comprehensive cancer control
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Assessment of Burden (Hospital/Population-b)Risk Factor Determination (Phys/Socioeco)
Interventions - Primary Prevention(Awareness/Tobacco Control/Lifestyle)
Interventions - Secondary Prevention(Screening/Monitoring/
Interventions - Therapeutic
(Surgical/Radio/Chemical/Hormonal)
Interventions - Palliative(Physical/Psychological)
Cancer Control Programs
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The Chinese National Centerfor Cancer Registries
Gulf Center for CancerRegistration
Australasian Association of
Cancer Registries
Korean CancerRegistration
Asian Network?
Thailand Registration Group
1) DiseaseDiagnosis/Registration
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CIV
Non-CIV IACR Voting
Non IACR Voting
Non IACR
Asian Cancer Registries
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APJCP Supplement 1,22nd Annual IACR Meeting, Khon Kaen, Thailand, 2001
CANCER REGISTRATION IN ASIA IN THE YEAR 2000:PAST, PRESENT AND FUTURE
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Male Burde n of Cancers in Major Organs - Incidences/100,000
Registry China India Indonesia Iran Japan Korea Pakist an Philippines# Thailand Vietnam Ranking
Oral 1.3 (9)R 16.3 (1) ? 6.6 (4) 6.0 (9) 4.4 (8) 25.8 (1) 8.6 (6) 8.5 (4) 8.2 (5) 45 (6)
Oesophagus 14.8 (3) 7.4 (2) ? 39.4 (1) 10.0 (5) 10.1 (5) 6.2 (5) 3.1 (9) 3.7 (8) 3.7 (6) 46 (5)
Stomach 14.7 (4) 6.8 (3) ? 17.3 (2) 67.0 (1) 70.0 (1) 4.6 (8) 11.1 (5) 4.9 (6) 23.7 (2) 58 (4)
Colorectal 11.5 (5) 5.4 (4) 6.8 (2) 3.8 (7) 48.0 (2) 40.9 (4) 5.9 (6) 18.7 (3) 10.4 (3) 11.4 (4) 60 (3)
Liver 21.0 (2) ? 5.7 (3) 3.9 (6) 26.0 (4) 48.8 (2) 5.0 (7) 23.9 (2) 37.4 (1) 22.6 (3) 70 (2)
Pancreas 3.9 (6) 1.7 (8) ? 1.2 (9) 9.2 (7) 7.7 (7) ? 4.7 (8) ? 1.6 (9) 16 (9)
Lung 26.6 (1) 4.0 (6) 14.8 (1) 14.2 (3) 39.9 (3) 48.4 (3) 20.0 (2) 64.3 (1) 26.5 (2) 29.3 (1) 77 (1)
Prostate 2.1 (8) 5.2 (5) 5.6 (4) 2.0 (8) 10.0 (5) 4.2 (9) 7.6 (4) 17.6 (4) 4.4 (7) 2.2 (8) 28 (8)
Bladder 3.4 (7) 3.5 (7) ? 4.4 (5) 8.2 (8) 9.5 (6) 9.4 (3) 4.9 (7) 5.2 (5) 2.4 (7) 35 (7)
*Dat a f rom Selected Cancer Regist ries (see text f or references)# Data from Parkin et al., 1997R, rank
Descriptive Epidemiology: Males
Data from APJCP Supplement 1
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Female Burden of C ancers i n Major Organs - Incidences/100,000
Registry China India Indonesia I ran Japan Korea Pakistan Philipp ines*Thailand Vietnam Ranking
Oral 0.8 (9)R 7.8 (3) ? 6.6 (4) 2.0 (8) 1.2 (8) 18.7 (2) 6.0 (8) 4.5 (7) 2.7 (8) 33 (6)
Oesophagus 6.0 (6) 5.8 (5) ? 24.9 (1) 1.3 (9) 1.0 (9) 6.9 (5) 1.6 (9) 1.3 (9) 0.5 (9) 28 (9)
Stomach 14.7 (1) 3.5 (7) ? 5.9 (5) 27.0 (2) 25.7 (1) 3.2 (8) 6.4 (7) 1.5 (8) 8.5 (3) 58 (3)
Colorectal 9.0 (4) 3.8 (6) 6.3 (3) 2.9 (6) 25.5 (3) 10.3 (6) 5.0 (6) 15.8 (3) 7.5 (5) 6.4 (5) 53 (4)
