Cancer Registration and Cancer Control in Asia

IACR Workshop: Beijing 16th Sept. 2004

THE POPULATION BASED CANCER REGISTRY IS THE INDISPENSIBLE FOUNDATION OF A SURVEILLANCE SYSTEM

A cancer surveillance programme exists to:

To assess the current magnitude of the cancer burden and its likely future evolution To provide a basis for research on cancer causes and prevention To provide information on prevalence and trends in risk factors,

To monitor the effects of early detection, screening, treatment, and palliative care.

PURPOSES AND USES OF CANCER REGISTRATION

Epidemiological Research
Descriptive Epidemiology Analytic Epidemiology

Health Care Planning and Monitoring

Patient Care Survival Screening Prevention

EPIDEMIOLOGY

1 Descriptive
The information on exposure comes from routine sources (registers, records, surveys...)

The variables are non-specific (indirect link to causes)

2 Analytic
Information on exposure is collected from individual subjects

Association between risk factors [possible causes] and disease

Cervix Uteri, Incidence Rates by Education Level, Quito Residents. 1985-1999

Rate per 100,000

80.0 70.0 60.0 50.0

In-situ Invasive

40.0
30.0 20.0 10.0 0.0 None Primary Secondary Higher
Cancer in Ecuadorian regions 1997-1999 NCR, Solca Quito, 2001

Education level
Source N.T.R.

Cancer in Scotland 1975-1980

Large Bowel, Females

IARC Scientific Publications No. 72, 1985

Trends in Colon Cancer Incidence: ASIA

Age Standardised Rate (World), MALES

Singapore Chinese Hong Kong Osaka Manila

. . ..

Bombay

PURPOSES AND USES OF CANCER REGISTRATION

Epidemiological Research
Descriptive Epidemiology Analytic Epidemiology

Health Care Planning and Monitoring

Patient Care Survival Screening Prevention

USES OF CANCER REGISTRY

PLANNING & EVALUATION OF CCPs I DEFINING THE PROBLEM Burden of cancer Past trends Future projections

CANCER INCIDENCE
Burden of cancer
as number of new cases Priority for cancer control (prevention, treatment) Estimating the resources required, based on numbers of new cases ( by age, stage, etc)

BREAST
asr 6 jpasr rural 6 asr jpasr urban

CERVIX
asr 6 jpasr rural 6 asr

urbanjpasr

4
per 100,000

4
per 100,000

Rate per 100,000

Rate per 100,000

Rate

Rate

2 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 year

2 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 year

1 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 year

1 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 year

Female Breast-Rural-Female

Female Breast-Urban-Female

Cervix uteri-Rural-Female

Cervix uteri-Urban-Female

MORTALITY TRENDS: CHINA 1987-1999

Estimates and projections of national cancer incidence & mortality

Sto mach O e s o pha rynx O t he r Liv e r Lung C o lo n R e c t um C e rv ix B re a s t Year 2005 Le uk a e m ia N a s o pha rynx B la dde r
350000 300000
285785 224807 134748 58553 48869 32290 56468 40429 33913 25669 22975 21461 20197 48164 34927 18857 29640 26585 22861 16400 15670 13207 12935 11417 8203 19094 18322 17996 7802 7095 5819 4430 3675 2845 102836 256679 225486 162004 58620 143151 197222 200518 181481 127726 131794 121508 126204 107439 75619 97843 95942 88790 57485 60598 63756 106611 86844 62264 100945 84349

Year 2000 Year 1 991

Male
250000 200000 150000 100000

Female
50000 100000 150000 200000

50000

PLANNING & EVALUATION OF CCP

MONITORING CANCER CONTROL

1 Primary prevention Time trends ? Control areas?

2 Screening & early detection Outcomes (incidence or mortality) Time trend studies (in relation to inputs) Linkage with screening programme records (distinguish screened/unscreened individuals) Incidence per 100,000 women-years Intermediate endpoints 75
50

Never screenedand stage of screen-detected cases Size screened EverIncidence of interval cancers Normal test Incidence of advanced cancers DENMARK
Reference period 1958-67 FINLAND ICELAND NORWAY SWEDEN

