Comprehensive Cancer Control

asian cancer control

Dharmais Cancer
Center

Penanggulangan Kanker
Di Indonesia
Malcolm A Moore, UICC-ARO and APJCP
 Cancer Control Programs
Assessment of Burden (Hospital/Population-b)
Risk Factor Determination (Phys/Socioeco)
Interventions - Primary Prevention
(Awareness/Tobacco Control/Lifestyle)
Interventions - Secondary Prevention
(Screening/Monitoring/
Interventions - Therapeutic
(Surgical/Radio/Chemical/Hormonal)
Interventions - Palliative
(Physical/Psychological)
 1) Disease
Diagnosis/Registration

Asian Network?
The Chinese National Center
for Cancer Registries
Gulf Center for Cancer
Registration
Australasian Association of
Cancer Registries

Korean Cancer
Registration
Thailand Registration Group
Asian Cancer Registries

CIV
Non-CIV IACR Voting
Non IACR Voting
Non IACR
 APJCP Supplement 1,
22nd Annual IACR Meeting, Khon Kaen, Thailand, 2001
CANCER REGISTRATION IN ASIA IN THE YEAR 2000:
PAST, PRESENT AND FUTURE
 Descriptive Epidemiology: Males
Mal e Burde n of Cancers in Major Organs - Incidence s/100,000
Registry China India Indonesia Iran Japan Korea Pakist an Philippines# Thailand Vietnam Ranking
Oral 1.3 (9)R 16.3 (1) ? 6.6 (4) 6.0 (9) 4.4 (8) 25.8 (1) 8.6 (6) 8.5 (4) 8.2 (5) 45 (6)
Oesophagus 14.8 (3) 7.4 (2) ? 39.4 (1) 10.0 (5) 10.1 (5) 6.2 (5) 3.1 (9) 3.7 (8) 3.7 (6) 46 (5)
Stomach 14.7 (4) 6.8 (3) ? 17.3 (2) 67.0 (1) 70.0 (1) 4.6 (8) 11.1 (5) 4.9 (6) 23.7 (2) 58 (4)
Colorect al 11.5 (5) 5.4 (4) 6.8 (2) 3.8 (7) 48.0 (2) 40.9 (4) 5.9 (6) 18.7 (3) 10.4 (3) 11.4 (4) 60 (3)
Liver 21.0 (2) ? 5.7 (3) 3.9 (6) 26.0 (4) 48.8 (2) 5.0 (7) 23.9 (2) 37.4 (1) 22.6 (3) 70 (2)
Pancreas 3.9 (6) 1.7 (8) ? 1.2 (9) 9.2 (7) 7.7 (7) ? 4.7 (8) ? 1.6 (9) 16 (9)
Lung 26.6 (1) 4.0 (6) 14.8 (1) 14.2 (3) 39.9 (3) 48.4 (3) 20.0 (2) 64.3 (1) 26.5 (2) 29.3 (1) 77 (1)
Pros tat e 2.1 (8) 5.2 (5) 5.6 (4) 2.0 (8) 10.0 (5) 4.2 (9) 7.6 (4) 17.6 (4) 4.4 (7) 2.2 (8) 28 (8)
Bladder 3.4 (7) 3.5 (7) ? 4.4 (5) 8.2 (8) 9.5 (6) 9.4 (3) 4.9 (7) 5.2 (5) 2.4 (7) 35 (7)
*Dat a f rom Sele cted Can cer Regist ries (see text f or ref ere nces)
#
Da ta fr om P arkin et al., 1997
R
, ra nk

Data from APJCP Supplement 1

 Descriptive Epidemiology:
Females
Fema le Burden of Cancers i n Major Org ans - Incidences/1 00,000
Registry China In dia Indonesia Iran Japan Korea Pakistan Philip p ines*Thailan d Vietnam Ranking

