Transcript 癌症預防及篩檢

Cancer Prevention in Taiwan
Bureau of Health Promotion
Department of Health
Taiwan
The Statistics of Cancer

the first leading cause of death since 1982

Crude incidence 265/105 (59,116), 2000

Crude mortality 141/105 (31,554), 2000

Direct medical cost : $ 0.7 billion dollars
annually (NHI), 2002
Trend of cancer mortality
(unit:per 10 5)
160
140
crue motality
120
age adjust motality
100
80
60
40
20
0
81
9
1
3
'8
5
'8
7
'8
9
'8
1
'9
year
3
'9
5
'9
7
'9
9
'9
1
'0
Five leading cancer sites
Mortality (1998)
M
F
Lung
Liver
Colorectal
Stomach
Oral
41.6
40.2
17.7
14.4
12.5
Lung
Liver
Colorectal
Breast
Cervix
17.9
15.1
13. 2
11.3
8.6
Lung
Liver
Colorectal
Oral
Stomach
45.2
32.4
29.0
20.9
17.5
Cervix
Breast
Colorectal
Liver
Lung
49.3
31.48
23.8
16.3
15.4
Incidence (1998)
M
F
Age-adjusted incidence and mortality
Cervical cancer
50
40
30
20
10
0
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
Incidence
19.24
19.90
26.03
25.56
26.44
21.16
24.06
22.61
24.19
20.44
26.54
30.60
29.43
29.92
30.02
40.90
42.84
49.32
Mortality
8.80
9.65
8.81
8.72
9.26
8.22
7.97
7.56
7.36
7.01
6.98
7.30
6.82
7.00
6.98
6.54
6.50
6.17
1999
2000
5.68
5.48
Coverage of Pap smear
60
50
（
40
annual screening rate
52.1
47.8
3-year screening rate
41.9
％ 30
）
20
21.1
55.7
25.5
28.0
29.6
31.2
1999
2000
2001
3
16.5
9.7
10
0
1995
1996
1997
1998
Age adjusted incidence and mortality
Breast cancer
35
30
單
位
：
每
十
萬
人
口
25
20
15
10
5
0
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Incidence 11.09 11.75 12.92 12.51 14.98 14.18 15.16 14.19 15.67 16.38 18.75 16.76 20.55 22.86 23.62 23.00 25.48 27.16 31.10 31.48
3.92 3.85 4.21 4.13 4.54 4.54 4.47 4.67 5.23 5.23 5.47 5.39 5.93 5.94 6.59 6.88 7.20 6.44 6.78 7.00
Mortality
Age adjusted incidence and mortality
male oral cancer
25
20
15
10
5
0
1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Incindence 5.07 5.73 5.16 5.04 5.96 6.86 7.23 7.16 8.33 8.27 9.37
M ortality
2.57 2.24 2.61 2.78 2.96 3.22
3.4
9.1 10.96 12.56 13.63 14.47 16.17 16.66 18.62 20.9
3.56 3.88 3.23 4.06 4.48 5.13 5.27 6.34 6.97 7.58 7.47 8.17 9.02
The prevalence of betel nut chewing
1996
1999
2001
Male
-
17.7
15.1
Female
-
1.0
1.1
Total
10.9
9.0
8.2
Proportion of CIS and Invasive Ca
Cervical cancer (1992-1998)
year
1992
In-situ Ca
Case No.（%）
1,060（31.1）
Invasive Ca
Case No.（%）
2,350（68.9）
1993
971（29.8）
2,291（70.2）
1994
1,169（35.2）
2,150（64.8）
1995
1,297（35.9）
2,312（64.1）
1996
1,987（43.3）
2,601（56.7）
1997
2,409（48.3）
2,575（51.7）
1998
3,095（52.5）
2,796（47.5）
Priorities and strategies for cancer
Prevention
Primary
Screen
Curative
Tx
Palliative
Care
＋＋
－
－
＋＋
Stomach
＋
－
－
＋＋
Breast
＋
＋＋
＋＋
＋＋
Colorectal
＋
－
＋
＋＋
Cervix
＋
＋＋
＋＋
＋＋
Oralpharynx
＋＋
＋
＋＋
＋＋
Liver
＋＋
－
－
＋＋
Lung
Future Burden of Cancer
( 2020 )

Cancer mortality will continue to
increase; The number of new cancer
cases per year will increase to 100,000
(from 60,000).

