comprehensive cancer control

8/8/2019 Comprehensive Cancer Control

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Assessment of Burden (Hospital/Population-b)Risk Factor Determination (Phys/Socioeco)

Interventions - Primary Prevention(Awareness/Tobacco Control/Lifestyle)

Interventions - Secondary Prevention(Screening/Monitoring/

Interventions - Therapeutic

(Surgical/Radio/Chemical/Hormonal)

Interventions - Palliative(Physical/Psychological)

Cancer Control Programs


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The Chinese National Centerfor Cancer Registries

Gulf Center for CancerRegistration

Australasian Association of

Cancer Registries

Korean CancerRegistration

Asian Network?

Thailand Registration Group

1) DiseaseDiagnosis/Registration


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CIV

Non-CIV IACR Voting

Non IACR Voting

Non IACR

Asian Cancer Registries


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APJCP Supplement 1,22nd Annual IACR Meeting, Khon Kaen, Thailand, 2001

CANCER REGISTRATION IN ASIA IN THE YEAR 2000:PAST, PRESENT AND FUTURE


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Male Burde n of Cancers in Major Organs - Incidences/100,000

Registry China India Indonesia Iran Japan Korea Pakist an Philippines# Thailand Vietnam Ranking

Oral 1.3 (9)R 16.3 (1) ? 6.6 (4) 6.0 (9) 4.4 (8) 25.8 (1) 8.6 (6) 8.5 (4) 8.2 (5) 45 (6)

Oesophagus 14.8 (3) 7.4 (2) ? 39.4 (1) 10.0 (5) 10.1 (5) 6.2 (5) 3.1 (9) 3.7 (8) 3.7 (6) 46 (5)

Stomach 14.7 (4) 6.8 (3) ? 17.3 (2) 67.0 (1) 70.0 (1) 4.6 (8) 11.1 (5) 4.9 (6) 23.7 (2) 58 (4)

Colorectal 11.5 (5) 5.4 (4) 6.8 (2) 3.8 (7) 48.0 (2) 40.9 (4) 5.9 (6) 18.7 (3) 10.4 (3) 11.4 (4) 60 (3)

Liver 21.0 (2) ? 5.7 (3) 3.9 (6) 26.0 (4) 48.8 (2) 5.0 (7) 23.9 (2) 37.4 (1) 22.6 (3) 70 (2)

Pancreas 3.9 (6) 1.7 (8) ? 1.2 (9) 9.2 (7) 7.7 (7) ? 4.7 (8) ? 1.6 (9) 16 (9)

Lung 26.6 (1) 4.0 (6) 14.8 (1) 14.2 (3) 39.9 (3) 48.4 (3) 20.0 (2) 64.3 (1) 26.5 (2) 29.3 (1) 77 (1)

Prostate 2.1 (8) 5.2 (5) 5.6 (4) 2.0 (8) 10.0 (5) 4.2 (9) 7.6 (4) 17.6 (4) 4.4 (7) 2.2 (8) 28 (8)

Bladder 3.4 (7) 3.5 (7) ? 4.4 (5) 8.2 (8) 9.5 (6) 9.4 (3) 4.9 (7) 5.2 (5) 2.4 (7) 35 (7)

*Dat a f rom Selected Cancer Regist ries (see text f or references)# Data from Parkin et al., 1997R, rank

Descriptive Epidemiology: Males

Data from APJCP Supplement 1


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Female Burden of C ancers i n Major Organs - Incidences/100,000

Registry China India Indonesia I ran Japan Korea Pakistan Philipp ines*Thailand Vietnam Ranking

Oral 0.8 (9)R 7.8 (3) ? 6.6 (4) 2.0 (8) 1.2 (8) 18.7 (2) 6.0 (8) 4.5 (7) 2.7 (8) 33 (6)

Oesophagus 6.0 (6) 5.8 (5) ? 24.9 (1) 1.3 (9) 1.0 (9) 6.9 (5) 1.6 (9) 1.3 (9) 0.5 (9) 28 (9)

