This document summarizes Malaysia's experience with cancer screening and control efforts. It notes that non-communicable diseases like cancer account for over 70% of deaths in Malaysia. The National Strategic Plan for Non-Communicable Diseases aims to reduce cancer morbidity, mortality, and improve quality of life through various prevention, screening, treatment, and palliative care initiatives. Specific programs are in place for cervical cancer screening via Pap smears and HPV vaccination, as well as other cancers. Challenges remain in increasing screening and treatment coverage, addressing barriers, and ensuring access. Continued efforts are needed to work towards cervical cancer elimination targets in Malaysia.
Breast and Cervical cancer awareness - breast cancer treatment in puneOnco Life Cancer Centre
Looking for breast specialist doctor in Pune? Onco Life Cancer Centre has top specialist in Breast Cancer Treatment in Pune and providing cancer patients with excellent patient care and best medical treatment facilities.
https://www.oncolifehospitals.com/services/breast-cancer-treatment/
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
What Are the Key Statistics About Cervical Cancer?
The American Cancer Society's estimates for cervical cancer in the United States for 2017 are:
About 12,820 new cases of invasive cervical cancer will be diagnosed.
About 4,210 women will die from cervical cancer.
Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.
Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 40 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage.
Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 15% of cases of cervical cancer are found in women over 65. However these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65. See the section, " Can cervical cancer be prevented?" and Cervical Cancer Prevention and Early Detection for more information about tests used to screen for cervical cancer.
In the United States, Hispanic women are most likely to get cervical cancer, followed by African-Americans, Asians and Pacific Islanders, and whites. American Indians and Alaskan natives have the lowest risk of cervical cancer in this country.
Lung cancer is a deadly disease. Tobacco being leading cause of cancer.
"Tripda International School" has invited me to give lung cancer awareness talk to their students and parents as a part of "World Cancer Day".
This presentation will give you brief regarding causes, signs, symptoms, prevention aspect, diagnosis and treatment of lung cancer.
Breast and Cervical cancer awareness - breast cancer treatment in puneOnco Life Cancer Centre
Looking for breast specialist doctor in Pune? Onco Life Cancer Centre has top specialist in Breast Cancer Treatment in Pune and providing cancer patients with excellent patient care and best medical treatment facilities.
https://www.oncolifehospitals.com/services/breast-cancer-treatment/
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
What Are the Key Statistics About Cervical Cancer?
The American Cancer Society's estimates for cervical cancer in the United States for 2017 are:
About 12,820 new cases of invasive cervical cancer will be diagnosed.
About 4,210 women will die from cervical cancer.
Cervical pre-cancers are diagnosed far more often than invasive cervical cancer.
Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 40 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage.
Cervical cancer tends to occur in midlife. Most cases are found in women younger than 50. It rarely develops in women younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 15% of cases of cervical cancer are found in women over 65. However these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65. See the section, " Can cervical cancer be prevented?" and Cervical Cancer Prevention and Early Detection for more information about tests used to screen for cervical cancer.
In the United States, Hispanic women are most likely to get cervical cancer, followed by African-Americans, Asians and Pacific Islanders, and whites. American Indians and Alaskan natives have the lowest risk of cervical cancer in this country.
Lung cancer is a deadly disease. Tobacco being leading cause of cancer.
"Tripda International School" has invited me to give lung cancer awareness talk to their students and parents as a part of "World Cancer Day".
This presentation will give you brief regarding causes, signs, symptoms, prevention aspect, diagnosis and treatment of lung cancer.
Assessment of MTCT prevention effectiveness in Kaliningrad Region and tasks f...THL
Nordic Council of Ministers, Nordic-Russian Health Program, Inter-regional international conference "Collaboration across healthcare and social services in prevention of mother-to-child HIV infection" Kaliningrad, 13-14 June 2017
Assessment of MTCT prevention effectiveness in Kaliningrad Region and tasks f...THL
Nordic Council of Ministers, Nordic-Russian Health Program, Inter-regional international conference "Collaboration across healthcare and social services in prevention of mother-to-child HIV infection" Kaliningrad, 13-14 June 2017
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Annette Verster, WHO
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Ghia Fdn overview-strategy update january 2017 (presentation resaved sept 14_...Ghia Foundation
GHIA FOUNDATION WAS FOUNDED IN 2013 by a team of kind-heated Professionals.
