Sri Lanka has made significant strides in cancer management during the last decade. Last week, Sri Lanka concluded a comprehensive review of National Cancer Control facilitated through the integrated mission of Programme of Action for Cancer Therapy (imPACT). The mission exemplifies a collaborative effort among international organizations, including the World Health Organization (WHO), International Atomic Energy Agency (IAEA) and International Agency for Research in Cancer (IARC). Additionally, prominent cancer institutions such as St Jude Children’s Research Hospital and MD Anderson Cancer Center from the United States of America have contributed to the expertise.
In 2019, Sri Lanka undertook a similar imPACT review, which laid the groundwork for the development of the National Strategic Plan on Prevention and Control of Cancer in Sri Lanka (2020-2024).
The imPACT Review serves an advisory service offered by IAEA, IARC, and WHO to assess the country's capacities and needs in the realm of cancer prevention and management. The specific focus areas of the review mission in Sri Lanka, as identified by the Ministry of Health, included:
- Primary prevention initiatives particularly in relation to HPV vaccination, cervical cancer screening, tobacco control including use of smokeless tobacco and areca nut use.
- Efforts in early detection of oral, cervical and breast cancers, alongside the necessity for population-based screening for other high burden cancers.
- Assessment of cancer management services evaluating the needs and capacities of major cancer hospitals for diagnosis and treatment.
- Evaluation of childhood cancer programme aligning it with ongoing activities by the WHO Global Initiative for Childhood Cancer.
- Exploration of the current health system financing for cancer control identifying potential collaborative opportunities with development partners and bilateral donors.
- Analysis of palliative care programme at both national and provincial level.
- Assessment of cancer related workforce needs across all oncology disciplines.
- Review of supply chain management system of cancer medicines and essential cancer diagnostic and treatment commodities.
The review process involved a collaborative effort between national and international experts, with designated teams utilizing virtual discussions, desk reviews and consultations to document the progress of the cancer prevention and management in Sri Lanka. This was followed by an in-country mission conducted from 23-29 March 2025, which included observation visits to cancer institutes, and interactions with senior officials and key stakeholders.
Sri Lanka is facing increasing burden of cancers. Between 2005 to 2021, the prevalence of various cancers - including breast, cervical, oral, lung, and colorectal cancers, has risen significantly contributing to morbidity and mortality rates. According to data from National Cancer Control Programme, age-standardized cancer incidence rates have increased from 70 per 100 000 adult population in 2005 to 151 per 100 00 adults by 2021 (figure 1). Many cancers are diagnosed at advanced stages, with 37% or breast cancer, 45% cervical cancer, and 63% oral cancers cases identified at stage III or above. Estimates from the global cancer observatory indicate that the cumulative risk of developing cancer before the age of 75 years was 11.4% in 2022, with 3% of all cancers occurring in children. Furthermore, the incidence of childhood cancers has surged from 73.1 per million population in 2005 to 107.8 in 2019 (figure 2).
Figure 1: Age Standardized Cancer Indicence rates in Sri Lanka.
Source. Sri Lanka Cancer incidence and mortality data 2021.
Figure 2: Age standardized incidence rate of childhood cancer in Sri Lanka.
Source: Childhood cancer registry Sri Lanka 2021
Research shows that between 30% and 50% of cancer deaths could be prevented by modifying environmental and behavioral risk factors, including infection control. The NCD Risk Factors Survey (STEPS) conducted in Sri Lanka in 2021 and recent surveys among the youth highlight a rise in prevalence of several behavioral risk factors. These risks increase the likelihood of developing cancer. There has been an almost a 30% increase in registered cancer cases during the last five years, with projections suggesting a further 42.5% increase in new cases by 2050.
The review team noted key areas of progress in cancer control in the past five years. First dose HPV vaccination coverage surpassed over 90% and cervical cancer screening coverage exceeded 50%, aligned with country’s objectives to eliminate cervical cancer as a public health priority by 2030. Advancements in clinical services have been made, including installation of new radiation therapy machines, establishment of outpatient chemotherapy services, and development of national guidelines for diagnosis and treatment of specific cancers. Additionally, palliative care consultation services are available in 11 institutions, with 230 public health nursing officers providing palliative home care.
On the concluding day of the mission, the imPACT review team presented preliminary recommendations to the Minister of Health aimed at further improving the cancer services in Sri Lanka. These recommendations include:
- Establishing an inter-ministerial body to oversee cancer-related policies and programmes addressing health and non-health areas.
- Implementing targeted risk factor and early detection interventions for estate workers, fishermen, and agriculture workers.
- Transitioning to a single-dose HPV vaccination schedule and adopting HPV DNA test-based cervical cancer screening.
- Strengthening the national early diagnosis programme and streamlining referral process.
- Improving care quality standards across facilities and levels of care.
- Integrating palliative care early in the disease progression and optimizing the use of hospices.
- Reducing out of pocket expenses through strategic purchasing to ensure financial protection, equitable access and universal health coverage.
- Institutionalizing of cancer registration and surveillance, including expanding population-based cancer registries (PBCR).
The mission team will continue to refine these
recommendations over the coming weeks and submit a comprehensive final report
to the Ministry of Health. The insights and recommendations outlined in the
report will inform the planned updates to the National Strategic Plan on Cancer
Control, set to effect from 2025, as well as the 'National Health Strategic
Master Plan 2026-2035. By incorporating
these recommendations into the new strategic plans, Sri Lanka aims to ensure that its cancer preventive and
management interventions are well aligned with the WHO South-East Asia Regional
Strategy for comprehensive cancer prevention and management 2024–2030 and the global
initiatives on cancer, including the Global Initiative for Childhood Cancer (GICC)
(2018), Global Strategy to Accelerate the Elimination of Cervical Cancer
(2020), Global Breast Cancer Initiative (2021), Global Initiative for Cancer
Registry Development, and the Rays of
Hope initiative to boost radiation medicine (2022).
In addition to these recommendations, the review team has identified opportunities for programmatic support and advisory services that can be provided by WHO, IAEA, IARC, and other partners to further enhance country's capacity and its needs in cancer prevention and control. The journey ahead is critical, as Sri Lanka works to combat growing burden of cancer and improve health outcomes of its population.
1. https://www.who.int/health-topics/cancer#tab=tab_1
2. https://www.who.int/teams/noncommunicable-diseases/surveillance/data/cancer-profiles
3. https://www.nccp.health.gov.lk/en
4. https://www.iaea.org/services/review-missions/impact-reviews