Stomach 14.7 (1) 3.5 (7) ? 5.9 (5) 27.0 (2) 25.7 (1) 3.2 (8) 6.4 (7) 1.5 (8) 8.5 (3) 58 (3)

Colorectal 9.0 (4) 3.8 (6) 6.3 (3) 2.9 (6) 25.5 (3) 10.3 (6) 5.0 (6) 15.8 (3) 7.5 (5) 6.4 (5) 53 (4)

Liver 8.0 (5) ? ? 1.8 (9) 7.7 (6) 11.6 (5) 3.4 (7) 8.0 (6) 15.5 (3) 4.6 (6) 33 (6)

Lung 10.2 (3) 3.1 (8) 4.8 (5) 2.5 (7) 11.2 (4) 12.7 (3) 2.8 (9) 17.7 (4) 11.1 (4) 7.9 (4) 49 (5)

Breast 12.7 (2) 22.6 (2) 14.8 (2) 12.3 (2) 31.0 (1) 12.5 (4) 56.6 (1) 47.7 (1) 16.3 (2)13.8 (1) 80 (1)

Ovary 5.3 (7) 5.9 (4) 5.2 (4) 2.5 (7) 6.4 (7) 4.0 (7) 9.5 (3) 9.4 (5) 4.7 (6) 4.4 (7) 43 (8)

Cervix 1.2 (8) 25.3 (1) 21.7 (1) 7.0 (3) 8.5 (5) 15.3 (3) 7.3 (4) 21.6 (2) 20.9 (1)13.1 (2) 70 (2)

*Data f rom Selected Cancer Regist ries (see text f or referen ces) # Data from P arkin et al., 1997R, rank

Descriptive Epidemiology:Females

Data from APJCP Supplement 1


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Soluble FiberInsoluble Fiber

N-6 PUFA's

High fat diet

High calorie consumption

Obesity

PRENEOPLASTIC/NEOPLASTIC CELL

GROWTH

IGF-I

Estrogen/Testosterone

Insulin Sensitivity

Glycemia

IGF-IR IR SHR

Insulin

N-3 PUFA's

GENE ACTIVATION

Physical Exercise

Physical Exercise

Receptor Impairment

Phys ical Exercise

N-3 PUFA's

N-6 PUFA's

Inflammation

Lipid peroxidation

?

NSAID's

Antioxidants

Carcinogens

INITIATION

Antioxidants

Insoluble Fiber

ODC Inhibitors

DHEA

HMG-CoA ReductaseInhibitors

Insulin sensitizers

DHEA

GENE ACTIVATION

ImmuneSystem

Lactoferrin

Parasites

2) Risk Factor Identification


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0-10 20-30 40-50

10-20 30-40 >50

0-5 10-15 20-25

5-10 15-20 >25

Incidence

RatesBreast

Cervix

Specific Cancer

Sites I

0 10 20 30 40 50 60 70 80 90Age (years)

Menarche Breast Density Menopause

Post-Menopausal Risk:Hormone Replacement/ ObesityNulliparity or late first pregnancy

Pre-Menopausa lR isk: Early menarche and late menopauseNulliparity or late first pregnancy

Pre-MenopausalProtection: Obesity Anovulation and low progesteroneEarly first pregnancy and multiparity

Oestrogen/Progesterone

Exposure

BREAST CANCER

Diet/Phytoestrogens

PhysicalExercise ReproductiveHistory Early Menarche/

Late Menopause

High D ensity

Low Density

Late Menarche/Early Menopause

Low Density

High D ensity

Risk and Protective Factors

Di et ar y F ac to rs P hysical Ex er ci se Hor mo na l E nv ir on ment

Persistent HPV High Risk Group Infection

Other STDsSmoking

EnvironmentalCarcinogens

Normal Epithelium CINI CINII CINIII CERVICAL CANCER

Dietary Factors Physical Exercise Hormonal Environment

:

:


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Site Specific Risk Factors I

