• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content

Loading…

Flash Player 9 (or above) is needed to view presentations.
We have detected that you do not have it on your computer. To install it, go here.

Like this presentation? Why not share!

Part 2.

on

  • 486 views

 

Statistics

Views

Total Views
486
Views on SlideShare
486
Embed Views
0

Actions

Likes
0
Downloads
9
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Part 2. Part 2. Presentation Transcript

    • Annual Burden of Cancer
      • 2005
      • 806,300 912,000
      With control of communicable diseases Increase in life expectancy Trends in smoking Changing life style Cancer incidence and burden  Cumulative Risk Male Female 1 in 9 1 in 8
    • ANTI-CANCER ACTIVITIES 1936 First effort to set up a cancer hospital – appeal to King George V Memorial Fund by Dr.Muthulakshmi Reddy No Major national effort for 30 years after this Dr. Reddy also responsible for including cancer in the National Health Programme in the First 5-year Plan of Govt. Of India. 1965-71 Govt. of India committee Concept of Regional Cancer Centre 1982 Demographic registries 1985 NCCP
    • Perception of Cancer Then 1949 Dr.Reddy had to justify the need for a Cancer Hospital Cancer perceived as a disease of the Aged a fatal / incurable disease Needed only Morphine to help their way to Eternity Cancer a major component of the National Health Plan Most states have a Cancer Centre Today’s Slogan Cancer is preventable, curable Stress on cancer survivors & Children of survivors Perception of Cancer now – 50 years later
    • National Cancer Registry Project (ICMR), 1981 & Other voluntary efforts
      • Setting up of 3 Demographic Registries
      • Bombay, Madras and Bangalore
      • A total of 14 Demographic Registries and 5 Hospital Cancer Registries (HCR) at present under NCRP
      • Only 3 are rural demographic registries
      • Six Demographic Registries outside NCRP network
      • ICMR Atlas Project – Data on cancer pattern in 82 districts from 105 centres in India.
      • Coverage: 6.9% of the population
      • Objectives based on the data from the Demographic registries
      • Primary prevention of Tobacco Related Cancers
      • Early detection and treatment of cancer of the cervix (extended to cover cancer at accessible sites cervix, breast and oral)
      • Enhancement of cancer treatment and control services through Regional Cancer Centres, Medical and Dental colleges.
      • Palliative care [added in – 1989]
      Objectives of the National Cancer Control Programme, 1985
    • Tobacco Research Activities in India
      • Chennai cohort study (300,000 men, aged ≥ 25 years)
      • 31% of total deaths due to any cancer was attributable to tobacco smoking ranging from 39% for stomach/oesophagus to 56% for lung/larynx cancers
      • Prevalence of tobacco smoking among men aged 35 and above is estimated to be 40%
      • Mumbai Cohort Study
      • 150,000 persons; Tobacco habit – 57.6% women; 69.3% men, smokeless tobacco use more common than smoking
      • Mortality rates higher for tobacco user than non-user
      • Global Youth Tobacco Survey (GYTS) among 13-15 yrs students
      • Prevalence ranged between 59% in Bihar, 4% in Goa;
      • 7% in Tamil Nadu and
      • Survey not carried out in Kerala.
    • MDCCP DATA FROM TAMIL NADU STATE (Women) Prevalence: Tobacco smoking: 3%; Tobacco chewing: 21% Age group Education Tobacco habit:  with increasing age;  with increasing education Frequency of women with awareness of Cancer as a term 79.2% Curability of cancer 45.0% Cancer Trt centres 32.4% Tobacco as a hazard 56.0%
    • Legislative Action
      • Anti-tobacco measures
        • Ban on tobacco advertisement
        • Ban on sale of tobacco near schools and colleges
        • Ban on smoking in public places
