Beruflich Dokumente
Kultur Dokumente
Dr D. Maxwell Parkin
University of Oxford, UK
Priorities in cancer control
1. Prevention
2. Early detection
3. Treatment
4. Palliative care
CANCER CONTROL PROGRAMME
A public health programme designed to reduce
the incidence and mortality of cancer and
improve the quality of life of cancer patients
Measuring
Burden of cancer
Past trends
Future projections
INDONESIA: Cancer cases, 2002
Lung
Males 80,000
Colon and rectum
19%
Liver
Prostate
2% Non-Hodgkin lymphoma
12%
3%
Nasopharynx
4%
5% Leukaemia
11%
6% Bladder
7% 6%
Stomach
Breast
Oral cavity & pharynx
(excl NPC) Cervix uteri
Singapore
Chinese
Hong Kong
Osaka
Manila
Bombay
…………………
….
…………………
….
…………………
..
PLANNING NCCPs
Tobacco
Infection
Bar 1
Diet H. pylori
HPV
Alcohol
Hepatitis viruses
Overweight Low fruit & veg.
Bar 6
Physical inactivity
Pollution
0 10 20 30
Percent of all cancer
PLANNING NCCPs
Prevention
Early detection
Diagnosis and Treatment
Palliative care
Activities of a Cancer Control Programme
For each:
Identify the immediate target
Estimate the impact (quantify reduction in
incidence and mortality)
Estimate the resources needed
Estimate the cost of the activity
(PRIMARY) PREVENTION
Tobacco
Infection
Avoidance
Immunisation
Treatment
Diet/Obesity/Physical exercise
Reproductive factors
Occupation
…
..
Percentages of all cancer cases attributable to tobacco smoking
Male Female
Eastern Africa 0.0 0.0
Middle Africa 1.7 0.0
Northern Africa 14.8 0.0
Southern Africa 18.7 3.4
Western Africa 0.0 0.0
Carribean 22.4 6.3
Central America 14.8 3.4
INDONESIA: Tobacco Use in 2005 (WHO InfoBase)
Temperate S. America 25.6 3.2
Tropical S. America 17.1 4.0
daily cigarette use 53.6% males, 2.8% females
Northern America 24.5 16.5
China 7.0 4.6
daily smoking tobacco 58.4% males 3.2% females
Japan 28.0 10.6
Other East Asia 35.4 10.8
South-Eastern Asia 27.8 7.4
South-Central Asia 13.5 0.0
Western Asia 27.9 0.2
Eastern Europe 42.3 4.1
Northern Europe 25.4 11.4
Southern Europe 36.5 3.0
Western Europe 29.4 4.4
Australia/New Zealand 17.9 8.6
Melanesia 0.7 0.0
Micronesia/Polynesia 29.7 11.1
HBV
(45%)
HCV
(10%)
Both
(18%)
INDONESIA: Prevalence of overweight and obesity (2005)
CANCER CONTROL
Prevention
Treatment
Rehabilitation / Palliation
Early detection
India
Bangladesh
Cancer of Philippines
cervix Thailand
Korea, Republic
World
Indonesia
Norway
Australia
0 5 10 15 20 25 30 35
Methods of screening for breast cancer
1. Imaging: mammography
2. Physical examination
3. Self-examination
INDONESIA – a mammography screening programme?
Screening every two years would require some 6-7 million tests every year
Of these, some 3-8% (say 300,000) would require follow up investigation for an
abnormal mammogram.
Each year, there are some 7-8000 deaths from breast cancer at ages 45-
64, and 2500 over the age of 45.
The maximum saving from this huge input of resources would therefore
be 2000 deaths
ALTERNATIVE:
Early clinical diagnosis:
In situ 1% I 4%
Unk 13%
Stage II+:
IV 8% 94%
II 50%
III 23%
Percentage of patients presented at late stage for nasopharyngeal cancer (NPC), breast and
cervix in Department of Radiotherapy and Oncology (DRO), Sarawak General Hospital (SGH)
(1991-1999) , following a programme of training of health personnel to improve their skills in early
detection of these cancers (1991-1996), and, at the same time, a public education programme to raise
awareness of these diseases, and their early signs and symptoms
1. Prevention
2. Early detection
3. Treatment
Management of pain
(and other
problems, physical, psychosocia
l and spiritual)
Surveillance is an essential component of a NCCP
Setting priorities
Setting objectives
Evaluating outcome
Comparing with resource inputs
EVALUATION OF
Effectiveness
Does the programme achieve its objective?
Efficiency
Costs in relation to outcome
Thank you