CANCER PLANNING in ASIA and VIETNAM

CANCER PLANNING in ASIA and VIETNAM Professor Robert Burton WHO Cancer Planning Consultant UICC Strategic Leader 2002-2006 Deaths, by broad cause group and WHO Region, 2001 Chronic Non-Communicable Diseases (NCD) Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 75% 50% 25% Africa Americas Eastern Europe Mediterranean South East Western Asia Pacific Source: WHR 2002 Main NCD and their Causes BEHAVIORAL  Tobacco  Diet  Physical Activity  Alcohol ENVIRONMENTAL  Socio-cultural  Policy  Economic  Physical NON-MODIFIABLE  Age, Sex, Genes INTERMEDIATE RISK FACTORS Hypertension Blood lipids Diabetes Obesity END-POINTS Ischemic Heart Dis. Stroke Peripheral Vasc. Dis. Cancer Chronic Lung Dis. Top Risk Factors in Most Regions << Inactivity Unhealthy Diet >> << Tobacco Alcohol >> NCD Prevention Heart Disease Cancer Stroke Diabetes Philippine Coalition for the Prevention and Control of Non-Communicable Diseases in 2004 Philippine Coalition for the Prevention and Control of NCDs (PCPCNCD): National NCD Control Plan 2005-2015 • • Vision “Improved Health for All Filipinos” Mission To achieve, through heightened, coordinated and evidence based primary prevention activities, measurable changes in the self-reported and measured risks and mortality of NCDs for all Filipinos in a 10 year time frame. • Goal To work together in the primary prevention of chronic NCD, initially by addressing the shared risk factors of tobacco use, physical inactivity and unhealthy nutrition. WHO-UICC COMPREHENSIVE CANCER CONTROL RESEARCH PREVENTION EARLY DETECTION TREATMENT PATIENT WELFARE CANCER MONITORING TitlQuo AD145 CANCER CONTROL PLANNING • UNDERTAKE A NEEDS ANALYSIS • DECIDE THE PLANNING METHOD • DEVELOP THE PLAN and Determine Priorities • IMPLEMENT THE PLAN • EVALUATE THE OUTCOMES CANCER CONTROL PLANNING UNDERTAKE A NEEDS ANALYSIS: • Burden of Risk Factors & Cancers • Resources of Skills & Infrastructure • Political and Public Support • Health Care provider Support • Cultural Facilitators & Barriers DECIDE THE PLANNING METHOD: • Bottom Up • Top down CANCER CONTROL PLANNING DEVELOP THE PLAN: • A Comprehensive Planning Framework • Inclusive Stakeholder Involvement • Criteria for Choosing Priority Actions IMPLEMENT THE PLAN: • WHO Recommends that Countries Choose and Implement Priority Actions by 4 Levels of Resources: Very Low , Low, Medium, High EVALUATE THE OUTCOMES WHO promotes the stepwise implementation of interventions according to the level of resources Example: Mammography breast cancer screening Cytology cervical cancer screening Treatment of all curable tumours High Level of resources Middle level of resources Low level of resources Very Low level of resources Awareness of early signs & symptoms of cervical & breast cancers plus adequate diagnosis and treatment Palliative care and prevention of the most prevalent cancer risk factors (e.g. tobacco) >80% of the Worlds Population PREVENTABILITY OF GLOBAL CANCERS-2000* CANCER NEW CASES Millions 1.3 1.0 1.0 0.9 0.6 0.5 0.5 0.5 0.5 4.3 10.1 PREVENTABLE % FACTOR LUNG STOMACH BREAST COLORECTAL HEAD AND NECK CERVIX LIVER OESOPHAGUS URINARY TRACT OTHER TOTAL * Skin Cancers excluded 95 tobacco 90 H.pylori / diet 10 screening/ diet/ exercise 60 diet / screening / exercise 75 tobacco / alcohol /screening 90 screening/ HPV 75 HBV / HCV / alcohol 75 tobacco / diet 30 tobacco 10 50 PrevScreen AD196 World Burden of Infectious Cancers 2000 - IARC*-1 CANCER ORGANISM BACTERIA NUMBER Gastric H.pylori VIRUSES 557,000 Ano-genital & oral Liver HPV HBV 54% 551,000 482,000 HCV 27% *Total 10 million new cancer cases in 2000--2 million “infectious” 27% of cancer in the Developing World, 9% of cancer in the Developed World IMMUNISATION AGAINST CANCER Cancer Hepatoma Cause HBV Vaccine Yes When 1980 Cervix Stomach Nasal cancer and lymphoma HPV Helicobacter Pylori EBV Yes In development In development 2006 ? ? PrevScreen AD057 NATIONAL CANCER CONTROL PROGRAM (NCCP) OF VIETNAM Period 2006-2010. General Objectives To reduce cancer incidence rate To reduce cancer mortality rate To improve quality of life for patients with cancer. TOP 10 CANCERS: HANOI REGISTRY 2001-2004 NO. 1 2 3 CANCER TYPE LUNG*** STOMACH*** BREAST TOTAL ASR 25.2 22.7 15.3 MALES 39.8 30.3 0.8 FEMALES 10.5 15.0 29.7 Stage at Diagnosis incurable incurable ? 4 5 6 7 8 LIVER*** COLORECTUM*** NASOPHARYNX + ORAL*** OESOPHAGUS CERVIX*** 12.2 12.0 6.0 4.9 4.8 19.8 13.9 4.6 9.8 0 4.5 10.1 7.4 ? 9.5 incurable ? ? Incurable ? 9 NON HODGKINS LYMPHOMA LEUKAEMA 4.8 4.0 5.6 Some curable Some curable 10 4.1 4.7 3,4 ***Incidence could be reduced by primary prevention and Mortality could be reduced by early detection and screening. Both are possible in Vietnam Specific Objectives To reduce incidence rate related to tobacco causes to 30% in year 2010 compared to year 2000. To implement vaccination against Hepatitis B for 100% newborn . To reduce mortality rate in some common cancer types: cancer of the breast, cervix, oral cavity, rectum and skin by screening, early detection and ontime treatment. To reduce rate of advanced stage cancer sufferrers seeking consultation and treatment at specilized health facilities from 80% in year 2000 to 50% in year 2010. 