Liver 8.0 (5) ? ? 1.8 (9) 7.7 (6) 11.6 (5) 3.4 (7) 8.0 (6) 15.5 (3) 4.6 (6) 33 (6)
Lung 10.2 (3) 3.1 (8) 4.8 (5) 2.5 (7) 11.2 (4) 12.7 (3) 2.8 (9) 17.7 (4) 11.1 (4) 7.9 (4) 49 (5)
Breast 12.7 (2) 22.6 (2) 14.8 (2) 12.3 (2) 31.0 (1) 12.5 (4) 56.6 (1) 47.7 (1) 16.3 (2)13.8 (1) 80 (1)
Ovary 5.3 (7) 5.9 (4) 5.2 (4) 2.5 (7) 6.4 (7) 4.0 (7) 9.5 (3) 9.4 (5) 4.7 (6) 4.4 (7) 43 (8)
Cervix 1.2 (8) 25.3 (1) 21.7 (1) 7.0 (3) 8.5 (5) 15.3 (3) 7.3 (4) 21.6 (2) 20.9 (1)13.1 (2) 70 (2)
*Data f rom Selected Cancer Regist ries (see text f or referen ces) # Data from P arkin et al., 1997R, rank
Descriptive Epidemiology:Females
Data from APJCP Supplement 1
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Soluble FiberInsoluble Fiber
N-6 PUFA's
High fat diet
High calorie consumption
Obesity
PRENEOPLASTIC/NEOPLASTIC CELL
GROWTH
IGF-I
Estrogen/Testosterone
Insulin Sensitivity
Glycemia
IGF-IR IR SHR
Insulin
N-3 PUFA's
GENE ACTIVATION
Physical Exercise
Physical Exercise
Receptor Impairment
Phys ical Exercise
N-3 PUFA's
N-6 PUFA's
Inflammation
Lipid peroxidation
?
NSAID's
Antioxidants
Carcinogens
INITIATION
Antioxidants
Insoluble Fiber
ODC Inhibitors
DHEA
HMG-CoA ReductaseInhibitors
Insulin sensitizers
DHEA
GENE ACTIVATION
ImmuneSystem
Lactoferrin
Parasites
2) Risk Factor Identification
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0-10 20-30 40-50
10-20 30-40 >50
0-5 10-15 20-25
5-10 15-20 >25
Incidence
RatesBreast
Cervix
Specific Cancer
Sites I
0 10 20 30 40 50 60 70 80 90Age (years)
Menarche Breast Density Menopause
Post-Menopausal Risk:Hormone Replacement/ ObesityNulliparity or late first pregnancy
Pre-Menopausa lR isk: Early menarche and late menopauseNulliparity or late first pregnancy
Pre-MenopausalProtection: Obesity Anovulation and low progesteroneEarly first pregnancy and multiparity
Oestrogen/Progesterone
Exposure
BREAST CANCER
Diet/Phytoestrogens
PhysicalExercise ReproductiveHistory Early Menarche/
Late Menopause
High D ensity
Low Density
Late Menarche/Early Menopause
Low Density
High D ensity
Risk and Protective Factors
Di et ar y F ac to rs P hysical Ex er ci se Hor mo na l E nv ir on ment
Persistent HPV High Risk Group Infection
Other STDsSmoking
EnvironmentalCarcinogens
Normal Epithelium CINI CINII CINIII CERVICAL CANCER
Dietary Factors Physical Exercise Hormonal Environment
:
:
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Site Specific Risk Factors I
0-2.5 5.0-7.5 10.0-15.0
2.5-5.0 7.5-10.0 >15.0
Oral Cavity/PharynxBetel, Smoking,
Alcohol, SunHPV
OesophagusTrauma, Smoking,Alcohol, Nutrition,
Obesity0-2.5 5.0-7.5 10.0-20.02.5-5.0 7.5-10.0 >20.0
StomachSalt, Stress
H.pylori
Colon/Rectum
Diet, Hyper-insulinemia
0-10 20-30 40-60
10-20 30-40 >60.0
0-5 10-15 20-40
5-10 15-20 >40.0
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LarynxDusts
