Cancer Prevention in Egypt : What can be done in low income ...

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  • The causes of these ever-increasing trends are four-fold:
    Infectious diseases continue to pose a significant threat to the health and wellbeing of the citizens of developing nations around the world.
    Tobacco use – despite all that we know of its deadly and addictive nature – is on the rise.
    More people from more nations are falling prey to unhealthy lifestyle choices, such as poor nutrition, overweight, and lack of physical activity, that have been linked to increased cancer risk.
    And the world’s populations are aging – meaning more and more people are living well into the years in which cancer is most common.
  • Today, roughly 10 percent of the world’s population is 60 or older. By 2050, that number will more than double. In developed nations, people older than 60 now account for one-fifth of the population; by 2050, they will account for more than one-third. During the same time period, the number of people 60 and older in developing regions will more than double – from eight percent to 20 percent.
    As the number of senior citizens worldwide continues its steady ascent, the cancer burden inevitably rises. This aging of the world’s population makes renewed focus on groundbreaking new cancer treatments, on compassionate palliative care, and on hospice facilities that help elderly patients face cancer with courage and dignity even more crucial.
  • Of the 10 million new cancer cases this year:
    4.5 million will be diagnosed in patients 65 and older
    5.5 million will be diagnosed in patients 55 to 64
    3.2 million will be diagnosed in patients 15 to 54
    166,000 will be diagnosed in children younger than 15
    Of the 12 million cancer deaths projected for 2020:
    6 million will be among patients 65 and older
    6 million will be among patients 55 to 64
    3.2 million will be among patients 15 to 54
    And 91,000 will be among children younger than 15.
    So as you can see, cancers in younger populations will remain consistent or in some cases decline, while cancers among patients older than 65 will show the most dramatic increase within the next 15 years – a growth of nearly 35 percent in that population segment alone.
  • Nearly 80 percent of the cancers caused by infectious agents worldwide each year occur in developing nations.
    For example, each year, cervical cancer, 70 percent of which could be prevented with regular Pap testing, is the second most common cause of cancer among women, accounting for 273,000 deaths each year.
    In developing countries, H. pylori is found in 80 to 90 percent of the population. It is responsible for 60 percent – or 490,000 – new cases of stomach cancer each year.
  • Currently, the plague of tobacco is split fairly evenly between developed and developing nations. But as the developed world enforces stringent restrictions on the tobacco industry and actively educates the public – especially vulnerable young people – smoking rates are declining in these parts of the world.
    But Big Tobacco is under no such restrictions in most developing nations.
    For example, smoking prevalence among men in China has increased to 65 percent. By 2025, one million lung cancer deaths each year are expected to occur there.
    If current trends continue, as many as 10 million people worldwide will die annually from tobacco-related diseases in the next 25 years – nearly three-fourths of them in the developing world.
  • Tobacco is an obvious and largely well known cancer-causing agent. But fewer people know that poor diets and lack of physical activity are almost as dangerous. As the tobacco pandemic spreads, overweight and obesity are keeping pace – with calamitous consequences.
    More than one billion people worldwide – including 17 million children under the age of five – are currently overweight. Three hundred million are clinically obese. As these lifestyle choices are exported from developed nations to developing ones, cancers linked to diet and physical activity join cancers caused by infectious agents and tobacco in a deadly trinity.
  • Why are global cancer trends so disturbing? There are many obstacles to global cancer control, and of course, each country has unique barriers and unique solutions. But there are a few factors many nations share in common.
    First, data quality among nations is poor. Until we have a clear picture of the burden our nations face individually, it will be difficult to take the necessary action to stem cancer’s tide. One way to correct this deficiency is through the development of detailed cancer registries, which are woefully lacking in many nations – but which, if properly developed, could provide a treasure trove of valuable information to guide the world’s governments, NGOs, and health care professionals.
    Awareness among the public is also a significant challenge in many countries. People are not aware of the risk factors for cancer, and they don’t always know the many screening options available to them.
  • We’ve already talked about the scourge of tobacco and its devastating human and economic toll, but it bears repeating. The tobacco industry is a powerful juggernaut that will require concerted effort and passionate commitment to overcome.
    Growing cancer incidence and mortality rates lead to overburdened treatment centers and a shortage of hospice facilities – so that more people suffer needlessly.
    And finally – and perhaps one root cause of all these other obstacles – many nations lack adequate financial resources to devote to public awareness campaigns; improved screening, treatment, and hospice options; enhanced data collection and sharing; and all the other barriers we face in applying what we know to eliminate cancer as a major health problem.