VISION: A World where women in developing Countries live healthier , longer lives
MISSION – To reduce morbidity and mortality among women in developing Countries by strengthening Health Systems to deliver high quality, comprehensive health services.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Cancer Screening in a Middle Income Country: Malaysia's experience
1. Cancer screening in a Middle-Income
country: Malaysia’s experience
Non Communicable Disease Section
Disease Control Division
Ministry of Health Malaysia
6 January 2020
2. Burden of Disease, Malaysia (2017)
2Institute for Health Metrics and Evaluation (IHME). Health-related SDGs. Seattle, WA: IHME, University of Washington, 2017
Available from http://vizhub.healthdata.org/sdg. (Accessed 26 August 2018)
3. Determinants of Health:
Proportional contribution to premature death
3
Behavioural
patterns
40%
Environmental
conditions
5%
Social
circumstances
15%
Medical care
10%
Genetic
predisposition
30%
Our health is determined
by much more than the
health services we
receive
Determinants of Health and their contribution to premature
death (adapted from McGinnis, et al., 2002)
5. National Strategic Plan for Non-Communicable
Diseases (NSP-NCD) 2016-2025
• Approved by MOH on 10 April 2017
• In-line with Malaysia’s commitment at the global
level for NCD prevention and control
– Including Sustainable Development Goals (SDGs)
– Universal Health Coverage
• Governance: Cabinet Committee for a Health
Promoting Environment
– Chaired by Deputy Prime Minister
– Membership: 12 ministers
5
6. Implementation of NSP-NCD 2016-2025
1. National Plan of Action for Nutrition of Malaysia III 2016-2025
2. National Strategic Plan for Tobacco Control 2015-2020
3. Policy Options to Combat Obesity in Malaysia
4. Salt Reduction Strategy for Malaysia 2015-2020
5. National Strategic Plan for Active Living 2016-2025
6. Malaysia’s Alcohol Action Plan 2013-2020
7. National Strategic Plan for Cancer Control
Program 2016-2020
8. Enhanced Primary Healthcare (EnPHC) initiative
9. Komuniti Sihat, Pembina Negara (KOSPEN) initiative
6
7. National Strategic Plan for Cancer Control Program
2016-2020
Overall objective:
To reduce the negative impact of cancer
by decreasing the disease morbidity,
mortality and to improve quality of life
of cancer patients and their families
• Cross Cutting Issues:
– Communication
– Patient navigation
– Social determinants
– Genetic testing
– Decision making
– Dissemination of evidence-
based info
– Quality of cancer care
– Surveillance
– Monitoring & evaluation
7
PreventionTraditional &
Complementary Medicine
Screening &
early detection
Diagnosis
Palliative Care
Rehabilitation
Treatment
8. A selection of interventions for NCD prevention
in Malaysia (life-course approach)
8
Pregnancy
Pre-
conception
Infant/
Toddler
Pre-
School
School-
going Age
Higher
Education
Adults Elderly
Kelab Doktor
Muda
Program Siswa
Sihat (PROSIS)
KOSPEN
KOSPEN Plus
Guideline on marketing of unhealthy F&B to
children
Guideline on enforcement of sale of food
outside of school perimeters
School canteen guidelines
mQuit Services
Smoke-free areas, and other tobacco-related policies
Mass media campaigns, medical/health camps, Healthier Choice Logo (HCL)
HPV vaccination
HepB
vaccination
SSB tax
Selected cancer screenings
Early intervention
for smoking
9. Organised Screening and Early Detection programmes
in Malaysia
Breast Cancer
Cervical cancer
Oral cancer
Colorectal cancer
Opportunistic
approach
9
12. Age standardised incidence rate for ten common
cancers, by sex, 2012-2016
12Malaysia National Cancer Registry Report, 2012-2016
13. ACTION Study: Financial catastrophe at one year of being
diagnosed with cancer; Country-specific outcomes
13
Country Per capita GDP
(USD)
Age-standardized
cancer incidence
(per 100 000)
Financial
catastrophe
at 1 year
Death at 1 year
Malaysia 10,830 143.6 621/1,373 (45%) 158/1,373 (12%)
Thailand 5,561 137.5 249/1,058 (24%) 276/1,058 (26%)
Indonesia 3,515 133.5 486/1,097 (44%) 405/1,097 (37%)
Philippines 2,843 140.0 369/660 (56%) 240/660 (36%)
Vietnam 2,052 140.4 1,016/1,490 (68%) 370/1,490 (25%)
Laos 1,708 141.8 11/56 (20%) 45/56 (80%)
Myanmar 1,198 140.5 495/995 (50%) 445/995 (45%)
Cambodia 1,084 140.4 1/58 (2%) 54/58 (93%)
Source: http://business.inquirer.net/198982/cancer-costs-southeast-asia-socially-and-economically#ixzz4dI0pTBnn
14. Life Course Approach to Cervical Cancer
Prevention and Control
14
Girls 9-14 years
• HPV vaccination
Girls and boys, as appropriate
•Health information and warnings about
tobacco use
•Sexuality education tailored to age &
culture
