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Implementation of National Cancer Control Programs A.Murat TUNCER MD Director, Cancer Control Department, MoH

Burden of the Diseases. Dramatic shift in the distribution of deaths from younger to older ages from Group I diseases (communicable, maternal, perinatal and nutritional) to non-communicable disease (Group II) The proportion of deaths due to non-communicable disease is projected to rise from 59

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Implementation of National Cancer Control Programs A.Murat TUNCER MD Director, Cancer Control Department, MoH

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    1. Implementation of National Cancer Control Programs A.Murat TUNCER MD Director, Cancer Control Department, MoH

    2. Burden of the Diseases Dramatic shift in the distribution of deaths from younger to older ages from Group I diseases (communicable, maternal, perinatal and nutritional) to non-communicable disease (Group II) The proportion of deaths due to non-communicable disease is projected to rise from 59% in 2002 to 66% in 2030

    4. Cancer Risk Factors Smoking Number of the smokers 2010 1.4 billion 2020 1.6 billion 2030 1.8 billion Ageing Number of people aged 60 years and above 2010 0.8 billion (11.2 %) 2020 1 billion (13.6 %) 2030 1.4 billion (16.7 %) Obesity Percentage of obese people in Europe 2010 15-28 % 2020 19-35 % 2030 23-43 %

    5. Cancer Burden in Europe (Ferlay et al. 2007) EU25; 2.3 million new cases, 1 million deaths Continent;3.2 million new cases, 1,7 million deaths (55% men) Lung+prostate+breast+colorectal>50% incidence, >45% mortality Male; Lung, prostate, colon-rectum, stomach, bladder Female; Breast, colon-rectum, lung, stomach, ovary

    6. Geographical Variations Two-fold range in age-adjusted incidence and mortality in man and 1.5-fold in women Highest overall cancer incidence rates in men; Hungary Highest overall cancer incidence rates in women; Denmark and Iceland

    18. Pharmacetical expenditure (% of total exp)

    19. Physician per 1.000 p

    21. Chemotherapy for advanced cancer

    23. International policies and instruments for primary prevention and health promotion General Europe Code against Cancer (2003 – being updated) Alcohol WHO Resolution on framework for alcohol policy EU Alcohol strategy European Alcohol and Health Forum Nutrition WHO food and nutrition action plan Global Strategy on Diet and Physical Activity EU White Paper on Strategy for Europe on nutrition overweight and Obesity EU Platform for action on Diet, Physical Activity and Health Tobacco EU Directives on advertising and product regulation Green Paper on Smoke-free environment WHO Framework Convention on Tobacco Control HELP campaign Environment European Environment and Health Strategy European Environment and Health Action plan 2004-2010 Health and safety at work strategy Other policies and instruments Free movement and pricing of unhealthy products, consumer protection, environmental policy, etc.

    24. The European Code Against Cancer Do not smoke Avoid obesity Moderate physical exercise every day Increase daily intake and variety of fruit and vegatables If you drink alcohol do so in moderation Avoid excessive sun exposure Stricktly apply the legislation designed to prevent any exposure to carcinogenic substances Women over 25 should participate in cervical screening Women over 50 should participate in breast screening Men and women over 50 should participate in colon screening Participate in vaccination programmes against hepatitis B

    25. Cancer Screening Issues Earlier detection ; higher survival chances. Screening: opportunistic, selective, organised, population based,national , regional, pilot studies (Variety of approaches throughout the EU, not all of them are equally effective!)

    26. Cervical cancer screeening in Europe National-population based UK Norvey,Finland,Sweden,Denmark,Netherland Hungary Slovenia,Latvia Regional Screening Spain,Portugal,Italy,Romania,Austria,Czhec Republic,Belgium Pilot Programs France,Greece,Ireland,Estonia No National Population Based Program Germany

    27. Cervical cancer screening in Europe Slovenia %30 coverage Scandinavian countries %100 Not younger than 20, not older than 35 Stop at 60-70 Intervals and policies are different

    28. Screening for breast cancer 50-69 years, two-year interval Northern European countries participation 80%, recall rates 1-8% Consistent mortality reduction 20-35% Sweden 15-20 years 12-18% Edinburgh,Scotland 14 years 21%

    29. Screening for colorectal cancer 50-74 age group two specimens on three consecutive days(FOB) one and two-year screening intervals meta-analysis(Towler et al,1998); 6-18%reduction in mortality Nottingham trial there was no reduction in incidence significant reduction (19%) in mortality Danish study 14% mortality reduction Finland; 1/3 population covered in 2007 France, Italy, Netherlands, Poland, UK; Regional initiatives implementation

    30. BULDING BLOCKS of CANCER’S FUTURE

    31. Organisation Health Authority ; Ministry of Health(MoH) Drug and pharmacy; Prices and certifications Treatment services; Hospitals Cancer Control Department; Cancer Control Program Public Health: Nutritional habits and control of the market, tobacco control and quitting/cessation programs,healthy life style,physical activity Collaboration; Education; Ministry of Education (Higher Education Council -Universities), NGOs Research projects (some): State Planning Department (DPT) and Turkish Scientific and Technical Council (TUBITAK) Finance ; Ministry of Finance, Department of Tresury

    33. Cancer Mortality: Turkey (ASR/World per 100,000; Source: Globocan 2002)

    34. Human Resources (for 150.000 new cases/year Doctors per 1.000 pop: 1.2) Medical Oncologist 175 Pediatric Oncologist 97 Radiation Oncologist 306 Pathologist 800 Radiation Physicist 88 Oncology Nurse 525 Physcolog 50 Social Workers 23

    35. International papers related with cancer

    41. Strategic Approach Reduce inequity Improve cancer services Resources Clinical guidelines Systematic training Accreditation Monitoring Increase prevention and early diagnosis Education Reduce avoidable premature deaths (150.000 12% ;EU) Budget and investment human resources, capacity building, substructur Priorities of the problems Differences and similarities National cancer research strategy Original and cost-benefit studies Implement policies, strategies and plans Collaboration/cooperation/ organisation Govermental responsibility

    42. WHO GLOBAL ACTION PLAN SEVEN COMPONENTS 1.Advocate for cancer prevention, cure and care 2.Promote WHO strategies impacting on cancer 3.Promote National Cancer Control Programmes (NCCP) in countries based on the four goals and multiple strategies approach 4.Support NCCP development and implamentation in High Burden Low and Middle Income Countries (LMCs) 5.Monitor implementation and impact of national and global interventions:the WHO Cancer Surveillance Project. 6.Develop WHO Technical Advisory Committee on Cancer 7.Develop concultation process to identify research priorities to support Action Plan.

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