Lung
Smoking,FumesNutrition
LiverHBV/HCVOpisthorchis
Urinary
BladderSmoking,Infection
0-5 10-15 20-30
5-10 15-20 >30
0-10 20-30 40-50
10-20 30-40 >50
0-2 4-6 8-10
2-4 6-8 >10
0-5 10-15 20-25
10-20 15-20 >25
Site Specific Risk Factors II
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15
20
25
30
35
40
45
SC
SC
SC
Singapore Chinese
SC
SM
SM
SM
SM
Singapore Mala
SISI
Singapore Indian
SI
SI
IB
IB IB
Indian Bombay IB
CSCS
Chinese Shanghai
CS CS
Chinese Hong Hong
CHK
CHK
CHKCHK
JM
JM
JM
JMJapaneseMiyagi
JO
JO
JO
Japanese Osaka
JO
1982 1987 1992 1997 2003
Year of Publication
Incidence(/100,000)
0
5
10
15
20
25
30
SC
SC
SC
Singapore Chinese
SC
SM
SM
Singapore Malay
SM
SM
SI
SingaporeIndian
SI
SI SI
IB
IB Indian Bombay IB
IB
CS
CS
ChineseShanghai
CS CS
Chinese Hong Kong
CHK
CHK
CHK
CHKJM
JM
JMJapanese
Miyagi
JM
JOJapanese Osaka
JO
JO
JO
HH
HH
HH
HH
HawaiinHawaii
1982 1987 1992 1997 2003
Year of Publication
0
5
10
15
20
25
30
Incidence(/100,000)
Generally IncreasingBreast, Colorectal, Prostate, Thyroid
Generally DecreasingCervical, Buccal
ParadoxicalLiver, Lung, Oesophageal
Breast
Cervix
Specific Cancer Sites II
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3) Primary and Secondary
Prevention
NORMALCELLS
PRENEOPLASIA/DYSPLASIA
Dietary Supplementation/Detoxification
Smoking, Endogenous and Dietary Carcinogens
Avoidance
MedicationVaccination
Trauma/ Infectious Agents/ Metabolic Stimuli
Regeneration/ Proliferation
Avoidance
HormonalMilieuManipulation
Initiation Growth
Naked Eye/PalpationOccult Blood
EndoscopyUltrasound/CTSerum markers
Screening and Resection
Progression
Chemoprevention
CANCER
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PSA/PSAD/DREFree PSA/RatiosAdjunct Therapy
HGPINASAPPCa
StageGrade
Risk Screening Biopsy Treatment Outcome
IncontinenceImpotenceErectileDysfunction
Psychological
HormonalSurgeryRadiotherapy
Chemotherapy
Cut-offComplicationsZone sizes
MethodologyNumber
Decision-makingQOLTiming
AlleviationQOLSalvage
Body SizeHormonesMorphology
DietExerciseSupplements
Intl Hospital-based ComprehensiveCase-control Studies!
4) Clinical Intervention
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Asian Cancer Control NetworkWho? What? Where?
Thai NCI Japanese NCC ???
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Political Pressure
Research Journals
Policy -making
Government
Politicians
The Media
Local Populace+
Patient Groups
Local Health/Registration Centre
Publication
Training
FundingFinancialSupport
Research Organizations
Asian Network?
IACR UICCIARC/WHO
Information
Evidence Base
Information
Rationale for Registration
Research Centres
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Cooperation for ComprehensiveCancer Control in Asia
Needs People Power
Thank you!
asian cancer control
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