  • But two things give me hope that the developing world will reverse these alarming cancer trends move ever closer to victory over cancer:
    Strong family bonds and support systems
    A network of competent, compassionate health care professionals like you, who are energetically seeking opportunities to ease the cancer burden in their countries
  • Cancer Prevention in Egypt : What can be done in low income ...

    1. 1. Cancer Prevention in Egypt : What can be done in low income countries Hussein M. Khaled Prof. of Medical Oncology Dean, National Cancer Institute Cairo , Egypt By:
    2. 2. Cancer Prevention in Egypt : What can be done in low income countries • Magnitude of the Problem • Causes of the Growing Cancer Burden • Obstacles to Progress in the Global Fight against Cancer • Local Strategies to Overcome These Obstacles
    3. 3. Cancer Prevention in Egypt : What can be done in low income countries • Magnitude of the Problem • Causes of the Growing Cancer Burden • Obstacles to Progress in the Global Fight against Cancer • Local Strategies to Overcome These Obstacles
    4. 4. EGYPT Gharbia Population–based registry, 1999 report
    5. 5. Site R.F % ASIR* 1. 1. Bladder 2. 2. Liver 3. 3. NHL 4. 4. Lung 5. 5. Colon Rectum 15.4 13.0 10.9 8.2 3.9 26.3 21.3 15.0 14.0 5.6 5 Most Common sites of cancer Egypt, 1999- 2001, Males *ASIR: / 100,000
    6. 6. Site R.F % ASIR* 1. 1. Breast 2. 2. NHL 3. 3. Liver 4. 4. Colon Rectum 5. 5. Ovary 37.6 8.0 4.1 3.7 3.7 49.6 10.7 6.0 5.2 5.0 *ASIR: / 100,000 5 Most Common sites of cancer Egypt, 1999- 2001, Females
    7. 7. The National Cancer Institute  Cairo University www.nci.edu.eg Cairo University National Cancer Institute
    8. 8. Most common sites in Males Females 3 3 3 7 5 6 8 10 10 17 3 3 3 3 4 6 8 11 11 16 2 3 4 4 5 6 9 10 12 17 0 5 10 15 20 Bones Larynx Skin Soft tissue Colorectal Lung Leukemia Lymphoma Liver Bladder Percent of cases 2003 2002 2001 2 3 6 4 4 4 5 6 5 35 2 3 2 4 4 4 4 7 6 38 2 3 3 4 4 4 5 6 6 38 0 10 20 30 40 50 Thyroid Cervix Soft tissue Liver Colorectal Ovary Bladder Lymphoma Leukemia Breast Percent of cases 2003 2002 2001
    9. 9. Cancer Prevention in Egypt : What can be done in low income countries • Magnitude of the Problem • Causes of the Growing Cancer Burden • Obstacles to Progress in the Global Fight against Cancer • Local Strategies to Overcome These Obstacles
    10. 10. Preventing Cancer in the Developing World Causes of the Growing Cancer Burden  Aging populations  Impact of infectious diseases  Increased tobacco use  Nutrition and lack of physical activity
    11. 11. Preventing Cancer in the Developing World Aging Populations 2050 2000 1950 5% 10% 15% 20% Percentage of global population 60 and older
    12. 12. Preventing Cancer in the Developing World Aging Populations 0 1 2 3 4 5 6 2005 2020 65+ 55-64 15-54 New cancer cases (in millions) by age, 2005 , 2020
    13. 13. Preventing Cancer in the Developing World • Infectious Agents 0% 20% 40% 60% 80% 100% Developed Developing New cancer cases due to infectious agents This year, as many as 1.5 million people will die of cancers that could have been prevented with a pill, a shot, or a Pap test.
    14. 14. Preventing Cancer in the Developing World •Tobacco 0 2 4 6 8 10 2000 2030 Developing Nations Developed Nations Annual deaths from tobacco This year, the tobacco industry will knowingly and will fully addict 33 million children to its products
    15. 15. Preventing Cancer in the Developing World Nutrition and PhysicalActivity • This year, more than one billion people, including 17 million children, are overweight worldwide. • In many emerging markets, changing work habits and growing wealth have led to the adoption of “Western” lifestyle behaviors. These result in higher risk of several cancers, including colorectal, prostate, and breast.
