Transcript Document

Cancer Registration
and Cancer Control in Asia
IACR Workshop: Beijing 16th Sept. 2004
THE POPULATION BASED CANCER REGISTRY IS THE
INDISPENSIBLE FOUNDATION OF A
SURVEILLANCE SYSTEM
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.
PURPOSES AND USES OF CANCER REGISTRATION
1
Epidemiological Research
Descriptive Epidemiology
Analytic Epidemiology
2
Health Care Planning and Monitoring
Patient Care
Survival
Screening
Prevention
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
Cervix Uteri, Incidence Rates by Education Level,
Quito Residents. 1985-1999
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
Source N.T.R.
Cancer in Ecuadorian regions 1997-1999
NCR, Solca Quito, 2001
Cancer in Scotland
1975-1980
Large Bowel, Females
IARC Scientific Publications
No. 72, 1985
Trends in Colon Cancer Incidence: ASIA
Age Standardised Rate (World), MALES
Singapore
Chinese
Hong Kong
Osaka
Manila
…………………
….
…………………
….
…………………
..
Bombay
PURPOSES AND USES OF CANCER REGISTRATION
1
Epidemiological Research
Descriptive Epidemiology
Analytic Epidemiology
2
Health Care Planning and Monitoring
Patient Care
Survival
Screening
Prevention
USES OF CANCER REGISTRY
PLANNING & EVALUATION OF CCPs
I DEFINING THE PROBLEM
•Burden of cancer
•Past trends
•Future projections
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)
CERVIX
BREAST
asr
2
4
Rate
4
Female Breast-Rural-Female
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
year
Female Breast-Urban-Female
urbanjpasr
asr
6
6
4
4
2
1
2
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
year
jpasr
rural
per 100,000
6
Rate per 100,000
Rate per 100,000
6
asr
jpasr
urban
per 100,000
jpasr
rural
Rate
asr
2
1
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
year
Cervix uteri-Rural-Female
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
year
Cervix uteri-Urban-Female
MORTALITY TRENDS: CHINA 1987-1999
Estimates and projections of national cancer incidence & mortality
197222
200518
181481
Sto mach
97843
95942
88790
127726
131794
121508
O e s o pha rynx
57485
60598
63756
126204
107439
O t he r
106611
86844
62264
75619
256679
Liv e r
100945
84349
225486
162004
Lung
58620
285785
143151
224807
102836
134748
56468
58553
48869
32290
C o lo n R e c t um
40429
33913
25669
22975
21461
20197
C e rv ix
48164
34927
18857
B re a s t
Year 2005
Le uk a e m ia
Year 2000
Year 1991
N a s o pha rynx
Male
B la dde r
350000
300000
250000
200000
29640
26585
22861
19094
18322
17996
16400
15670
13207
7802
7095
5819
12935
11417
8203
150000
100000
50000
4430
3675
2845
0
Female
50000 100000 150000 200000
PLANNING & EVALUATION OF CCP
MONITORING 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)
Incidence per 100,000 women-years
•Intermediate
endpoints
75
50
 NeverSize
screenedand stage of screen-detected cases
screened
 Ever
Incidence
of interval cancers
Normal test
 IncidenceDENMARK
of advanced cancers
Reference period 1958-67
FINLAND
ICELAND
NORWAY
SWEDEN
25
0
20
30
1945
40
1950
50
1955
60
1960
196570
197080
1975 90 1980
PLANNING & EVALUATION OF CCP
MONITORING 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
EVALUATION OF CANCER CONTROL
PROGRAMMES
SURVIVAL DATA
Effectiveness of Treatment
in delaying/preventing death
BUT,
consider other factors influencing survival
especially earlier diagnosis
FACTORS INFLUENCING SURVIVAL FROM CANCER
Disease:
Treatment:
Availability
Access
Natural history
Clinical extent
Definitions
Quality
Host:
Early Detection:
Age
Sex
Early clinical detection
SES
Screening
Comorbidity
Behaviour
Trends in 5-Year Relative Survival from Selected Cancers in
Women, Singapore, 1968-92
100
90
80
70
NASO
COLON
RSR
60
BREAST
50
CERVIX
UTERI
40
OVARY
THYROID
30
20
10
0
1970
1975
1980
Year
1985
1990
PLANNING & EVALUATION OF CCP
MONITORING 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
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)

