Bangladesh is facing a growing cancer burden with rising incidence and mortality rates. Limited healthcare infrastructure, high costs, and a shortage of trained professionals contribute to inadequate cancer care, especially in rural areas. Although the country has implemented the “Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases” to improve cancer care, significant gaps remain in access to diagnostic tools, specialized treatment, and affordable cancer drugs. Community-based screening programs for breast and cervical cancer have been introduced, but have limited coverage. Efforts to establish comprehensive cancer centers in each division and integrate advanced technologies, like AI, are underway to enhance early diagnosis, treatment, and surveillance. There is a need for improved healthcare governance, sustainable financing, and collaboration among various sectors to manage and reduce the cancer burden in Bangladesh effectively. Establishing a National cancer registry, expanding access to specialized care, and enhancing research capabilities are crucial steps for improving cancer care management.

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Demographic differential has been linked with the treatment outcome and survival in recent literature, mostly from the developed world. Considering diversity in population characteristics across income strata, it’s worth assessing the link in low- and middle-income population as well. Current study aimed to assess the association of demographic characteristics with lung cancer survival in Bangladeshi lung cancer patients. Methods & results: All newly diagnosed primary lung cancer cases attending the national institute of cancer research & Hospital (NICRH), a tertiary cancer care center in Dhaka, Bangladesh between 2018 and 2019 were considered for the study. Demographic information and clinical data were obtained from the patients’ medical records by a trained physician. Survival estimate was generated using the Kaplan-Meier method and compared across demographic and clinicopathological categories using the log-rank test. Hazard ratio and 95% CI for treatment options are generated fitting multivariable Cox proportional hazard regression. Among 1868 patients, 84.6% were males and 15.4% were females, average (± standard deviation) age at diagnosis was 59.6±10.9 years, only 10.8% had not consumed tobacco of any form. Around two-thirds of the patient had Eastern Cooperative Oncology Group (ECOG) performance score ≥2, 29.5% had at least one comorbidity and 19.4% had metastasis at the time of presentation. Higher survival was associated with institutional education (HR 0.9; 95% CI 0.77, 0.99), and receipt of combined radiotherapy and chemotherapy (HR 0.56; 95% CI 0.46, 0.65; p <0.001). In contrast, lower survival was associated with older age between 60–69 years (HR 1.3; 95% CI 1.3, 1.5;), age ≥ 70 years (HR 1.4; 95% CI 1.1, 1.7), having any comorbidity (HR 1.1; 95% CI 1.0, 1.3), with ECOG score ≥ 3 (HR 1.41; 95% CI 1.01, 1.96) and receipt of radiotherapy treatments only (HR 1.6; 95% CI 1.3, 1.9). Conclusion: Older age, presence of one or more comorbidity, poorer performance status, and treatment with only RT appeared as a significant predictor of poorer prognosis of lung cancer in Bangladeshi patients. In contrast, having institutional education and treatment with combined Radiotherapy and Chemotherapy appeared as a predictor of a better prognosis. The finding of this study could serve as a basis for future studies inquiring into novel approaches for certain subgroups of patients believed to be challenged in limited resources.

Lung cancer remains a leading cause of cancer-related deaths globally, with increasing incidence among females. Sex differences in lung cancer risk and outcomes are influenced by various factors, including biological characteristics. In Bangladesh, where lung cancer mortality rates are high, patients often present at advanced stages. However, real-time data on sex-specific survival outcomes for inoperable lung cancer in Bangladesh is lacking. This retrospective study analyzed patients with inoperable lung cancer at the National Institute of Cancer Research and Hospital in Dhaka, Bangladesh, from 2018 to 2019. Patient demographics and clinical parameters were assessed, with survival tracked until June 2020. Statistical analyses included descriptive statistics, Chi-square tests, t-tests, Kaplan-Meier curves, and multivariable Cox regression models. Females were diagnosed at a younger age (55.3 ± 12.7 vs 60.5 ± 10.2 years, p < 0.001) and had higher comorbidity rates (36.2 %, p = 0.004). Males had higher smoking rates, while females used more smokeless tobacco. Adenocarcinoma was more prevalent in females (47.2 %) and squamous cell carcinoma in males (42.7 %). After adjusting for various factors, females showed a significant survival advantage (median 16 vs 12 months), particularly in adenocarcinoma (HR: 0.64, 95 %CI:0.46-0.90, p = 0.01) and squamous cell carcinoma (HR: 0.52, 95 %CI:0.32-0.85, p = 0.009). Females also demonstrated better survival when receiving supportive care, chemotherapy, or radiotherapy alone but not in combined therapy. Older males (>70), illiterate, smokers, and those with comorbidities had a poor prognosis compared to females. This study reveals significant sex-based differences in inoperable lung cancer patients in Bangladesh. Despite earlier diagnosis and higher comorbidities, females demonstrated better survival rates, particularly in adenocarcinoma and squamous cell carcinoma. These findings highlight the need for sex-specific approaches in lung cancer management to improve patient outcomes.

