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Cancer Registration and Cancer Control in Asia

Cancer Registration and Cancer Control in Asia. IACR Workshop: Beijing 16 th Sept. 2004. THE POPULATION BASED CANCER REGISTRY IS THE INDISPENSIBLE FOUNDATION OF A SURVEILLANCE SYSTEM. A cancer surveillance programme exists to:.

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Cancer Registration and Cancer Control in Asia

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  1. Cancer Registration and Cancer Control in Asia IACR Workshop: Beijing 16th Sept. 2004

  2. THE POPULATION BASED CANCER REGISTRY IS THE INDISPENSIBLE FOUNDATION OF A SURVEILLANCE SYSTEM

  3. A cancer surveillance programme exists to: ·To assess the current magnitude of the cancer burden and its likely future evolution ·To provide a basis for research on cancer causes and prevention ·To provide information on prevalence and trends in risk factors, ·To monitor the effects of early detection, screening, treatment, and palliative care.

  4. PURPOSES AND USES OF CANCER REGISTRATION 1 Epidemiological Research Descriptive Epidemiology Analytic Epidemiology 2 Health Care Planning and Monitoring Patient Care Survival Screening Prevention

  5. EPIDEMIOLOGY 1 Descriptive The information on exposure comes from routine sources (registers, records, surveys...) The variables are non-specific (indirect link to ‘causes’) 2 Analytic Information on exposure is collected from individual subjects Association between “risk factors” [possible ‘causes’] and disease

  6. Rate per 100,000 80.0 In-situ Invasive 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 None Primary Secondary Higher Education level Cervix Uteri, Incidence Rates by Education Level, Quito Residents. 1985-1999 Cancer in Ecuadorian regions 1997-1999 NCR, Solca Quito, 2001 Source N.T.R.

  7. Cancer in Scotland 1975-1980 Large Bowel, Females IARC Scientific Publications No. 72, 1985

  8. Trends in Colon Cancer Incidence: ASIAAge Standardised Rate (World), MALES Singapore Chinese Hong Kong Osaka Manila Bombay ……………………. ……………………. …………………..

  9. PURPOSES AND USES OF CANCER REGISTRATION 1 Epidemiological Research Descriptive Epidemiology Analytic Epidemiology 2 Health Care Planning and Monitoring Patient Care Survival Screening Prevention

  10. USES OF CANCER REGISTRY • PLANNING & EVALUATION OF CCPs • I DEFINING THE PROBLEM • Burden of cancer • Past trends • Future projections

  11. CANCER INCIDENCE “Burden” of cancer as number of new cases • Priority for cancer control (prevention, treatment) • Estimating the resources required, based on numbers of new cases ( by age, stage, etc)

  12. CERVIX BREAST urban rural rural urban MORTALITY TRENDS: CHINA 1987-1999

  13. Estimates and projections of national cancer incidence & mortality

  14. PLANNING & EVALUATION OF CCP MONITORING CANCER CONTROL Incidence per 100,000 women-years 75 50 Reference period 1958-67 Never screened Ever screened Normal test DENMARK FINLAND ICELAND NORWAY SWEDEN 25 0 20 30 40 50 60 70 80 90 1945 1950 1955 1960 1965 1970 1975 1980 1 Primary prevention Time trends ? Control areas? 2 Screening & early detection • Outcomes (incidence or mortality) • Time trend studies (in relation to inputs) • Linkage with screening programme records • (distinguish screened/unscreened individuals) • Intermediate endpoints • Size and stage of screen-detected cases • Incidence of interval cancers • Incidence of advanced cancers

  15. PLANNING & EVALUATION OF CCPMONITORING CANCER CONTROL 1 Primary prevention Time trends ? Control areas? 2 Screening & early detection Outcomes (incidence or mortality) Time trend studies (in relation to inputs) Linkage with screening programme records (distinguish screened/unscreened individuals) Intermediate endpoints Incidence of interval cancers Size and stage of screen-detected cases Incidence of advanced cancers 3 Treatment :Study of SURVIVAL 4 Cancer care

  16. EVALUATION OF CANCER CONTROL PROGRAMMES SURVIVAL DATA Effectiveness of Treatment in delaying/preventing death BUT, consider other factors influencing survival especially earlier diagnosis

  17. FACTORS INFLUENCING SURVIVALFROM CANCER Disease: Natural history Clinical extent Definitions Treatment: Availability Access Quality Host: Age Sex SES Comorbidity Behaviour Early Detection: Early clinical detection Screening

  18. Trends in 5-Year Relative Survival from Selected Cancers in Women, Singapore, 1968-92

  19. PLANNING & EVALUATION OF CCPMONITORING CANCER CONTROL 1 Primary prevention Time trends ? Control areas? 2 Screening & early detection Outcomes (incidence or mortality) Time trend studies (in relation to inputs) Linkage with screening programme records (distinguish screened/unscreened individuals) Intermediate endpoints Incidence of interval cancers Size and stage of screen-detected cases Incidence of advanced cancers 3 Treatment :Study of SURVIVAL 4 Cancer care

  20. EVALUATING CLINICAL CARE IN CCP Patterns of clinical care • Place of treatment • Percent treated by “specialists” • Percent of cases with adequate staging • Percentage on treatment protocols • Delay (diagnosis-treatment)