Why do we need cancer registries

Current situation in Asia
ASIA – 12 COUNTRIES REPRESENTED
Russia
Kazakhstan
Mongolia
Kyrgyzstan
Turkey
JAPAN
KOREA
Turkmenstan
Tajikstan
CHINA
Syria
ISRAEL
Iran
Iraq
Lebanon
Afghanistan
Jordan
Egypt
Bhutan
PAKISTAN
KUWAIT
Qatar.
Saudi Arabia
U.A.E.
Karachi
INDIA
Bangladesh
Burma
Laos
PHILIPPINES
OMAN
Sudan
VIET NAM
Yemen
Manila & Rizal
THAILAND
Cambodia
Ethiopia
Arabian
Sea
Sri Lanka
Malaysia
Uganda Kenya
SINGAPORE
India
Afghanistan
INDIA – 9 registries
9 registries
China
Pakistan
Delhi
Nepal
Bhutan
Bangladesh
Ahmedabad
Burma
Nagpur
Mumbai (Bombay)
Poona
Bay of Bengal
Arabian Sea
Chennai
(Madras)
Bangalore
Karunagappally
Trivandrum
Sri
Lanka
South-East
Asia
China
Burma
VIETNAM
Hanoi
Chiang Mai
Laos
Lampang
THAILAND
Khon Kaen
Bangkok
Cambodia
Andaman
Sea
Gulf of
Thailand
Ho Chi Minh
City
South
China Sea
Songkhla
Malaysia
Indonesia
Malaysia
SINGAPORE
Indonesia
Japan
and
Korea
Russia
China
Yamagata
KOREA
Kangwha
Seoul
Miyagi
North Pacific
Ocean
Daegu
JAPAN
Busan
Hiroshima
Saga
Nagasaki
East China Sea
Osaka
Russia
Kazakhstan
China
10
Mongolia
registries
Korea
Beijing
Tianjin
Cixian
Qidong County
Shanghai
Wuhan
Jiashan
Bhutan
Changle
India
India
Taiwan
Bangladesh
Hong Kong
Burma
Viet Nam
Laos
South China Sea
Bay of Bengal
Thailand
Philippines
CI5 incidence data
% population coverage, 1995
26.2%
32%
4.7%
3%
12.7%
1%
82%
INTERNATIONAL ASSOCIATION OF CANCER REGISTRIES
Membership
447
19
385
366
19
18
186
Oceania
134
Asia
Africa
11
91
7
39
26
88
3
1979
9228ASIAN MEMBERS 87
92
38
54
68
48
83
37
40
68
74
24
28
30
42
44
1992
1996
1997
2002
2003
59
16
7
12
11
1982
1986
12
68
46
91
55
12
70
187
171
67
15
N. America
S. America
163
191
Europe
19
402
20
144
458
Incidence data
% population coverage, around 1995
36.5%
99%
7%
19.6%
8%
10.5%
86%

Why do we need cancer registries

Current situation in Asia

What’s new?
GULF STATES: 6 population-based registries
Now joined by Yemen: The Aden Cancer Registry
THE INDIAN CANCER ATLAS
Using pathology-based data to obtain clues about geography of cancer
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)
Lahul & Spiti (15.1)
Senapati (8.7)
Tamenglong (9.1)
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)
Population -based
cancer registry
Active surveillance
Tehran
KOREA: National population-based cancer registry network
6
Seoul, 1990
Incheon, 1998
 Area : 99,394 Km2
 Population : 47,275,000 (2000)
Daegu, 1997
Daejeon, 1997
 7 metropolitan cities
 9 provinces
Ulsan, 2001
Pusan, 1995
Kwangju, 1997
Jeju, 2001
Using the existing “Korean Central Cancer Registry” – a hospital based system providing
national level, but incomplete, data since 1980.
THAILAND
Cancer in Thailand, vol III
based on the established 5
Registries
There are another 5-6 start-ups
CHINA: Survey of cancer registries nationwide
Information from 48 PBCRs
They cover 5.7% population
Jiamusi
Qiqihaer
Boli
Haerbin
of China
Ningan
Shenyang
Anshan
Chicheng
Beijing
Wuwai
Tianjin
Dalian
Ganyu
Zanghuang
Jiaxian
Yangcheng
Huaian
Shexian
Linqu
Cixian
Feicheng
Linzhou
Jianhu
Taixing
Luoyang
Jintan
Lueyang
Yanting
Jiaxing
Wuhan
To be published in
Shanghai
Jiashan
Haining
Hangzhou
Changle
Eur. J. Cancer Prevn.
Gejiu
Tin Mine
Fusui
Guangzhou (1,2)
Shenzhen
Sihui
Hong Kong
Zhongshan
Dafeng
Yangzhong
Haian
Haimen
Qidong
Shanghai

Why do we need cancer registries

Current situation in Asia

What’s new

The role of IACR
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
SUPPORT TO CANCER
REGISTRIES
1.
International Standards
2.
Publications related to cancer registration
3.
Consultancy (+ WHO regions)
4.
Training of staff
5.
Fellowships
6.
Computer software
CANCER REGISTRATION
PRINCIPLES AND
METHODS
Comparability and
quality control in
Cancer Registration
Manual for Cancer
Registry Personnel
ICD Conversion
Programs for Cancer
International
Classification of
Childhood Cancer 1996
Guidelines on
Confidentiality in the
Cancer registry
Histological Groups for
Comparative Studies
IACR MEETINGS
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Hamburg, Germany
Quito, Ecuador
Ottawa, Canada
Bratislava, Slovakia
Bangalore, India
Rio de Janeiro, Brazil
Edinburgh, UK
Abidjan, Ivory Coast
Atlanta, USA
Lisbon, Portugal
Khon Kaen, Thailand
Havana, Cuba
Tampere, Finland
Honolulu, Hawaii
Beijing, China, 2004
THANK YOU.
See you next year
(and before that, I
hope!)