•Condom promotion/provision for those
engaged in sexual activity
•Male circumcision
Women > 30 years of age
“Screen and treat” – single visit
approach
• Point-of-care rapid HPV testing for
high risk HPV types
• Followed by immediate treatment
• On site treatment
All women as needed
Treatment of invasive cancer at any age
and palliative care
•Ablative surgery
•Radiotherapy
•Chemotherapy
•Palliative Care
Primary Prevention Secondary Prevention Tertiary Prevention
Source: World Health Organization
15. Pap Smear Coverage for Malaysia
15
22.7 23.5
23.4
23
26.3
20
21
22
23
24
25
26
27
2013 2014 2015 2016 2017
Percentage
Source: Family Health Development Division, MOH Malaysia
16. HPV Vaccination Programme in Malaysia
16
What When, who and how
Year initiated 2010
Implementing organisation Ministry of Health
Financed by Government of Malaysia
Vaccination protocol 2 doses (0, 6 months)
Vaccination target School going 13-year old girls
Community mobilisation activities Catch-up provided in health clinics
Implementation of vaccination School Health teams
Surveillance and program monitoring Routine, Paper-based
Source: Family Health Development Division, MOH Malaysia
17. Increased coverage of HPV vaccination
17
WHO recommendations
• 2 doses to girls 9-14 years, minimum 6 months apart
• Introduce to multi-age cohort, 9-14 years (15-18 if feasible) in first year
• 3 doses for: girls 15 years and older; and for immuno-compromised individuals
Challenges
• Poor parental awareness and public confusion
• Perceived religious and cultural issues
• Financial allocation
• Logistic issues leading to delay of vaccine delivery
Accelerators
Sufficient, affordable supply of HPV vaccine
• Competitive procurement mechanism
• Concerted effort between partners and private sector to overcome vaccine supply constraints
Introduction of HPV vaccine as school based programmes
• Strong relationship with MOE
• School health services infrastructure
• Develop high quality and sustained communication and mobilisation approaches
Political will and commitment
Public trust in NIP
Effective risk communication strategy
• Addressing religious issues
18. HPV Immunisation Rates in Malaysia
18
92
93
94
95
96
97
98
99
100
2010 2011 2012 2013 2014 2015 2016 2017
Parents' Consent 95.88 97.59 98.18 98.44 98.48 98.23 98.40 98.60
First Dose 99.50 99.66 99.82 99.94 99.91 99.98 99.91 99.82
Second Dose 98.94 98.97 98.66 99.75 99.84 99.62 99.12 99.40
Third Dose 97.93 98.25 99.13 99.31 99.54
Completed Dose 98.41 98.87 99.31 99.37 99.63 99.64 99.12 99.58
Percentage
Source: Family Health Development Division, MOH Malaysia
19. Increased coverage of screening & treatment of pre-
cancer lesions
WHO recommendations
• Women aged 30-49 years be screeened at least once in their life-time for cervical cancer, and re-screened
every 5 years
• HIV positive women should be screened every 3 years
• Immediate treatment where possible
Challenges
• Patient barriers: Fear, embarrassment, perceived benefits, inconvenience (no time), negative experience, low
awareness
• Healthcare barriers: Lack of space and privacy, human resources, screening infra-structure
• Expensive and complex screen and treat technologies complicate scaling-up
• New or optimised service delivery methods required for LMIC contexts
Accelerators
• Use of self sampling HPV DNA testing
• National scale-up of screen & treat
• Simple algorithms need to be introduced for different settings
• Increased quality and coverage of service delivery
• Countries detailed implementation plans to introduce and scale-up products and delivery models
• Strengthen patient retention and linkage to treatment
19
20. 20
Eligibility Education Registration
Sample
collection
Results
0m 0.5m 2.5m 6.0m 9.5m 3 working days
• New approach to complex and
persistent problem through
human-centered research,
collective and diverse teamwork
and rapid prototyping
• ROSE is innovation that aims to
create more efficient screening,
improvement of quality and
lower total cost
Slide courtesy of Prof. Dr Woo Yin Ling, Universiti Malaya
21. A good screening program ensures every obstacle is addressed from
start to completion of the screening continuum
Slide courtesy of Prof. Dr Woo Yin Ling, Universiti Malaya
22. What else needs to be done? Increased coverage of
diagnosis, treatment and palliative care for invasive cancer
WHO recommendations
• Women diagnosed with early invasive cervical cancer can be cured with effective quality treatment
• Cervical cancer diagnosis must be confirmed by histopathological examination
• Cancer surgery and radiotherapy are major primary treatment modalities