25 0
20 30 1945 40 1950 50 1955 60 1960 70 1965 80 1970 1975 90 1980

PLANNING & EVALUATION OF CCP

MONITORING CANCER CONTROL

1 Primary prevention Time trends ? Control areas? 2 Screening & early detection Outcomes (incidence or mortality) Time trend studies (in relation to inputs) Linkage with screening programme records (distinguish screened/unscreened individuals) Intermediate endpoints
Incidence of interval cancers Size and stage of screen-detected cases Incidence of advanced cancers

3 Treatment :Study of SURVIVAL 4 Cancer care

EVALUATION OF CANCER CONTROL PROGRAMMES

SURVIVAL DATA
Effectiveness of Treatment
in delaying/preventing death BUT,

consider other factors influencing survival especially earlier diagnosis

FACTORS INFLUENCING SURVIVAL FROM CANCER

Disease: Treatment: Natural history Clinical extent Definitions

Availability
Access Quality

Host:
Early Detection: Early clinical detection Age Sex SES Comorbidity Behaviour

Screening

Trends in 5-Year Relative Survival from Selected Cancers in Women, Singapore, 1968-92
100 90 80 70 60
NASO COLON BREAST CERVIX UTERI OVARY THYROID

RSR

50 40 30 20 10 0
1970 1975 1980 1985 1990

Year

PLANNING & EVALUATION OF CCP

MONITORING CANCER CONTROL

1 Primary prevention Time trends ? Control areas? 2 Screening & early detection Outcomes (incidence or mortality) Time trend studies (in relation to inputs) Linkage with screening programme records (distinguish screened/unscreened individuals) Intermediate endpoints
Incidence of interval cancers Size and stage of screen-detected cases Incidence of advanced cancers

3 Treatment :Study of SURVIVAL 4 Cancer care

EVALUATING CLINICAL CARE IN CCP

Patterns of clinical care
Place of treatment Percent treated by specialists Percent of cases with adequate staging Percentage on treatment protocols Delay (diagnosis-treatment)

Why do we need cancer registries

Current situation in Asia

ASIA 12 COUNTRIES REPRESENTED

Russia

Kazakhstan Mongolia

Kyrgyzstan Turkey Turkmenstan Tajikstan Syria

JAPAN KOREA CHINA

ISRAEL
Lebanon Jordan Iraq

Iran

Afghanistan

KUWAIT
Egypt Saudi Arabia
Qatar. U.A.E.