Background: Breast cancer poses a significant health challenge in Bangladesh, where limited screening and unique reproductive patterns contribute to delayed diagnoses and subtype-specific disparities. While reproductive risk factors such as age at menarche, parity, and contraceptive use are well studied in high-income countries, their associations with hormone-receptor-positive (HR+) and triple-negative breast cancer (TNBC) remain underexplored in low-resource settings. Methods: A case-control study was conducted at the National Institute of Cancer Research and Hospital (NICRH) including 486 histopathologically confirmed breast cancer cases (246 HR+, 240 TNBC) and 443 cancer-free controls. Socio-demographic and reproductive data were collected through structured interviews. Machine learning models—including Logistic Regression, Lasso, Support Vector Machines, Random Forest, and XGBoost—were trained using stratified five-fold cross-validation. Model performance was evaluated using sensitivity, F1-score, and Area Under Receiver Operating Curve (AUROC). To interpret model predictions and quantify the contribution of individual features, we employed Shapley Additive exPlanation (SHAP) values. Results: XGBoost achieved the highest overall performance (F1-score = 0.750), and SHAP-based interpretability revealed key predictors for each subtype. Rural residence, low education (≤5 years), and undernutrition were significant predictors across subtypes. Cesarean delivery and multiple abortions were more predictive of TNBC, while urban residence, employment, and higher education were more predictive of HR+. Age at menarche and age at first childbirth showed decreasing predictive importance with increasing age for HR+, while larger gaps between marriage and childbirth were more predictive of TNBC. Conclusions: Our findings underscore the value of machine learning coupled with SHAP-based explainability in identifying context-specific risk factors for breast cancer subtypes in resource-limited settings. This approach enhances transparency and supports the development of targeted public health interventions to reduce breast cancer disparities in Bangladesh.

In colorectal carcinoma (CRC), 5-fluorouracil (5-FU) remains the cornerstone of adjuvant systemic therapy, with folic acid (FA) serving as an essential adjunct. Expression of genes related to the metabolism and action of 5-FU and FA can be influenced by patient- and tumor-specific biological factors. In this study, we explore differential gene expression profiles of 180 genes representing 14 different gene sets associated with different 5-FU and FA metabolism processes, at both gene and pathway levels across clinical and molecular subgroups. In 71 patients with CRC, paired tumors and normal colonic tissues were analyzed. In CRC tissue, several gene sets (including Cell Cycle Checkpoint, Oxidative Stress Response, and Signaling Pathway, etc.) were upregulated, while three gene sets (Apoptotic, Tumor Suppressor, and Endoplasmic Reticulum Stress) were downregulated. Kirsten rat sarcoma virus (KRAS), tumor protein p53 (TP53), and microsatellite instability (MSI) status impacted gene expression across molecular subgroups. At the individual gene level, among cell cycle genes, the BUB3 mitotic checkpoint protein (BUB3) was upregulated in MSI tumors compared to MSS, whereas SMAD family member 4 (SMAD4) was downregulated in MSS tumors compared to MSI. DNA fragmentation factor alpha (DFFA) was downregulated in MSI and upregulated in MSS. Notably, thymidylate synthetase (TYMS) was more upregulated in MSI tumors (1.65-fold; 95% CI: 1.27–2.13) compared to MSS (1.19-fold; 95% CI: 1.02–1.39). Dysregulation of these genes across these factors will broaden our understanding of 5-FU-based treatment in CRC. Furthermore, targeting dysregulated pathways could form the basis for improved precision therapies tailored to CRC subtypes.