• Palliative care is an essential element of cervical cancer control
• Reducing delays in access to diagnosis and treatment can improve survival of women with cervical cancer
Challenges
• About 40% of cervical cancer is detected in late stages
• Treatment is often associated with catastrophic health expenditure
• Access to palliative care is poor
Accelerators
• Access to quality pathology, cancer surgery and radiotherapy
• Reducing cost of equipment and cancer medicines
• Sufficiently trained health workforce
• Implemented protocols and care pathways
• Timely diagnosis, staging, treatment, and referral of patients
• Increased access to palliative care
• Ensured financial access to treatment
• Integrated into UHC or other social support programs
22
23. Towards Cervical Cancer Elimination in Malaysia
• Malaysia is well positioned for cervical elimination targets
• Must retain vaccine uptake among adolescents to 90% and above
• It is necessary to transition from pap smear to HPV test
• It is necessary for monitoring and surveillance to achieve 70%
screening targets with 90% of abnormal screens being followed up
• Cross ministry and cross sector collaboration is necessary for
organised screening and surveillance
• International collaboration is an accelerator
23
A paper by McGinnis in 2002 examined the contributions of various factors to premature mortality.
Their paper found that medical care only contribute 10% - meaning that our health is determined by much more than the health services that we receive.
The National Strategic Plan for Non-Communicable Diseases (or NSP-NCD) provides the overall framework for Malaysia’s response to the increasing burden of NCDs.
This Strategic Plan is in-line with Malaysia’s commitment at the global level, including the SDGs.
To support the implementation of the NSP-NCD, there is a Cabinet level committee called the JK Kabinet bagi Persekitaran Hidup yang Sihat or JKPHS
This Committee is chaired by the Deputy Prime Minister and membership consisted of 12 ministers.
Under the NSP-NCD, these are the various Strategic Plans that addresses the various NCDs and NCD risk factors.
This shows a selection of interventions for NCD prevention – depicted graphically along the life-course approach.
We have implemented many interventions, targeting the school-going children and adults.
Unfortunately, we are still not doing enough
528,000 new cases with 266,000 deaths
90 % of the deaths in LMICs
Cervical cancer is an unacceptable disease and the burden is still far too high in many countries, principally in middle and low income countries, reflecting the many inequities across the world in terms of access to services.
High income countries have addressed the burden with organized screening programmes and now the low cx ca incidence can be maintained by the introduction of vaccines
Cervical cancer is a completely preventable disease, yet it remains the leading cause of cancer-related death and morbidity among women in the developing world, with approximately 85 percent of the disease burden occurring in low- and middle-income countries. To address this challenge, countries need to use testing as part of population-based screening for human papillomavirus (HPV), which is the principal cause of cervical cancer.
The strategic direction 2, highlights the 3 key WHO recommendations to be implemented at scale in countries based on a life course approach, as represented on this figure:
- HPV vaccination;
- Screening and treatment;
- Treatment of cancer and access to palliative care.
For vaccination, the vaccine group in WHO is currently looking at new evidence available to update the recommendation if needed, and to present findings to the next SAGE meeting
For screening and treatment: new recommendations are going to be published on thermal ablation and screening amog HIV positive women. The strategy will focus on the extensive implementation of one of the recommended algorithm: HPV testing followed by immediate treatment for women tested positive in a single visit approach
As more cancer will be identified in the context of an intensive screening campain, strengthen access to reatment and palliative care is essential
1969- Introduced of Pap Smear in few clinics as package for family planning acceptors
1995- Expansion of pap smear screening to eligible women – opportunistic screening
2010 - Introduction of School Based HPV vaccination to 13 yrs old girls
Why HPV vaccination?
Low smear uptake
Delay in seeking treatment
WHO endorsement
Presentation of cervical cancer
Stage 1 – 24%
Stage 2 – 38%
Stage 3 – 21%
Stage 4 – 17%