Oral 0.8 (9)R 7.8 (3) ? 6.6 (4) 2.0 (8) 1.2 (8) 18.7 (2) 6.0 (8) 4.5 (7) 2.7 (8) 33 (6)
Oesop hagus 6.0 (6) 5.8 (5) ? 24.9 (1) 1.3 (9) 1.0 (9) 6.9 (5) 1.6 (9) 1.3 (9) 0.5 (9) 28 (9)
Sto mach 14.7 (1) 3.5 (7) ? 5.9 (5) 27.0 (2) 25.7 (1) 3.2 (8) 6.4 (7) 1.5 (8) 8.5 (3) 58 (3)
Colorect al 9.0 (4) 3.8 (6) 6.3 (3) 2.9 (6) 25.5 (3) 10.3 (6) 5.0 (6) 15.8 (3) 7.5 (5) 6.4 (5) 53 (4)
Liv er 8.0 (5) ? ? 1.8 (9) 7.7 (6) 11.6 (5) 3.4 (7) 8.0 (6) 15.5 (3) 4.6 (6) 33 (6)
Lung 10.2 (3) 3.1 (8) 4.8 (5) 2.5 (7) 11.2 (4) 12.7 (3) 2.8 (9) 17.7 (4) 11.1 (4) 7.9 (4) 49 (5)
Breast 12.7 (2) 22.6 (2) 14.8 (2) 12.3 (2) 31.0 (1) 12.5 (4) 56.6 (1) 47.7 (1) 16.3 (2) 13.8 (1) 80 (1)
Ovary 5.3 (7) 5.9 (4) 5.2 (4) 2.5 (7) 6.4 (7) 4.0 (7) 9.5 (3) 9.4 (5) 4.7 (6) 4.4 (7) 43 (8)
Cervix 1.2 (8) 25.3 (1) 21.7 (1) 7.0 (3) 8.5 (5) 15.3 (3) 7.3 (4) 21.6 (2) 20.9 (1) 13.1 (2) 70 (2)
*Data f rom Sele cted Canc er Regist ries (see text f or ref eren ces) # Da ta fr om P arkin et al., 1997
R
, ra nk

Data from APJCP Supplement 1

2) Risk Factor Identification
Phys ical Exercise
N-3 PUFA's N-6 PUFA's

High calorie consumption Receptor Impairment

Insulin Sensitivity High fat diet
Phys ical Exercise Obesity
Soluble Fiber Glycemia
Insoluble Fiber

Insulin sens itizers

DHEA Insulin Estrogen/ Phys ical Exercise
Testosterone ? Antioxidants
Lipid peroxidation
Antioxidants
IGF-IR IR SHR Lactoferrin N-6 PUFA's
Insoluble Fiber
Parasites
Immune
Carcinogens System Inflammation
IGF-I
NSAID's
INITIATION GROWTH
N-3 PUFA's

GENE
GENEACTIVATION
ACTIVATION ODC Inhibitors
DHEA
HMG-CoA Reductase
PRENEOPLASTIC/NEOPLASTIC CELL Inhibitors
 Specific Cancer
Sites I

0-10 20-30 40-50

Incidence
10-20 30-40 >50

Rates Cervix
Breast
0-5 10-15 20-25

Pre-Menopausal Risk: Early menarche and late menopause

Nulliparity or late first pregnancy 5-10 15-20 >25
Pre-Menopausal Protection: Obesity Anovulation and low progesterone
BREAST CANCER Early first pregnancy and multiparity
Hormone Replacement/ Obesity
Post-Menopaus al Risk: Nulliparity or late first pregnancy

Diet/ Physical Reproductive High D ensity

Phytoestrogens Exercis e History Early Menarche/
Late Menopause Low Density

Oestrogen/ Menarche Breast Density Menopause High D ensity Dietary Factors Physical Exercise Hormonal Environment
Late Menarche/
Progesterone Early Menopause
Exposure Low Density Smoking Other STDs
Risk and Protective Factors
Environmental Persistent HPV High Risk Group Infection
Carcinogens

Normal Epithelium CINI CINII CINIII CERVICAL CANCER

0 10 20 30 40 50 60 70 80 90
Age (years) Dietary Factors Physical Exercise Hormonal Environment

Comprehensive Cervical Cancer Research Program

Ques tionnaire: Lifestyle Factors (Smoking, Diet, Exercise, Cooking/Work Environment, Sexual Behaviour
Disease and Reproductive History

Screening: HPV Tes ting, Pap Smear (Self/Non-self Sampling), Direct Visual Acetic Acid
 Site Specific Risk Factors I
Oral Cavity Oesophagus
/Pharynx Trauma, Smoking,
Betel, Smoking, Alcohol, Nutrition,
0-2.5 5.0-7.5 10.0-15.0
Alcohol, Sun 0-2.5 5.0-7.5 10.0-20.0
Obesity
2.5-5.0 7.5-10.0 >20.0

