By Muhammad Zuhair
Hospital authorities in Skardu recently confirmed six cancer cases reported at the Regional Headquarters Hospital in a single day. For a region with a relatively small and scattered population, the number is unsettling. It does not, on its own, establish that cancer incidence is rising but it adds to a concern that has been quietly taking hold across Baltistan: cancer appears to be becoming more visible in our communities, while we still know remarkably little about its actual scale. The real problem is not simply that cancer appears to be increasing; it is that we lack the data to know whether it is.
Last year, DAWN, citing an oncologist at RHQ Hospital Skardu, reported that the number of cancer patients recorded across Baltistan had crossed 2,000. The hospital was treating around 150 patients at the time and had referred approximately 90 to better-equipped facilities elsewhere in the country. More striking was the report of 26 cancer cases from Khundus valley in Ghanche, a union council with a population of roughly 3,500.
These numbers naturally cause alarm. They also expose a more fundamental problem we do not have a population-based cancer registry that can tell us how many people in Gilgit-Baltistan develop cancer each year, which cancers are increasing, which age groups are most affected, or whether particular districts and valleys carry a disproportionate burden.
An increase in patients presenting at a hospital may reflect a genuine rise in disease, but it can also result from better diagnosis, increased awareness, improved referral, population growth or changes in access to healthcare. Without systematic registration over time, separating one explanation from another becomes difficult.
This is why it would be premature to declare that Skardu is experiencing a cancer epidemic. It would be equally unwise to dismiss the concern simply because the epidemiological evidence is incomplete. There are other signs that the health profile of Gilgit-Baltistan has been changing considerably.
Research in villages of Ghizar found hypertension among men rising from 14.1 per cent to 45.6pc between 1995 and 2014, and among women from 16.6pc to 37.6pc, with obesity increasing over the same period an illustration of how rapidly the health profile of mountain communities can change. Food habits have changed alongside it. Packaged and highly processed foods are more available than a generation ago, traditional patterns of physical activity are shifting, and tobacco remains another preventable risk.
Salt consumption is particularly striking. A study examining nutrition and environmental micronutrients in Gilgit-Baltistan estimated average salt intake at about 13 grams per person per day more than twice the World Health Organisation’s recommended limit of less than five grams. The same research found low iodine and selenium availability, suggesting that dietary excess and micronutrient deficiency can exist side by side.
Cancer is not a disease with a single cause. Age, genetics, infections, tobacco, diet, obesity, occupational exposures and environmental factors can all influence risk, often over decades. Looking for one culprit may be tempting, but it is unlikely to give us the answer.
Environmental findings from the region nevertheless deserve closer attention. Recent research examining drinking water, vegetables and soil in Skardu and Gilgit has reported potentially concerning concentrations of several heavy metals, including chromium, nickel and cadmium, in some samples, with risk assessments raising concerns about possible long-term health effects.
Finding potentially hazardous metals in drinking water does not prove that they have caused cancer among people living in Skardu. Environmental risk and demonstrated cancer causation is not the same thing. But when contaminants of potential health significance are detected in water consumed by local communities, the appropriate response is not indifference it is more extensive testing, regular monitoring and action where unsafe exposure is confirmed. The same should apply to food if questions exist about the quality of meat, poultry and processed foods transported into the region, veterinary and food-safety authorities should inspect products routinely, test them where necessary and make the findings public.
Cancer patterns reported by local hospitals provide another reason for closer investigation. A four-year hospital-based study published this year examined 121 surgically treated malignancies in Gilgit-Baltistan. Stomach cancer was the most frequent tumor site, at 18.1pc, followed by skin cancer at 15.7pc. Colorectal and breast cancers each accounted for 9pc, while gastrointestinal malignancies together represented 35.3pc of cases studied. These figures describe the distribution of cancers among patients treated surgically at one hospital not the prevalence of cancer in the population. The authors themselves make this limitation clear and call for a regional cancer registry.
That recommendation goes to the heart of the problem. We should know how many new cancer cases are diagnosed in Gilgit-Baltistan every year, what types they are, the age and sex of patients, where they live, and at what stage their disease is detected. Over time, such information would let researchers identify trends and investigate apparent clusters instead of relying on scattered hospital records and anecdotal reports.
The absence of reliable data also makes it easier for speculation to fill the gap. One person blames the water, another food, and other changing lifestyles. Each may contain an element worth investigating, but none can substitute for epidemiology.
For patients and families, the problem is far less abstract. A cancer diagnosis in Skardu frequently means travelling to Islamabad, Lahore or another major city for specialized investigations and treatment. Transport, accommodation and repeated journeys add substantially to the financial burden of the disease for a family with limited income, geography itself becomes part of the cost of cancer. Women in remote communities face additional barriers: distance from healthcare facilities, limited availability of female healthcare providers and reluctance to discuss breast or reproductive health can all delay consultation. Strengthening awareness, early diagnosis and screening and referral services needs to be part of any regional cancer strategy.
So where should we begin? The most immediate requirement is a population-based cancer registry for Gilgit-Baltistan. This is not an elaborate intervention; it is basic public-health infrastructure. Without reliable registration, authorities cannot plan services properly, researchers cannot establish trends, and the public cannot be given an evidence-based answer to whether cancer is actually increasing.
Environmental surveillance should follow the same principle. Water quality cannot be assessed through occasional research projects alone drinking-water sources should be tested routinely for contaminants of health concern, with results made public. Food-safety monitoring should similarly become systematic rather than reactive. Where unusual concentrations of cancer cases are reported, properly designed epidemiological studies should investigate them; hospitals and universities have an obvious role, but sustained work will require support from the GB government and public-health authorities.
There are also measures that do not need to wait for perfect data: tobacco control, lower salt consumption, healthier diets, physical activity, greater awareness of early cancer symptoms and improved access to diagnosis are worthwhile regardless of what a future cancer registry shows. Local diagnostic and oncology capacity needs strengthening too, alongside an organized referral system for patients requiring treatment outside the region.
The challenge is to avoid both alarmism and complacency. Six cancer cases reported at a hospital in one day cannot tell us that cancer is rising across Baltistan. Neither can a collection of hospital records establish what is causing the disease. But neither should these numbers be treated as meaningless.
Gilgit-Baltistan is routinely celebrated for its mountains, glaciers and seemingly pristine environment. That image should not discourage scrutiny of the health of those who live among them.
The writer is a PhD researcher in cancer biology at School of medicine University of Campinas (UNICAMP), Brazil, and is from Skardu, Gilgit-Baltistan.