    16. 16. Cancer Prevention in Egypt : What can be done in low income countries • Magnitude of the Problem • Causes of the Growing Cancer Burden • Obstacles to Progress in the Global Fight against Cancer • Local Strategies to Overcome These Obstacles
    17. 17. Obstacles to Progress in the Global Fight against Cancer  Data quality  Lack of cancer registries  Weak infrastructures  Low public awareness of cancer  Poor utilization of cancer screening
    18. 18. Overcoming Obstacles to Progress in the Global Fight against Cancer  The scourge of tobacco  Overburdened treatment centers  Lack of hospice facilities  Insufficient financial support
    19. 19. Cancer Prevention in Egypt : What can be done in low income countries • Magnitude of the Problem • Causes of the Growing Cancer Burden • Obstacles to Progress in the Global Fight against Cancer • Local Strategies to Overcome These Obstacles
    20. 20. Main Strategies NCI , Cairo University • Management: Diagnosis and Treatment • Cancer Registry • Education: Training and degree- granting programs • Research: Basic science, Population, and Clinical studies of National Interest • Prevention and early detection
    21. 21. I. A Network of National Cancer Control Centers • National Cancer Institute. • M.O.H. 8 cancer centres. • Oncology departments of other 14 universities. • Non Governmental Organizations.
    22. 22. Cancer Control in Egypt
    23. 23. EGYPT Gharbia Population–based registry, 1999 report
    24. 24. III. Education: Training • Educating doctors throughout Egypt who serve in various health care sectors via its visiting residency programs. • Continuing education programs, and staff visits to satellite clinics. • Journal of the National Cancer Institute
    25. 25. Education; Training & Certification (cont.)
    26. 26. Education: degree-granting programs • NCI offers academic degrees in various oncology specialties, including : Doctoral degrees in No of degrees awarded until May 2006 Surgical oncology 72 Adult & pediatric medical oncology 42 Radiotherapy, 23 Pathology 24 Clinical pathology, and 100 Cancer biology 23 Anesthesia & pain management 30 Master's degree in pain control 29
    27. 27. IV. Examples of cancers of National Interest at NC-Cairo University (research groups’ activities) • Bladder cancer--- large number of patients • Breast cancer --- early detection • Lung cancer---- reflects tobacco and pollution problems • Liver cancer--- reflects hepatitis infection • Colorectal cancer--- unusual young-onset ( Currently 18 ongoing national and international research projects)
    28. 28. International collaborations of NCI-Cairo Universities Examples of Collaborators • European Organization for Research and Treatment of Cancer EORTC. • International Union Against Cancer UICC • World Health Organization WHO. • International Atomic Energy Agency IAEA. • International network for cancer treatment & research INCTR. • National Cancer Institute, Bethesda, USA.
    29. 29. V. Prevention and Early Detection • Active programs in cancer prevention and early detection through public education.
    30. 30. Prevention and Early Detection • Active programs in cancer prevention and early detection through public education.
    31. 31. After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo Schistosomiasis
    32. 32. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo
    33. 33. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo
    34. 34. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo
    35. 35. Control of Schistosomiasis in Egypt Mass Treatment Less infested Snails Less chance of re-infection Lower prevalence of Schistosomiasis Less ova in urine fter: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo
    36. 36. Prevalence of schistosomiasis in Egypt: 1935-2003 0 5 10 15 20 25 30 35 40 1980 1985 1990 1995 2000 2005 %
    37. 37. Relative Frequency of Bladder Cancer, NCI 1975-2002 * * * * * * * * * * * * * * * 1975-85 1990 1995 2000 Year 0 5 10 15 20 25 30 35 Percent 1975-94 1998-2002* *
    38. 38. What to do for Bladder Cancer ? Continue with the Schistosomiasis Control Initiative that combats schisto among school- age children After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo
    39. 39. Etiologic Factors of HCC
    40. 40. Prevalence of HBV
    41. 41. Action needed • Study of the viral etiology of HCC and the role played by HBV and HCV (possibly a multinational comparative study). • HBV vaccination specially children and high risk groups. • Proper follow up of hepatitis patients, specially cirrhotic for early detection of HCC.
    42. 42. HBV Immunization
    43. 43. Smashing the smoking epidemic After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo
    44. 44. Smashing the smoking epidemic After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo
    45. 45. Asbestosis Mokhtar,N. 2003
    46. 46. Pollution
    47. 47. Overcoming Obstacles to Progress in the Global Fight against Cancer Developing nations have two powerful assets to help them overcome these obstacles:  Strong family ties and support  A lower costs health care delivery
    48. 48. National Cancer Institute Cairo University Thank youThank you 200 years ago2006

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