This document proposes a regional framework for cancer prevention and control in the Eastern Mediterranean region. It summarizes the high cancer burden in the region, with nearly 400,000 cancer deaths and over 500,000 new cases per year expected to double in the next 15 years. The framework then outlines strategic interventions in six areas - governance, prevention, early detection, treatment, palliative care, and surveillance/research. For each area, it proposes actions countries could take to strengthen cancer control, such as developing national cancer plans, increasing screening and diagnosis, ensuring access to treatment, and improving data collection. The goal of the framework is to encourage a coordinated, evidence-based approach to reducing the cancer burden in the region.

1. 64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017
A regional framework for action
on cancer prevention and
control
Agenda item 3(a)
9–12 October 2017, Islamabad

2. Outline
• Epidemiology
• Achievements and challenges
• The proposed framework
– What is it?
– What will it change?
• The way forward
2
A regional framework for action on cancer
prevention and control

3. Cancer burden in the Region
3
Almost 400 000 cancer related deaths and
>1/2 million new cases/year
Source: IARC 2012 and WHO GHE 2015
32%
10%
3%
4%
13%
13%
25%
Cardiovascular diseases
Cancers
Diabetes
Chronic Respiratory Diseases
Other NCDs
Injuries
Communicable, maternal, child/perinatal and
nutritional conditions
The Region is
expected to
experience a
100% increase
in the number
of new cancer
cases in the 15
years (highest
globally)
A regional framework for action on cancer
prevention and control

4. Most frequent cancers by total number
in the Eastern Mediterranean Region
(by EMR country grouping and sex)
4
Country
Group
Men Women
1st 2nd 3rd 1st 2nd 3rd
Group I Colorectal Lung
Prostate
NHL
Breast
Colorectal
Thyroid
Cervix uteri
Thyroid
Group II Lung
Colorectal
Bladder
Prostate
Bladder
Leukemia
Breast Colorectal
Thyroid
NHL/Leukemia
Group III
Oral
Stomach
NHL
Leukemia
Oesophagus
Colorectal
Lung
Leukemia
NHL
Brain
Nervous
system
Breast
Cervix uteri
Oral
Leukemia
Cervix uteri
Ovary
Total
EMR
Lung Bladder Liver Breast Colorectal Cervix uteri
Adapted from: Kulhánová, I., Bray, F., Fadhil, I., Al-Zahrani, A.S., El-Basmy, A., Anwar, W.A., Al-Omari, A., Shamseddine, A., Znaor, A. ,
Soerjomataram, I., 2017. Profile of cancer in the Eastern Mediterranean Region: The need for action.
Cancer Epidemiology, 47, pp.125-132.
A regional framework for action on cancer prevention and control

5. Age-standardized incidence and mortality
rates in the Region
by country, sex and level of human development index (HDI)
(all cancers, per 100 000 person-years, 2012)
5
Men Women
Source: Kulhánová, I., Bray, F., Fadhil, I., Al-Zahrani, A.S., El-Basmy, A., Anwar, W.A., Al-Omari, A., Shamseddine,
A., Znaor, A. and Soerjomataram, I., 2017. Profile of cancer in the Eastern Mediterranean region:
The need for action. Cancer Epidemiology, 47, pp.125-132.
A regional framework for action on cancer prevention and control

6. Selected country experiences & achievements
• Islamic Republic of Iran: Early detection of three cancers (breast,
cervical and colorectal) within primary health care package
• Jordan and Kuwait: Palliative care programmes
• Morocco: 1st country participating in United Nations Global
Cervical Cancer Programme (inception mission December 2016)
• Qatar: Breast and colorectal screening programmes
• United Arab Emirates: Steps taken to cover cancer treatment as
part of basic insurance scheme
• Important contributions from non-state actors: e.g. Lalla Salma
Foundation, King Hussein Cancer Foundation, The Gulf Federation
for Cancer Control
• Other e.g. Bahrain, Egypt, Oman, Saudi Arabia
6
A regional framework for action on cancer
prevention and control

7. • Political context: instability, humanitarian emergencies
• Limited strategic direction and prioritization based on
available data
• Insufficient attention to preventive measures
• Cancer screening programmes with limited impact and
evaluation
• Late diagnosis of cancer
• High cost of cancer medicines and technologies
• Insufficient health systems development for sustained
quality services
Challenges
A regional framework for action on cancer
prevention and control
7

8. Purpose and scope of the framework
• Provide an updated strategic reference for national cancer
programmes in countries in an integrated fashion (updating
preceding regional cancer strategy 2009-13)
• Operationalize WHA70.12 resolution (2017) on ‘Cancer
prevention and control through an integrated approach’
• Align cancer work with the regional Framework for action
on noncommunicable disease prevention and control
(2012), thus contributing towards meeting national, regional
and global targets for noncommunicable diseases.
A regional framework for action on cancer
prevention and control
8

