The Current Situation with Colorectal Cancer in Kazakhstan

In the inaugural event of the Global Cancer Movement, initiated by OncoDaily, Abay Jumanov, Head of the Surgery Department at the Kazakh Institute of Oncology and Radiology (KazIOR), explores the state of colorectal cancer care in Kazakhstan. The virtual event, held from December 6-8, 2024, highlighted the nation’s advancements and ongoing efforts to enhance cancer outcomes.

Abay Jumanov, the head of the Abdominal Oncology Department at the Kazakh Institute of Oncology and Radiology, opened his speech by expressing gratitude to the organizing committee of the Global Cards Movement and the institute’s director, Academician Dilyara Kaidarova, for the opportunity to present at the conference. He introduced the topic of her presentation, which focused on the current situation of colorectal cancer in Kazakhstan.

Fabay provided an overview of Kazakhstan, highlighting its vast land area of over 2.7 million square kilometers, making it the ninth-largest country in the world. In 2022, the global incidence of colorectal cancer was 17.6 cases per 100,000 people, while in Kazakhstan, it was slightly higher at 19.8, making it the second most common cancer in the country. In 2023, approximately 4,000 new cases were registered, with an almost equal male-to-female ratio. The mortality rate from colorectal cancer in Kazakhstan stands at 7 cases per 100,000, which is comparable to the global average.

Colorectal cancer ranks second in incidence after breast cancer and third in mortality after lung and stomach cancers. The incidence rate varies across different regions, with the highest rates in the central and eastern regions and the lowest in the southern regions, likely due to dietary differences. The incidence increases from the age of 40, peaking at 60-70 years, before declining in older age groups due to population aging.

Recent years have seen a decline in adverse cases and an increase in early-stage diagnoses, attributed to improvements in early detection and the introduction of a national screening program.

Although screening has led to a rise in detected cases, mortality rates have decreased due to earlier interventions and more effective treatments. Surgery remains the primary treatment for colorectal cancer in Kazakhstan, with over 80% of operations performed laparoscopically using advanced technologies such as 3D, 4K, and ICG imaging. A team of specialists has recently completed training in robotic surgery, and the institute expects to introduce a robotic surgery system by the end of the year, marking a significant advancement in surgical oncology.

Treatment protocols in Kazakhstan align with international standards, including those set by NCCN, ASCO, and DSMA. These guidelines were reviewed by the World Health Organization (WHO) in 2018, with a new review scheduled soon.

Before treatment decisions are made, molecular genetic testing is conducted at no cost to patients. Kazakhstan has implemented comprehensive molecular genetic testing, including tissue block analysis and liquid biopsy techniques, facilitated by the NEXT-Seq550 Illumina sequencer. The Center for Molecular Genetic Research continues to advance diagnostic accuracy using PCR and next-generation sequencing methods, promoting personalized medicine in clinical practice.

Kazakhstan, with a population of 20 million, has over 200,000 cancer patients, including 18,500 with colorectal cancer. Around 40,000 new cancer cases are diagnosed annually, and the number is rising. Approximately 50,000 patients receive anti-tumor therapy each year, which is provided free of charge through state funding. The government launched the cancer treatment program in 2000, and its budget has grown from $5 million in 2002 to $200 million in 2024.

The 2024 drug list includes 100 medications, with 45 being targeted therapies and three immunotherapy drugs. Thanks to increased funding, more than 80% of patients now have access to targeted therapies, and immunotherapy coverage has reached around 40%.

Treatment decisions are made by a multidisciplinary team, including the chemotherapy tumor board. Radiation therapy is an essential component of colorectal cancer treatment in Kazakhstan, and the country has expanded its capabilities with modern accelerators.

The introduction of advanced equipment, such as electrophototherapy accelerators, allows for precise radiation delivery, minimizing damage to healthy tissues and improving treatment outcomes. In September 2024, a new AI-powered accelerator was introduced to enhance personalized adaptive radiation therapy.

Kazakhstan employs various advanced radiation therapy techniques, including 3D conformal radiation therapy, IMRT (intensity-modulated radiation therapy), and SBRT (stereotactic body radiation therapy), which are used either alone or in combination with chemotherapy. The country follows internationally recognized diagnostic and treatment protocols and adheres to the IARC concept, emphasizing the importance of screening, broad coverage, and adequate treatment to reduce cancer mortality.