PAKISTAN Karachi INDIA

Bhutan

Bangladesh Burma Laos

Sudan Yemen

OMAN VIET NAM THAILAND

Cambodia

PHILIPPINES Manila & Rizal

Ethiopia

Arabian Sea

Sri Lanka Malaysia

Uganda Kenya

SINGAPORE

India
9 registries

Afghanistan China

INDIA 9 registries
Pakistan

Delhi

Nepal
Bhutan

Bangladesh

Ahmedabad Nagpur

Burma

Mumbai (Bombay) Poona

Bay of Bengal Arabian Sea

Chennai (Madras) Bangalore

Karunagappally Trivandrum
Sri Lanka

South-East Asia

China Burma

VIETNAM Hanoi Chiang Mai

Laos

Lampang

THAILAND Bangkok

Khon Kaen

Cambodia Andaman Sea

Gulf of Thailand

Ho Chi Minh City

South China Sea

Songkhla

Malaysia

Indonesia Malaysia

SINGAPORE

Indonesia

Japan and Korea

Russia China

KOREA Kangwha Seoul

Yamagata Miyagi
North Pacific Ocean

Daegu

JAPAN
Busan Hiroshima

Osaka

Saga Nagasaki

East China Sea

Russia

Kazakhstan

China
10
Mongolia

registries
Beijing Tianjin
Korea

Cixian

Qidong County Shanghai Wuhan Jiashan

Bhutan

India India
Bangladesh

Changle
Taiwan

Burma Viet Nam Laos

Hong Kong

South China Sea Bay of Bengal Thailand Philippines

CI5 incidence data

% population coverage, 1995

26.2% 32% 4.7% 12.7%

3%

1% 82%

INTERNATIONAL ASSOCIATION OF CANCER REGISTRIES

Membership
447
19

458
19

385

402
19 187

366
20

18 186 163 171

144

Oceania Europe N. America S. America Asia Africa 91

7 39 26 88 3

191
15

67 91 70 68 46 38 40

68

134
11 55

48

83

28 92 ASIAN MEMBERS 87 54 59 24 68 28 74 30 42 16

92

37 12 12 7 12 11

44

1979

1982

1986

1992

1996

1997

2002

2003

Incidence data
% population coverage, around 1995

36.5% 99% 7% 19.6%

8%
10.5% 86%

Why do we need cancer registries

Current situation in Asia

Whats new?

GULF STATES: 6 population-based registries

Now joined by Yemen: The Aden Cancer Registry

THE INDIAN CANCER ATLAS

Using pathology-based data to obtain clues about geography of cancer

Fig 8. Districtwise Microscopic Age Adjusted Incidence Rates (MAAR) Per 100,000 Stomach (ICD 10 : C16) Males Year 2001 - 2002
Imphal West (12.2) Dimapur (10.0) Lahul & Spiti (15.1) Tamenglong (9.1) Churachandpur (19.2) Kolasib (56.1) East Sikkim (15.4) North Sikkim (27.7)

Senapati (8.7)

Kohima (34.0) Ukhrul (11.2) Aizawl (47.0) Champai (46.3) Serchhip (70.2) Saiha (23.0) Lawngtlai (10.2) Lunglei (25.3) Mamit (53.4)

Thiruvallur (10.7)

Thrissur (12.6)

Population -based

cancer registry

Active surveillance

Tehran

KOREA: National population-based cancer registry network

6

Seoul, 1990 Incheon, 1998

Area : 99,394 Km2 Population : 47,275,000 (2000)

Daegu, 1997

7 metropolitan cities 9 provinces

Daejeon, 1997

Ulsan, 2001 Pusan, 1995 Kwangju, 1997

Jeju, 2001

Using the existing Korean Central Cancer Registry a hospital based system providing national level, but incomplete, data since 1980.

THAILAND
Cancer in Thailand, vol III
based on the established 5 Registries
There are another 5-6 start-ups

CHINA: Survey of cancer registries nationwide

Information from 48 PBCRs cover 5.7% population They

of China
Chicheng Beijing Wuwai Jiaxian Yangcheng Tianjin

Jiamusi Qiqihaer Haerbin Ningan Boli

Shenyang Anshan

Dalian

Ganyu Huaian Jianhu Taixing Jintan Dafeng Yangzhong Haian Haimen Qidong Shanghai

Zanghuang Shexian Linqu Cixian Feicheng Linzhou

Luoyang Lueyang Yanting Jiaxing Wuhan

Shanghai Jiashan Haining Hangzhou

be published in To
Eur. J. Cancer Prevn.
Gejiu Tin Mine Fusui Guangzhou (1,2) Shenzhen Sihui Hong Kong Zhongshan

Changle

Why do we need cancer registries

Current situation in Asia

Whats new
The role of IACR

International Association of Cancer Registries

Founded in 1966 Aims: To improve quality of data and comparability between registries To disseminate information on the uses of cancer registry data

SUPPORT TO CANCER REGISTRIES

1. 2. 3. 4. 5. 6. International Standards Publications related to cancer registration Consultancy (+ WHO regions) Training of staff Fellowships Computer software

CANCER REGISTRATION PRINCIPLES AND METHODS

Comparability and quality control in Cancer Registration

Manual for Cancer Registry Personnel

Guidelines on Confidentiality in the Cancer registry

ICD Conversion Programs for Cancer

International Classification of Childhood Cancer 1996

Histological Groups for Comparative Studies

IACR MEETINGS
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Hamburg, Germany Quito, Ecuador Ottawa, Canada Bratislava, Slovakia Bangalore, India Rio de Janeiro, Brazil Edinburgh, UK Abidjan, Ivory Coast Atlanta, USA Lisbon, Portugal Khon Kaen, Thailand Havana, Cuba Tampere, Finland Honolulu, Hawaii

Beijing, China, 2004

THANK YOU.
See you next year

(and before that, I hope!)