        • Ban on smoking in buses, airports. etc
        • Ban on sports promotion by tobacco companies
        • Hazards of tobacco in school books (hygiene, preventive medicine)
        • Monitoring of industries
        • Our recommendations
      • Preference to non-smokers as teachers in schools and colleges
      • Declare cancer a “ Notifiable Disease ”
    • CHINGLEPUT SURVEY OF CANCER 1961-63 % Stage Distribution of Carcinoma Cervix 1961 – 63 Number surveyed : 10,775 Male : 3,239 Female : 4,842 Children : 2,092 Cancers detected : 67 Oral : 24 Cervix : 27 Breast : 16 Foundation for the first ever pilot cancer control Programme – Kanchipuram 1967, WHO 1 st INTERNATIONAL WHO CANCER CONTROL PROJECT KANCHIPURAM 1967 Opportunistic Screening! 94.24 30.43 Late 5.76 69.57 Early C.I. Survey Stage
    • Objective To integrate the screening & education programme with the states’ permanent health infrastructure and delivery system This would significantly reduce cost Trained 258 Medical officers 672 VHNs 30 Block health educators 2 cytotechnicians Setup 2 Cytology laboratories in Cuddalore and Villupuram Total women examined 59314 Cancers detected 310 Early 12.3% Late 87.7% MOTIVATION POOR South Arcot District Level Cervical cancer early detection project: 1992-99
    • Problems in the South Arcot Programme
      • VHN had multiple duties and received incentives for the FPP & immunization drive
      • No incentives in cancer detection programme
      • Fresh young women medical graduates – not confident
      • Compliance of women to be screened – Dependant on men folk!
    • Information, Education and Health Care Intervention IARC in collaboration with Nargis Dutt Memorial Cancer Hospital, Barshi Int. Area Non Int. Area Ca Cervix 66% 25% Stage I & II
    • Major conclusions from various Indian studies
      • Population screening not practicable
      • For Cervical cancer VIA recommended at present
      • High priority and focus on
      • Educational Programmes
      • Serious effort to integrate screening with
      • routine health delivery system
      • Introduction of opportunistic screening can be considered
    •  
      • Enhanced Imaging
      • Enhancement in Tissue diagnosis
      • Molecular Diagnostics
      Technologic Advances
    • Enhanced Imaging
      • For evaluation of extent of disease / tumour size and tumour spread and monitor response to therapy
      • Ultrasound
      • CT Scan, Spiral CT
      • MRI, PET
      • Implications of sophisticated Imaging
        • Expertise in interpretation
        • Knowledge of relative merits of diff. available techniques
        • Increase in cost of diagnosis
    • Molecular Markers
      • Molecular diagnostics
      • Prognostic & Predictive Markers
      • Minimal Residual Disease
    • Conceptual influences in Therapeutic Oncology
      • Preventive Oncology : Based on natural history of evolution of disease
      • Definition of early disease
      • Concept of Micrometastasis
      • Evaluation of extent of disease
      • Introduction of multi disciplinary approach
    • Multidisciplinary approach in Oncologic care
      • Appreciates limitation inherent in different modalities of treatment
      • Sequencing of different modalities
      • Surgery, radiation and chemotherapy based on biologic needs
      • Different in early disease and locally advanced disease
    • RESEARCH Synthesis of clinical practice studies & laboratory and research data Essential for progress Hereditary Cancer Clinic only one of its kind in India - 2002
    • Palliative Care: Palliative care medicine – a speciality A major component in cancer control Facilities in India Palliative care centres, hospices, hospital based centres Domiciliary services Andhra Pradesh 1 Tamil Nadu 5 Kerala 4 Assam 1 Uttar Pradesh 1 with 50 satellite Chandigarh 1 Rajasthan 1 centers Karnataka 4 Goa 1 55% of cancers Madhya Pradesh 2 have access to Maharashtra 3 Palliative Care New Delhi 2 Orissa 2 Calicut Centre WHO Demo Project PAIN CONTROL