1. 85+ Million People: 60% under 35 & 10% over 55 years. Life expectancy at birth is 70 years. 2. An increasing Cancer Burden: Cancer New Cases: 80,000+ per year Crude Incidence (6 Registries: 2001-3) is at least: Men-114 per 100,000, Women-82 per 100,000, and must increase. 3. Most cancers diagnosed late: incurable e.g. Can Tho breast cancer 1997-2000: 60% were incurable Stages III & IV at diagnosis; Only 3% were Stage I and easily cured. VIETNAM CANCER REALITIES 2006 MALAYSIA 8 Priority Areas For NATIONAL CANCER CONTROL 2004–2013 8 PRIORITIES 1. Implementation of Framework Convention for Tobacco Control (FCTC) 2. Integrated prevention for cancer, CVD, DM via tobacco control, nutrition & alcohol 3. Cervical cancer. screening, targeted for women >30yrs 4. Breast cancer. early detection by self & clinical breast examination for women >30yrs 8 PRIORITIES 5. Oral cancer screening : normally occurs among selective population. 2. Staged implementation of Oncology Services Development Plan 7. Provision of oral morphine to all who need it via education of doctors. 8. Continued development of inpatient palliative care services at home. PREVENTION and EARLY DETECTION of CANCER in SINGAPORE Programs • • • • • • • Breast Cancer Facts Breast Screen Singapore Cervical Cancer Facts Cervical Screen Singapore Colorectal Cancer Facts Colorectal Cancer Screening Breast & Colorectal Cancer Awareness NCCP Thailand Strategies for Primary Prevention Liver and Lung Cancers Vaccination against hepatitis B virus infection Major risk factors for HCC: Hepatitis B Virus Hepatocellular carcinoma(HCC) Anti – smoking campaigns Government organizations : Institute of Tobacco Consumption Control Non- Government organizations : Action on Smoking and Health Foundation NCCP Thailand Programmes for screening and early detection of cancer Cervix Cancer Screening Public Education Education andTraining • Nurses, PHC Personnels for Pap smear taking • Re-training cytotechnicians Quality Assurance System Campaigns for early detection of breast cancer Public awareness Breast self examination NATIONAL CANCER CONTROL PROGRAMME OF INDIA • Objectives – Primary prevention of tobacco related cancers – Early diagnosis and Treatment of Ca Cervix – Extension and strengthening of therapeutic services including pain relief CHINA • National cancer prevention and control programme for year 2004 to 2010: - Setup and improve cancer information system: setup unified cancer dataset ; - Control the major risk factors for cancer in public by developing an efficient prevention programme for cancer; - Develop early detection, early diagnosis and early treatment programmes for certain cancers; - Revise and implement the clinical guideline for the diagnosis and treatment for major cancers. Ling Yang, MD MPH, National Office for Cancer Prevention and Control, Beijing, P.R. China The workshop on Prevention and Early Detection of Cancer in Asia, Mumbai, Aug. 26th-28th, 2004 age-standardised rate per 100,000 women 1.5 2 3 4 2.5 3.5 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 Australia: Cervical Cancer Screening & Mortality IARC’s CERVICAL CANCER SCREENING PROGRAMME STUDY LOCATIONS IARC’s CERVICAL CANCER SCREENING PROGRAMME ACCURACY OF SCREENING TESTS T est C ytology H P V testin g V IA V IA M V IL I V IA + or V IL I + V IA + an d V IL I + N o. of w om en (stu d y sites) 22,633 (5) 18,065 (4) 54,981 (11) 16,900 (3) 49,080 (10) 49,080 (10 ) 49,080 (10) S en sitivity % (ran ge in stu d y sites) S p ecificity % (ran ge in stu d y sites) 58 67 77 64 92 (29 -7 7 ) (46 -8 1 ) (58 -9 4 ) (61 -7 1 ) (76 -9 7 ) 94 79 95 94 86 87 85 (89 -9 9 ) (92 -9 5 ) (75 -9 4 ) (83 -9 0 ) (73 -9 1 ) 81 89 Int J Cancer 2004; 110-907-13; J Med Screening 2004; 11:77-84; Int J Cancer 2004 (in press); Cancer Detect Prev 2004 (in press) HOW EFFECTIVE ARE THE TREATMENT OF PRECANCERS IN THE DEVELOPING WORLD? Cryotherapy: Data from Indian studies Lesion CIN 1 CIN 2 & 3 Total 1264 234 Cured at 1 year 90% (N=1137) 79% (N=184) LEEP: Data from Indian studies Lesion CIN 1 CIN 2 & 3 Total 296 336 Cured at 1 year 96% (N=283) 86% (N=288) Overall 1 cure rate in CIN = 89% (1892/2130) Supported by the ACCP through the Bill & Melinda Gates Foundation BREAST SELF-EXAMINATION A. Correct position B. Use the flat of the fingers C. Cover the whole area D. Feel with light and firm pressure BreCan AD164 Early Detection of Common Cancers in Women, Tata Memorial Centre, India Aim: To investigate low cost technology N = 150000 women socio economically low Age : 35-64 yrs R Intervention Every 18 months X 6 yrs CBE by Health worker VIA Control ALL cycles of Intervention have been completed Today, cancer is potentially the most preventable and the most curable of the major life-threatening diseases. TitlQuo AD145