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Implem e ntation of National Cancer Control P rograms A.Murat TUNCER MD Director, Cancer Control Department, MoH

Implem e ntation of National Cancer Control P rograms A.Murat TUNCER MD Director, Cancer Control Department, MoH. Burden of the Diseases. D ramatic shift in the distribution of deaths from younger to older ages

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Implem e ntation of National Cancer Control P rograms A.Murat TUNCER MD Director, Cancer Control Department, MoH

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

  2. Burden of the Diseases • Dramatic shift in the distribution of deaths • fromyounger to older ages • fromGroup 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

  3. 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 %

  4. 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

  5. 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

  6. Pharmacetical expenditure (% of total exp) Health Expenditure (USD/pp)

  7. Physician per 1.000 p

  8. Tobacco consumption(% of adults) Obesity (BMI>30 % of adults)

  9. Chemotherapy for advanced cancer 5% 40% 55% 95% Non-small cell lung Colon Stomach Prostate Pancreas Glioma AML Breast Ovary Small-cell lung Sarcoma Myeloma Hodgkin ALL Testis Choriocarcinoma Childhood Burkitt

  10. 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. International policies and instruments for primary prevention and health promotion

  11. 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 The European Code Against Cancer

  12. Cancer ScreeningIssues • 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!)

  13. 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

  14. 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

  15. 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%

  16. 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

  17. BULDING BLOCKS of CANCER’S FUTURE Society willingness to pay Expectations Economy Selfishness Spirutialism Family integrity Ethics Political ideology TECHNOLOGY Biomarker Prevention Screening Diagnosis Surgery Radiotherapy Drugs Supprtive care THE CANCER FUTURE FINANCE Self-pay Co-payment Optional insurance Mandatory insurance State insurance HMO NHS Charity DELIVERY Hospital-hotel Specialist-primary Care Professionals role Public vs private Globalization

  18. 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

  19. Responsability Admission flow Money Screening State Hospitals Primary Health Care General Health Insurance System MoH Patient Ministry of Finance DPT Private Hospitals University Hospitals Research Ministry of Education (High Education Council) TUBİTAK

  20. Cancer Mortality: Turkey (ASR/World per 100,000; Source: Globocan 2002) Lung cancer in Turkey is an even higher percentage (40%) of male cancer deaths Stomach cancer is unusually high in Turkey accounting for 9.5% of male cancer deaths Stomach cancer is unusually high in Turkey accounting for 9% of female cancer deaths Cervix cancer = >4% of female cancer deaths in Turkey

  21. Human Resources(for 150.000 new cases/yearDoctors 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

  22. International papers related with cancer

  23. VISION OF CANCER CONTROL PROGRAM SHORT TERM 2008-2010 MID TERM 2010-15 LONG TERM 2030 Organisation for treatment and palliative care 17 Comprehensive center 54 Cancer center 14 Treatment center Human resources New specialities Dosimetrist Cytotechnologist Radiology,Pathology Education and sub.sp. Screen %70 of the target population National Cancer Institute Cancer early diagnosis, screening and education centers for each city (81) National standart protocols for breast, cervical and colorectal cancer screening Active, population based 11 registries covering 35% Tobacco control Decrease %15 incidence rate in tobacco related cancers , %10 in total. Decrease the advanced stage in screened cancers Decrease cancer mortality

  24. CSED and ECs (KETEM) Awareness Diagnosis and treatment standarts Screening Breast, cervix and colon-rectum Advanced stage Mortality

  25. Proje Diyarbakır Kanser Tarama ve Eğitim Merkezleri Projesi / Cancer Screening and Education Centers Project

  26. Proje İstanbul Kanser Tarama ve Eğitim Merkezleri Projesi / Cancer Screening and Education Centers Project

  27. Proje Antalya Kanser Tarama ve Eğitim Merkezleri Projesi / Cancer Screening and Education Centers Project

  28. 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 Strategic Approach

  29. WHO GLOBAL ACTION PLANSEVEN 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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