chitwan district (population 475,000) are presently being seen at the BPKMCH itself, while the remainder are probably treated at one of three existing radiotherapy facilities in Nepal – Bir Hospital, Kathmandu, Bhaktapur Cancer Care Centre (BCCC), Bhaktapur, and the radiotherapy facility at the Medical College, Pokhara – or through the medical and surgical oncology facilities at the Tribhuvan University Hospital, Kathmandu.

Dhurba Bahadur Rawat, President of the Lalithpur branch of the Nepal Cancer Relief Society, outside the Early Detection Cancer Clinic in Lalithpur, Nepal.

If active case finding at the above five facilities and other selected sources (e.g., major centers in India) were to be implemented, a population-based cancer registration for the Chitwan district would be feasible. One staff member at the BPKMCH has already received training in population-based cancer registration at the IARC. An additional cancer registrar's position would greatly facilitate cancer registration and communication among the other institutions.

Further discussion of existing and planned cancer control activities in Nepal took place with representatives of BPKMCH, BCCC, Tribhuvan University Hospital, Bir Hospital, the Nepal Cancer Relief Society and the Nepal Network for Cancer Treatment and Research (NNCTR, INCTR's Nepalese collaborating unit), who were enthusiastic about such collaboration. The BCCC, BPKMCH, and the Scheer Memorial Hospital (where the NNCTR office has been established) will participate in an IARC-supported early detection program for cervical cancer. A course will be organized to train nurses in the screening methods and to train doctors in colposcopy and LEEP. The IARC would provide the equipment required, including colposcopes, cryotherapy devices, LEEP apparatus, speculae, reagents, punch biopsy kits and other supplies. The screening method to be used is visual inspection of the cervix with acetic acid. This is considerably cheaper than the western standard of pap smears. Because no delay is involved in obtaining the results, as is the case when pap smears are performed, this will eliminate the need to recall screened women and will reduce the chance that early lesions will go untreated. Women with positive lesions can usually be treated at the same visit, e.g., with cryotherapy.

Members of the Nepal Network for Cancer Treatment and Research (NNCTR) are eager to join a collaborative effort to facilitate cancer control activities in Nepal.

Radha P Nakarmi, Program Officer, and Amala Devi Manandhar, Assistance Officer, presently staff the NNCTR office at the Scheer Memorial Hospital. During this visit, it was agreed that the NNCTR would become a Branch of the INCTR, since it will function at the regional and national levels.

Magrath and Adde also visited the Medical School of Kathmandu University, located at the Scheer Memorial Hospital. Dr Arjun Kaki, the Director of the Medical School and Dr Sharma, the Vice-Chancellor of Kathmandu University, expressed interest in having the INCTR design and conduct an intensive course for medical students in cancer control. Plans were made to schedule a course for June 2003.