0-2.5 5.0-7.5 10.0-15.0

2.5-5.0 7.5-10.0 >15.0

Oral Cavity/PharynxBetel, Smoking,

Alcohol, SunHPV

OesophagusTrauma, Smoking,Alcohol, Nutrition,

Obesity0-2.5 5.0-7.5 10.0-20.02.5-5.0 7.5-10.0 >20.0

StomachSalt, Stress

H.pylori

Colon/Rectum

Diet, Hyper-insulinemia

0-10 20-30 40-60

10-20 30-40 >60.0

0-5 10-15 20-40

5-10 15-20 >40.0


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LarynxDusts

Lung

Smoking,FumesNutrition

LiverHBV/HCVOpisthorchis

Urinary

BladderSmoking,Infection

0-5 10-15 20-30

5-10 15-20 >30

0-10 20-30 40-50

10-20 30-40 >50

0-2 4-6 8-10

2-4 6-8 >10

0-5 10-15 20-25

10-20 15-20 >25

Site Specific Risk Factors II


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15

20

25

30

35

40

45

SC

SC

SC

Singapore Chinese

SC

SM

SM

SM

SM

Singapore Mala

SISI

Singapore Indian

SI

SI

IB

IB IB

Indian Bombay IB

CSCS

Chinese Shanghai

CS CS

Chinese Hong Hong

CHK

CHK

CHKCHK

JM

JM

JM

JMJapaneseMiyagi

JO

JO

JO

Japanese Osaka

JO

1982 1987 1992 1997 2003

Year of Publication

Incidence(/100,000)

0

5

10

15

20

25

30

SC

SC

SC

Singapore Chinese

SC

SM

SM

Singapore Malay

SM

SM

SI

SingaporeIndian

SI

SI SI

IB

IB Indian Bombay IB

IB

CS

CS

ChineseShanghai

CS CS

Chinese Hong Kong

CHK

CHK

CHK

CHKJM

JM

JMJapanese

Miyagi

JM

JOJapanese Osaka

JO

JO

JO

HH

HH

HH

HH

HawaiinHawaii

1982 1987 1992 1997 2003

Year of Publication

0

5

10

15

20

25

30

Incidence(/100,000)

Generally IncreasingBreast, Colorectal, Prostate, Thyroid

Generally DecreasingCervical, Buccal

ParadoxicalLiver, Lung, Oesophageal

Breast

Cervix

Specific Cancer Sites II


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14/18

3) Primary and Secondary

Prevention

NORMALCELLS

PRENEOPLASIA/DYSPLASIA

Dietary Supplementation/Detoxification

Smoking, Endogenous and Dietary Carcinogens

Avoidance

MedicationVaccination

Trauma/ Infectious Agents/ Metabolic Stimuli

Regeneration/ Proliferation

Avoidance

HormonalMilieuManipulation

Initiation Growth

Naked Eye/PalpationOccult Blood

EndoscopyUltrasound/CTSerum markers

Screening and Resection

Progression

Chemoprevention

CANCER


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PSA/PSAD/DREFree PSA/RatiosAdjunct Therapy

HGPINASAPPCa

StageGrade

Risk Screening Biopsy Treatment Outcome

IncontinenceImpotenceErectileDysfunction

Psychological

HormonalSurgeryRadiotherapy

Chemotherapy

Cut-offComplicationsZone sizes

MethodologyNumber

Decision-makingQOLTiming

AlleviationQOLSalvage

Body SizeHormonesMorphology

DietExerciseSupplements

Intl Hospital-based ComprehensiveCase-control Studies!

4) Clinical Intervention


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Asian Cancer Control NetworkWho? What? Where?

Thai NCI Japanese NCC ???


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Political Pressure

Research Journals

Policy -making

Government

Politicians

The Media

Local Populace+

Patient Groups

Local Health/Registration Centre

Publication

Training

FundingFinancialSupport

Research Organizations

Asian Network?

IACR UICCIARC/WHO

Information

Evidence Base

Information

Rationale for Registration

Research Centres


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Cooperation for ComprehensiveCancer Control in Asia

Needs People Power

Thank you!

asian cancer control

comprehensive cancer control

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