2.5-5.0 7.5-10.0 >15.0 HPV

Stomach Colon/
Salt, Stress Rectum
H.pylori Diet, Hyper-
0-10 20-30 40-60
insulinemia 0-5 10-15 20-40

10-20 30-40 >60.0 5-10 15-20 >40.0

 Site Specific Risk Factors II

Liver Larynx
HBV/HCV Dusts
Opisthorchis
0-5 10-15 20-30
0-2 4-6 8-10

5-10 15-20 >30

2-4 6-8 >10

Lung Urinary
Smoking, Bladder
Fumes Smoking,
Nutrition Infection
0-10 20-30 40-50

10-20 30-40 >50 0-5 10-15 20-25

10-20 15-20 >25

 Specific Cancer Sites II
45 SC
Generally Decreasing
40
Breast Singapore Chinese
Cervical, Buccal
Singapore Malay
Incidence SI
(/100,000) CHK
35 Singapore Indian CHK

CHK SM
Chinese Hong Hong SI Japanese 30 Chinese Hong Kong
JM Miyagi 30
SC
30
Indian Bombay IB Singapore
CHK
SI
SI JM
CS CS
JO
25
25 SI
Indian
Cervix
25 IB IB IB
Japanese Osaka Incidence CHK
SC SM
JM JO
(/100,000)
IB CS Indian Bombay
SM 20
IB IB
20 Chinese Shanghai 20
CS JO CHK
CS HH SC
JM SC
JO IB
Japanese Osaka Singapore Chinese
SC
15 SM 15
15 SC
JO CHK
JO
SI CHK
1982 1987 1992 1997 2003 JM HH SM
JM SM HH Hawaiin
Year of Publication 10
10 Hawaii
Singapore Malay JO SM
SC SI
SM SI
CS HH

Generally Increasing 5
5
JM

Chinese
Japanese
Miyagi
JO
JM

Shanghai

Breast, Colorectal, Prostate, Thyroid 0

0
CS CS

1982 1987 1992 1997 2003

Year of Publication

Paradoxical
Liver, Lung, Oesophageal
 Health Problem Explosion?
Diabetes Prevalence

2025
2005
0-1.0 2.0-3.0 4.0-5.0 0-1 2-3 4-5 6-10

1-2 3-4 5-6 >10

1.0-2.0 3.0-4.0 >5.0
 3) Primary and Secondary
Prevention
Smoking, Endogenous and Dietary Carcinogens
Chemoprevention
Dietary Supplementation/
Avoidance
Detoxification
Initiation Growth Progression
NORMAL PRENEOPLASIA/
CELLS DYSPLASIA CANCER

Regeneration/ Proliferation
Screening and Resection

Naked Eye/Palpation
Trauma/ Infectious Agents/ Metabolic Stimuli Occult Blood
Endoscopy
Ultrasound/CT
Medication Serum markers
Vaccination Hormonal
Milieu
Avoidance Manipulation
 4) Clinical Intervention
Diet Cut-off Methodology Decision-mak ing Alleviation
Exercise Complications Number QOL QOL
Supplements Zone sizes Timing Salvage

Risk Screening Biopsy Treatment Outcome

Body Size PSA/PSAD/DRE HGPIN Incontinence
Hormonal
Hormones Free PSA/Ratios ASAP Impotence
Surgery
Morphology Adjunct Therapy PCa Erectile
Radiotherapy
Stage Dysfunction
Chemotherapy
Grade Psychological

Intl Hospital-based Comprehensive

Case-control Studies!
Asian Cancer Control Network
Who? What? Where?

Thai NCI Japanese NCC ???

 Rationale for Registration
Research Centres
Political Pressure Local Populace Information
Politicians +
Patient Groups
Policy -making

Government The Media

Training Asian Network?
Financial
Local Health/ IACR UICC
Support Registration Centre Funding
IARC/WHO
Evidence Base
Publication
Information
Research Journals Research Organizations
Cooperation for Comprehensive
Cancer Control in Asia

asian cancer control Needs People Power

Thank you!