    •  
    • INCIDENCE AND BURDEN OF CANCER $ INDIA, 2001 & 2005 $ Estimates based on urban & rural registries Source: NCRP, ICMR Report (2004) & Individual Cancer Registry Reports 1116.8 912,000 539.9 469,000 576.9 443,000 Population (In millions) New Cancer cases 2005 CIR/10 5 Population (In millions) New Cancer cases 78.0 1033.7 806,300 84.1 499.0 419,700 72.3 534.7 386,600 2001 M+F Female Male
    • CIRs of Cervical & Breast cancers in India (Urban vs Rural registries) Source: NCRP, ICMR Report (2005) & Individual Cancer Registry Reports Trend of CIR of Cervical & Breast Cancers Urban India:1983-2002 (93-01) 19.8 5.6 Rural Barshi (1999-00) 11.8 21.3 Urban Mumbai (2000) Maharashtra 11.2 14.4 Rural Karunagapally 8.7 26.5 Urban Trivandrum (2000) Kerala 27.8 13.1 Rural Dindigul (2003) 24.3 24.5 Urban Chennai (1999-02) Tamil Nadu Cervix Breast Registry (Period) Reversed now   Trend 1:1.38 21.9 15.9 1998-02 1:1.05 18.2 17.4 1993-97 1:0.87 16.7 19.3 1988-92 1:0.63 10.4 16.6 1983-87 Cx :Brt Breast Cervix Period
    •   Trend of stage distribution (%), Trivandrum, 1984-1999 21.1 36.3 22.2 36.8 4 4.2 6.5 9.9 6.9 4 21.0 16.1 9.4 17.3 4 47.2 25.6 53.3 39.7 3 21.1 22.4 15.8 17.8 2 10.6 15.6 8.7 5.7 1 Oral Cancer 50.9 49.5 44.5 59.4 3 32.1 29.6 34.6 27.4 2 12.7 14.4 11.1 6.3 1 Cervix 42.5 37.4 41.9 34.6 3 33.3 43.3 47.5 43.3 2 3.2 3.3 1.3 4.8 1 Breast 1999 1994 1989 1984 Stage
    • Trend in survival(%) at 5 years ALL: 0-25 Years : 1970-99 : (C.I) 62.6 (233) 52.0 (128) 35.1 (33) 0-25 Yrs. 59.6 (57) 42.3 (39) 35.3 (3) 15-25 Yrs. 62.6 (176) 55.1 (89) 35.3 (30) 0-14 Yrs. RFS 1990-99 (%) 1983-89 (%) 1970-82 (%) Age Group 54.0 (270) 46.6 (73) 56.8 (197) 38.9 (171) 30.7 (57) 43.0 (114) 24.0 (48) 16.7 (6) 25.1 (42) 0-25 Yrs. 15-25 Yrs. 0-14 Yrs. OS
    • Carcinoma Breast : Survival : HBCR All cases accepted for Treatment (All stages) Cancer Institute(WIA), Chennai * 9 year survival 36.8 47.8 46.8 60.6 1767 1990-95 <0.001  <0.001  6604 p-value 46.3* 55.7 57.3* 66.3 1558 1996-99 31.8 44.5 35.7 49.3 2503 1975-89 1960-74 Period Disease free survival (%) Overall survival (%) No. 10 yr 5 yr 10 yr 5 yr 29.3 21.5 24.3 35.0 776
    • Testicular Germ Cell Tumour Cancer Institute, Chennai
      • Treatment
      • Stage I : High Inguinal Orchidectomy - Observation
      • Stage II-III : High Inguinal Orchidectomy - CT
      • Role of Retroperitoneal lymphadenopathy is controversial
      World Survival Cancer Institute Institution 97.0 34 PVB (Testicular) Proc Am Soc Cli Onc 1998; 17: 525 165 34 No. 60.0 1985-89 (All Stages) 30.2 1970-84 (All Stages) 5 Yr. OS % Period / Regimen
    •  
    • Disease profile in India Shift from communicable to Non communicable diseases
    • Health Budget and Cancer Budget (Government of India) % of Total outlay Health and Family Welfare 8.6% (Rs.6,283 crores) Health 2.0% (includes cancer Annual Rs.55 crores) Family Welfare 6.45% Indigenous medicine 0.18%
    • Change in cancer scenario : 1955-2005
      • Improved Survival
      • Organ conservation
      • Concept of cancer prevention &
      • stress on early detection
      Result of advances in Technology & conceptual influences
      • High technology involves heavy financial investment
      • Increases cost and treatment
      • Reduces affordability
    • Future Directions
      • Identify individuals who have inherited or acquired defective suppressor gene
      • Identify precursor lesions & chemoprevention
      • Vaccine Based Strategies
      • Predictive Medicine – Pharmacogenomics
      • Array based methods for diagnosis, prognosis and choice of drugs for treatment