9. Purpose and scope of the framework (2)
• Articulated along six integrated areas:
1. Governance
2. Prevention
3. Early detection
4. Treatment
5. Palliative care
6. Surveillance and research
• For each area, a number of strategic interventions are
proposed along with indicators to measure progress
A regional framework for action on cancer
prevention and control
9

10. In the area of governance
Strategic interventions
Develop a multisectoral strategy and action plan for cancer
prevention and control, as part of national response to
noncommunicable diseases
Establish a national multisectoral committee for cancer
prevention and control
Ensure sufficient national budget availability for cancer
Define an essential cancer care package and identify financing
mechanisms to reduce out-of-pocket expenditure
Appoint a national cancer control programme manager
A regional framework for action on cancer
prevention and control
10

11. In the area of prevention
Strategic interventions
Healthy lifestyle interventions in the areas of tobacco control,
physical activity, healthy diet and alcohol, in line with the
regional framework for action on noncommunicable diseases
(2012)
Ensure vaccination against hepatitis B in infancy
Ensure human papillomavirus (HPV) vaccination in
preadolescents in countries with high risk of cervical cancer
Eliminate or reduce exposure to occupational and environmental
carcinogens, such as asbestos
A regional framework for action on cancer
prevention and control
11

12. In the area of early detection
Strategic interventions
Develop, implement and update evidence-based, nationally
approved guidelines/protocols/standards for the early detection
of priority cancers, with a focus on early diagnosis
Promote community awareness about the early symptoms
of priority cancers
Promote health professional education on early signs and
symptoms of common cancers, for prompt referral of
symptomatic patients to diagnostic and treatment services
Ensure availability, affordability and accessibility of diagnostic
tests for suspected cases
Periodically assess effectiveness of early diagnosis and screening
programmes
A regional framework for action on cancer
prevention and control
12

13. In the area of management
Strategic interventions
Develop, implement and update evidence-based, nationally
approved guidelines/protocols/standards for management of
priority cancers
Assess the human resource requirements and develop plans to
scale up to meet local needs
Ensure availability, affordability and accessibility of an essential
cancer care package
Strengthen coordination of referral system with targets to
reduce delays to diagnosis and treatment.
A regional framework for action on cancer
prevention and control
13

14. In the area of palliative care
Strategic interventions
Ensure inclusion of palliative care within national cancer control
plans
Develop, implement and update evidence-based, nationally
approved guidelines/protocols/standards for palliative care
Introduce palliative care into the curricula of healthcare
professionals
Develop affordable, multidisciplinary integrated palliative care
services, including pain relief, psychosocial and spiritual support,
in both hospital and community settings
Ensure availability and accessibility of opioids, analgesics and
other essential palliative care medicines, addressing legal and
regulatory barriers.
A regional framework for action on cancer
prevention and control
14

15. In the area of surveillance and research
Strategic interventions
Establish and strengthen hospital- and population-based cancer
registries that cover a population not less than one million
Develop a system to monitor quality of care and the
performance of national cancer control programs
Develop and implement a cancer research plan relevant to
country needs.
A regional framework for action on cancer
prevention and control
15

16. 16
A regional framework for action on cancer
prevention and control

17. What would the Framework change?
• Encourage countries to take a whole system approach to
cancer, which will enable more efficient allocation of
resources, based on population needs
• Operationalize WHA resolution 70.12 on cancer prevention
and control in the context of an integrated approach
• Emphasise the importance of prevention, building synergies
with measures to reduce risk factors for all NCDs
• Prioritize early diagnosis strategies for cancers, as too many
cancers are diagnosed at an advanced stage in the Region
• The indicators will strengthen monitoring and evaluation, and
reporting of cancer programme performance.
A regional framework for action on cancer
prevention and control
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18. WHO support for implementation
The implementation of
strategic interventions
outlined in the Framework
is supported by a series of
implementation tools.
A regional framework for action on cancer
prevention and control
18

19. Way forward and next steps
• Regional Committee invited to endorse proposed
Framework.
• Guided by the framework, Member States may scale up
national cancer prevention and control strategies focusing
on:
1. Prevention: building synergies with measures put in place to
prevent and reduce risk factors exposure for all NCDs, guided
by EM NCD RFA
2. Early diagnosis of priority cancers amenable to treatment
3. Developing and strengthen monitoring and evaluation, and
reporting of cancer program performance.
A regional framework for action on cancer
prevention and control
19

20. Thank you