Incidence of all cancers will increase to
410/105 (from 265/105).
National Cancer Control
Five- year Program
Goals of NCCP


To slow down the increase of the age-adjusted mortality
rate of all cancers, especially breast cancer, oral cancer
and colon-rectum cancer.
To reduce the age-adjusted mortality rate of cervical
cancer to 3.9/105; to reduce the proportion of invasive
cervical cancer to all cervical cancer to 35%.;

To increase the male five-year survival rate of all
cancers by 1%; to increase the female five-year survival
rate of all cancers by 2%;

To improve the approval rate of patients for the medical
care of cancer.
Objectives of NCCP
Itemized Goals
2003
2009
Improve the public’s anti-cancer capabilities
see Tobacco Hazards Control Plan
Smoking rate
Betel nut chewing rate (male adults)
Obese population
17.5％
17％
see National Nutrition Improvement
Program
Improve coverage rates of major cancer
screenings
Cervical cancer (women 30-69)
(three-year screening rate for
women 30-69)
Breast cancer (women 50-69)
Oral cavity cancer (smoking or betel nut
chewing persons 20 and above)
Colon-rectum cancer (general public 50-69)
74.8％
80％
55.6％
60％
2.8％
20％
19.9％
35％
1.3％
30％
Strategy 1
Building Healthy Lifestyles & Reducing
Risks of Cancer

Promotion of tobacco hazards control plan

Promotion of betel nut hazards control

Promotion of cancer prevention diet

Promotion of hepatitis control

Promotion of HPV prevention and control plan
Promotion of Betel Nut Hazards Control

To recommend practicable plans for the control and
taxation of betel nut; to establish legal sources and
financial basis for the control of betel nut;

To build up partnership for the control of betel nut hazards;
to develop NGOs;

To continue to supervise betel nut managers to label health
warnings on packs;

To strengthen education through mass media on betel nut
hazards, and to conduct preventive intervention projects
among specific groups (schools, worksites, army, and
communities of high betel nut use).
Promotion of HPV Prevention and Control Plan

To improve the public’s awareness of the relationship
between HPV and cervical cancer; to promote safe sexual
behavior;

To set up epidemiological data on HPV infection in Taiwan
and also KAP data of women on HPV;

To participate in international HPV vaccine development
research; to recommend the promotion of immunization
programs.
Strategy 2
Promotion of Cancer Screening for Early Detection
and Early Treatment

Establishing evidence-based screening models;

Including screening in the health promotion services of the
National Health Insurance;

Improving alertness to the early symptoms of some common
cancers;

Reducing obstacles; improving coverage rate of screening;

Establishing an effective referral and follow-up system for
positive cases;

Establishing a quality monitoring system for screening;

Establishing databanks of screening.
Cancer Screening Programs
Cancer
Target
Cervical Women aged 30 and
above
cancer
Policy
The year of
beginning
Pap smear (once/year)
1990 (BHP)
July 1995 (NHI)
July 2002
(BHP)
Breast
cancer
High-risk women
aged 50-69
Mammography (once/year for
women with family history; once
every three years for other highrisk women)
Oral
cancer
Smoking or betel nut
chewing persons
aged 18 and above
Examination of oral cavity mucus 1999 (BHP)
(once/3 years)
Colonrectum
cancer
General public aged
50-69
FOBT
(once/year)
Liver
cancer
By findings of liver cancer screenings, to conduct abdominal ultra-sound
screening for hepatitis B carriers for persons 40 and above.
July 2003
(BHP)
Strategy 3
To improve hospital accountability

To promote evidence-based medicine consensus on the
diagnosis and treatment of cancer;

To realize management of cancer diagnosis and treatment in
hospitals, and to upgrade quality, safety, and “patientoriented” medical care services

To establish an assessment system for the medical care of
cancer

To make cancer care hospitals improve their quality; to
make hospitals set up a mechanism for the realization of
cancer care management.
Strategy 4
To Consolidate and mobilize Community Resources for preventive
and supportive Services

To support cancer-related public-interest civic
groups, and to establish a collaborative
mechanism between governmental and NGOs;

To overall plan the allocation of service
resources and contents to meet the needs of the
target population.
Strategy 5
To Promote Hospice Care and Improve the Quality of Life of Patients





To promote education to make people
understand the meaning of hospice care;
To set up a hospice care network accessible to
those in need;
To improve the quality of hospice care;
To train cancer care-associated medical
personnel in hospice care;
To develop different reasonable payment
schedules for hospice care.
Strategy 6
To Establish Cancer Databanks, to Continue to Monitor and
Assess the Cancer Control Plan
To establish and manage
associated databanks;
cancer
control-

To set up a quality improvement mechanism
for the reporting of cancer information

To set up a cancer control information
management center; to publish major
information.
Strategy 7
To Consolidate Cancer Research through a Cancer
Research Center
 To set up by regulations a cancer research center
in the National Health Research Institutes to
formulate national research and development
directions for cancer, and to consolidate research
resources;

To promote the “three-step five-level” research
of cancer;

To plan for the establishment of a research
utilization mechanism and a feedback to policy
making mechanism.
Strategy 8
To Establish a Long-Term Manpower Development Policy





To regulate qualifications of service providers;
To assess the manpower demands and current
supply;
To provide on-job training and advanced
training overseas;
To supervise relevant medical associations to
set up professional licensure systems for special
demands of cancer care;
To include communication skills, and concepts
of holistic care and hospice in the education.
Budget and human resources
in our division

There are currently 17 members in our
division, one chief, one senior executive
officer, other are distributed in three
sections.
 In year 2005, we will invest about 14
million dollars in cancer control (if the fiveyear program is approved, there will be 115
million dollars invested).
Thank you for your attention