  21. Why do we need cancer registries • Current situation in Asia

  22. Russia Kazakhstan Mongolia Kyrgyzstan JAPAN KOREA Turkey Turkmenstan Tajikstan CHINA Syria ISRAEL Afghanistan Iran Iraq Lebanon Jordan Bhutan PAKISTAN Nepal KUWAIT Egypt Qatar. Karachi Bangladesh INDIA U.A.E. Saudi Arabia Burma Laos PHILIPPINES OMAN Sudan VIET NAM Yemen Manila & Rizal THAILAND Cambodia Arabian Sea Ethiopia Sri Lanka Malaysia Somalia SINGAPORE Kenya Uganda ASIA – 12 COUNTRIES REPRESENTED

  23. Afghanistan China Pakistan Delhi Nepal Bhutan Bangladesh Ahmedabad Burma Nagpur Mumbai (Bombay) Poona Bay of Bengal Arabian Sea Chennai (Madras) Bangalore Karunagappally Trivandrum Sri Lanka India 9 registries INDIA – 9 registries

  24. China Burma VIETNAM Hanoi Chiang Mai Laos Lampang Khon Kaen THAILAND Bangkok Cambodia South China Sea Andaman Sea Ho Chi Minh City Gulf of Thailand Songkhla Malaysia Indonesia Malaysia Indonesia SINGAPORE South-East Asia

  25. Russia China Yamagata KOREA Kangwha Seoul Miyagi North Pacific Ocean Daegu JAPAN Busan Osaka Hiroshima Saga Nagasaki East China Sea Japan and Korea

  26. Russia Kazakhstan Mongolia Korea Beijing Tianjin Cixian Qidong County Shanghai Jiashan Wuhan Nepal Bhutan Changle India India Taiwan Bangladesh Hong Kong Burma Viet Nam Laos South China Sea Bay of Bengal Thailand Philippines China 10 registries

  27. CI5 incidence data % population coverage, 1995 26.2% 32% 12.7% 4.7% 1% 3% 82%

  28. Oceania Europe N. America S. America Asia Africa INTERNATIONAL ASSOCIATION OF CANCER REGISTRIES Membership 458 447 402 385 366 191 134 92 ASIAN MEMBERS 91

  29. Incidence data % population coverage, around 1995 36.5% 99% 19.6% 7% 8% 10.5% 86%

  30. Why do we need cancer registries • Current situation in Asia • What’s new?

  31. GULF STATES: 6 population-based registries Now joined by Yemen: The Aden Cancer Registry

  32. THE INDIAN CANCER ATLAS Using pathology-based data to obtain clues about geography of cancer

  33. Fig 8. Districtwise Microscopic Age Adjusted Incidence Rates (MAAR) Per 100,000 Stomach (ICD 10 : C16) Males Year 2001 - 2002 Imphal West (12.2) Dimapur (10.0) Senapati (8.7) Tamenglong (9.1) Lahul & Spiti (15.1) Churachandpur (19.2) Kolasib (56.1) East Sikkim (15.4) North Sikkim (27.7) Kohima (34.0) Ukhrul (11.2) Aizawl (47.0) Champai (46.3) Serchhip (70.2) Saiha (23.0) Lawngtlai (10.2) Lunglei (25.3) Mamit (53.4) Thiruvallur (10.7) Thrissur (12.6)

  34. Population -basedcancer registryActive surveillance Tehran

  35. KOREA: National population-based cancer registry network Using the existing “Korean Central Cancer Registry” – a hospital based system providing national level, but incomplete, data since 1980.

  36. THAILAND Cancer in Thailand, vol III based on the established 5 Registries There are another 5-6 start-ups

  37. Jiamusi Qiqihaer Boli Haerbin Ningan Shenyang Chicheng Anshan Beijing Dalian Tianjin Ganyu Wuwai Zanghuang Jiaxian Dafeng Huaian Shexian Linqu Yangzhong Jianhu Cixian Haian Yangcheng Feicheng Haimen Taixing Linzhou Qidong Luoyang Shanghai Jintan Lueyang Shanghai Jiashan Jiaxing Yanting Haining Wuhan Hangzhou Changle Guangzhou (1,2) Gejiu Shenzhen Fusui Tin Mine Sihui Hong Kong Zhongshan CHINA: Survey of cancer registries nationwide • Information from 48 PBCRs • They cover 5.7% population • of China • To be published in Eur. J. Cancer Prevn.

  38. Why do we need cancer registries • Current situation in Asia • What’s new • The role of IACR

  39. International Association of Cancer Registries Founded in 1966 Aims: To improve quality of data and comparability between registries To disseminate information on the uses of cancer registry data Ottawa, 1992

  40. SUPPORT TO CANCER REGISTRIES International Standards Publications related to cancer registration Consultancy (+ WHO regions) Training of staff Fellowships Computer software

  41. CANCER REGISTRATION PRINCIPLES AND METHODS

  42. Manual for Cancer Registry Personnel Comparability and quality control in Cancer Registration Guidelines on Confidentiality in the Cancer registry ICD Conversion Programs for Cancer International Classification of Childhood Cancer 1996 Histological Groups for Comparative Studies

  43. IACR MEETINGS 1990 Hamburg, Germany 1991 Quito, Ecuador 1992 Ottawa, Canada 1993 Bratislava, Slovakia 1994 Bangalore, India 1995 Rio de Janeiro, Brazil 1996 Edinburgh, UK 1997 Abidjan, Ivory Coast 1998 Atlanta, USA 1999 Lisbon, Portugal 2000 Khon Kaen, Thailand 2001 Havana, Cuba 2002 Tampere, Finland 2003 Honolulu, Hawaii

  44. Beijing, China, 2004 THANK YOU. See you next year (and before that, I hope!)

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