Professor Dr Jalal Arif
Cancer is fast becoming one of Pakistan’s gravest and least acknowledged public-health emergencies. It is not only a disease of hospitals and laboratories; it is a crisis of families, household incomes and social protection. For millions of Pakistanis below the poverty line or in the lower-middle-income bracket, a diagnosis marks the start of a financial struggle that runs alongside the fight for survival. -GLOBOCAN 2022 estimated 185,748 new cancer cases and 118,631 cancer deaths in Pakistan in that year. Worldwide, about 20 million new cases and 9.7 million deaths were recorded, and new cases are projected to exceed 35 million by 2050. Pakistan cannot meet this burden with scattered, hospital-by-hospital efforts. It needs an integrated national strategy with one directing authority.
The real question is no longer whether Pakistan has capable oncologists and modern hospitals; it has both. The question is whether a poor patient in Faisalabad, Multan, Dera Ghazi Khan, rural Sindh, Balochistan or Khyber Pakhtunkhwa can obtain early diagnosis, reach a specialised centre and complete treatment without being financially destroyed. The poor patient fights two battles. A poor family fights cancer and then fights the cost of cancer. The diagnostic journey alone may involve biopsy, histopathology, molecular testing, CT or MRI and PET-CT; treatment may then demand surgery, chemotherapy, radiotherapy, targeted therapy or hormonal therapy. The hidden costs are equally cruel. A patient from a distant district needs transport, lodging and food for weeks, while a daily-wage earner loses income. Families borrow, sell livestock, jewellery or land, or quietly abandon treatment. The hospital is free, but the test is not. The treatment is free, but the medicine is unavailable. That is not genuine universal cancer care. Punjab Chief Minister Maryam Nawaz Sharif has spoken openly of the grief of losing her mother to cancer, and of how heavily the cost of treatment falls on ordinary families. She has turned that personal loss into public resolve. The Chief Minister’s Special Initiative for Cancer Patients now provides free diagnosis, chemotherapy, radiotherapy, surgery and medicines at an annual cost of about Rs13 billion, with a dedicated card covering up to Rs1 million per patient.
On 18 September 2026, she inaugurated at Nishtar Hospital Multan a 100-bed cancer centre, a PET-CT and cyclotron facility and a cryoablation centre, bringing modern staging and minimally invasive therapy to South Punjab and sparing patients the long journey to Lahore. The provincial health minister has also spoken of a linear accelerator for Allied Hospital Faisalabad and a cancer hospital for Dera Ghazi Khan. This must now become the national standard. The government should stand beside every poor patient suffering from cancer and provide tests, medicines and surgeries entirely free of cost, from the first biopsy to the final follow-up, so that no family has to sell its land, livestock or jewellery to buy a life. A province, however, cannot carry a national burden alone. Cancer does not respect provincial boundaries, and Punjab’s example will achieve its full promise only if the federation adds standards, data, financing and coordination. The Nawaz Sharif Institute of Cancer Treatment and Research in Lahore is the most ambitious public-sector cancer project in Pakistan’s history. Planned as a 915-bed comprehensive institute costing over Rs70 billion, it will offer radiology and mammography, radiotherapy, bone marrow treatment and a fully paperless digital system. The Punjab government has pledged that no patient will be denied treatment and that patients from other provinces will be treated free.
Captain (retd) Zahid Saeed, former Chief Secretary Punjab, leads the institute, and a few public servants bring a stronger record to the task. As Chief Secretary from 2016 to 2018, he headed the provincial administration through a period of large development programmes; he later served as Chairman of the Federal Public Service Commission and in 2023 received the Hilal-e-Imtiaz. At the institute, his administrative skill shows in the discipline of delivery: fixed completion timelines for the first phase, regular board reviews of construction and recruitment, and senior appointments such as the Dean made through a special selection board on merit. Yet even a world-class institute in Lahore cannot by itself solve the national problem. It must become the apex of a hub-and-spoke system linked to regional cancer centres, district hospitals, basic health units and digital referral pathways, and its standards must be shared with every province. Pakistan already possesses models of compassionate, high-quality cancer care. For three decades, Shaukat Khanum Memorial Cancer Hospital has shown that professional management, research, cancer registration and public generosity can provide free treatment to roughly three of every four patients; its third hospital, in Karachi, is due to open in December 2026. Combined Military Hospital Lahore is another leading cancer-care hospital, practising multidisciplinary tumour-board decision-making and advanced radiotherapy, with oncologists such as Dr Zeeshan Ahmed Alvi at its core. Dr Alvi is a visionary oncologist, sound in diagnosis and firmly committed to patient-centred, patient-friendly treatment.
The country’s leading oncologists prove that Pakistan does not need to import the idea of modern oncology. Professor Dr Zeba Aziz, head of medical oncology at Hameed Latif Hospital, Lahore, since 1994, founding president of the Society of Medical Oncology of Pakistan and a member of a World Health Organisation expert advisory panel, is among the most respected. In Faisalabad, Dr Muhammad Tahir Bashir, who leads medical oncology at Faisalabad Medical University and Allied Hospital, and Dr Muhammad Khalid of the same university serve the patients of central Punjab. Among the country’s leading oncologists, the late Dr Neelum Siddiqui of Shaukat Khanum Memorial Cancer Hospital will also be gratefully remembered.
Countries that have reduced cancer mortality did so through national frameworks, not isolated institutions. The United States anchored its progress in the National Cancer Act of 1971 and the National Cancer Institute. The United Kingdom pursues successive national cancer plans with measurable targets for early diagnosis. India’s National Cancer Grid links hundreds of hospitals to share protocols, negotiate drug prices and train specialists.
I respectfully urge the Prime Minister and the Federal Minister for National Health Services to constitute a National Commission on Cancer, by executive notification initially and by statute thereafter. It should be chaired by the Federal Health Minister, with provincial health ministers, leading oncologists, public-health experts and representatives of Shaukat Khanum, CMH, the Pakistan Atomic Energy Commission and the Nawaz Sharif Institute, and leaders such as Captain (retd) Zahid Saeed as members or advisers. Its mandate should include:
* A National Cancer Registry. Reliable population-based data on incidence, mortality and survival are the foundation of every rational decision.
* Division-level comprehensive cancer centres. Nishtar Multan should be the model, with similar centres in every division and province, linked to the Nawaz Sharif Institute as the national apex.
* Free tests, medicines and surgery for the poor. Patients below the poverty line should be identified at diagnosis and guaranteed a complete pathway, from biopsy, pathology, CT and PET-CT to surgery, chemotherapy, radiotherapy and follow-up, entirely free of cost and without paperwork.
* Uninterrupted essential medicines, through pooled national procurement and price negotiation, so that treatment never stops for want of a drug.
* A national digital referral and tracking system, so that a patient diagnosed at a district hospital is followed electronically through referral, treatment and follow-up.
* Screening and prevention. Breast, cervical, colorec
