An international review has found that Sri Lanka has made strides in cancer control in the past five years, boosting vaccination against the human papillomavirus (HPV) and cervical cancer screening, and expanding access to treatment services and palliative care. The country now plans to address a growing burden of oral cancers and to reinforce childhood cancer programmes as part of its upcoming health strategy.  

The imPACT review, concluded in March 2025, was carried out jointly by the IAEA, the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), with technical engagement from St. Jude Children’s Research Hospital and the MD Anderson Cancer Center in the United States of America.  

The review covered Sri Lanka’s capacities and progress in cancer management since a previous assessment in 2019, which laid the groundwork for the National Strategic Plan on Prevention and Control of Cancer (2020-2024).   

The 2025 review team comprised 17 international experts nominated by the three organizations. Evaluation areas, as identified by the Sri Lanka Ministry of Health, included prevention initiatives at the primary care level, early detection initiatives, cancer services at major hospitals, and oncology workforce capacities and needs.  

“We noted key areas of progress in the past five years across the continuum of care, including in prevention and access to treatment services,” said Arsen Juric, IAEA Programme Officer and imPACT review team leader. First dose HPV vaccination coverage surpassed 90% and cervical cancer screening exceeded 50% in 2022. Advancements were also made in clinical services, including the installation of new radiation therapy machines and the establishment of outpatient chemotherapy services. Palliative care consultation services are now available in 11 institutions, with 230 public health nursing officers providing palliative home care.  

“The recommendations from the review are timely and will help to inform the new National Strategic Plan on Cancer Control, set to take effect from 2025, as well as the National Health Strategic Master Plan 2026-2035,” said Asela Gunawardena, Director General of Health Services at Sri Lanka’s Ministry of Health and Mass Media. “The journey ahead is critical, as Sri Lanka works to combat a growing burden of cancer and to improve health outcomes for its population,” Gunawardena added.  

The international experts visited hospitals, including the National Cancer Institute in Colombo, and held discussions with oncology staff.  (Photo: WHO Sri Lanka)

Cancer Prevalence in Sri Lanka

According to data from the National Cancer Control Programme, cancer incidence has more than doubled in Sri Lanka in the last 20 years, rising from 70 cases per 100 000 in the adult population in 2005 to 151 in 2021. Many cancers are diagnosed at advanced stages, with 37% of breast cancer, 45% of cervical cancer and 63% of oral cancer cases identified at stage III or IV.   

Oral cancer, which ranks as the 13th most common cancer worldwide, is the most prevalent cancer among men in Sri Lanka, followed by lung cancer, while breast and cervical cancers are the highest in women. Childhood cancers remain an important issue, with a surge in incidence from 73.1 per million population in 2005 to 107.8 in 2019, according to national data.  

Several of these cancers can be prevented and associated mortality reduced through early interventions.  

“Research shows that between 30% and 50% of cancer deaths could be prevented by modifying environmental and behavioural risk factors, including infection control,” said Rui De Jesus, WHO Country Representative in Sri Lanka. He also noted that recent surveys show a rise in the prevalence of behavioural risk factors, such as tobacco use, which highlights the need to effectively and holistically implement cost-effective interventions to reduce the cancer burden.   

Review Methodology

The imPACT review encompassed desk reviews, discussions with national health authorities, medical staff and key stakeholders, as well as an in-country mission in March 2025. During the mission, the team visited healthcare facilities in the capital, Colombo, and in the cities of Ratnapura, Kandy and Galle to gather first-hand information. They also met with representatives from the Sri Lanka Atomic Energy Board to review radiation safety infrastructure and services and participated in a national workshop on cancer control with Ministry of Health leadership and representatives from national medical associations and universities.  

The imPACT team also reviewed services in Kandy and Galle, including for cervical and oral cancers as well as palliative care.  (Photo: WHO Sri Lanka)  

Recommendations to Improve Cancer Care and Prevention

At the end of the country visit, the imPACT review team presented preliminary findings and recommendations to the Minister of Health and Mass Media and other senior officials. The recommendations include establishing an inter-ministerial body to oversee national cancer policies and programmes; increasing oral cancer early detection interventions for at-risk populations, including estate workers, fishermen and agriculture workers; streamlining the national referral system; improving quality standards across facilities and levels of care; integrating palliative care early in the cancer continuum; and strengthening population-based cancer registries and reporting.  

The team also identified opportunities for programmatic support and advisory services that can be provided by the IAEA, WHO, IARC and other partners to further enhance Sri Lanka’s capacity to meet its needs in cancer prevention and control.  

“The IAEA remains committed to supporting Sri Lanka’s needs in cancer care, including to enhance national capacities in radiation medicine for safe and effective diagnosis and treatment,” said Tomoaki Tamaki, Head of the IAEA’s Applied Radiation Biology and Radiotherapy section. 

The IAEA supports countries in strengthening radiation medicine services, including through its Programme of Action on Cancer Therapy, its human health programme and the Rays of Hope initiative, which aims to increase access to radiotherapy, diagnostic imaging and nuclear medicine in underserved populations.  

At the end of the visit, the team participated in a national workshop with Ministry of Health staff and representatives from medical colleges to provide recommendations to strengthen cancer control. (Photo: WHO Sri Lanka)