Improving Cancer Care in India: Prospects and Challenges

The World Cancer Report, a 351 - page global report issued by International Agency for Research on Cancer ‍(IARC) tells us that cancer rates are set to increase at an alarming rate globally (Stewart and Kleiues 2003). Cancer ‍rates could increase by 50 % to 15 million new cases in the year 2020. This will be mainly due to steadily aging ‍populations in both developed and developing countries and also to current trends in smoking prevalence and the ‍growing adoption of unhealthy lifestyles. The report also reveals that cancer has emerged as a major public health ‍problem in developing countries, matching its effect in industrialized nations. Healthy lifestyles and public health ‍action by governments and health practitioners could stem this trend, and prevent as many as one third of cancers ‍worldwide. ‍In a developing country such as India there has been a steady increase in the Crude Incidence Rate (CIR) of all ‍cancers affecting both men and women over the last 15 years. The increase reported by the cancer registries is nearly ‍12 per cent from 1985 to 2001, representing a 57 per cent rise in India's cancer burden. The total number of new ‍cases, which stood at 5.3 lakhs Care lakh is 100,000 in 1985 has risen to over 8.3 lakhs today. The pattern of cancers ‍has changed over the years, with a disturbing increase in cases that are linked to the use of tobacco. In 2003, there ‍were 3.85 lakhs of cases coming under this category in comparison with 1.94 lakhs cases two decades ago. Lung ‍cancer is now the second most common cancer among men. Earlier, it was in fifth place. Among women in urban ‍areas, cancer of the uterine cervix had the highest incidence 15 years ago, but it has now been overtaken by breast ‍cancer. In rural areas, cervical cancer remains the most common form of the disease (The Hindu 2004).     

Cancer Mortality in a Hanoi Population,Viet Nam, 1996-2005

Background: Hitherto, cancer mortality data have not been available in Viet Nam, so that the real public health ‍problem with this disease has yet to be addressed and recognized in the country with a population of over 80 million ‍in South East Asia. The aim of the present pilot study was to examine cancer mortality in a commune population of ‍Hanoi city, 1996-2005. Methods: Cancer data was accessed from the database of the population-routine-based death ‍registration performed by medical workers at commune health stations based on the guidelines of the Ministry of ‍Health at Hanoi city. All deaths occurring in the community were registered. This registration process was monthly ‍reviewed for each fatal case regarding the name, age, sex, address, occupation, date - place - cause of death, and ‍information concerning to pre - death medical care during the study period from Jan. 1996 to Dec. 2005. The list of ‍death and residents of the study population was carefully cross-checked with other information sources to avoid ‍under- or over-registration. The world population structure was used to estimate Age-standardized cancer mortality ‍rates per 100,000, (ASR). Results: During 60,770 person-years estimated from Jan. 1996 to Dec. 2005, 320 deaths ‍and their causes were registered. Among them, 100 cancer cases of all sites (66 males and 34 females) were included. ‍Cancer mortality rates were 222 and 109 (Crude), 353 and 115 (ASR), for males and females, respectively. For both ‍genders combined, lung cancer was the most common, 27 cases, followed by liver, 26 cases and stomach, with 19. ‍Proportion of death from cancer was about 31% of all causes. Conclusions: The present findings suggest that in Viet ‍Nam, a developing country, cancer is indeed an important public health problem.     

Alleviating the burden of cancer: a perspective on advances, challenges, and future directions.

The control of the burden of cancer would be achievable by promoting health-maintaining lifestyle behavioral practices in conjunction with facilitated access to affordable and effective periodic screening and early detection examinations combined with comprehensive treatment services. In a global population exceeding six billion in the year 2002, there were approximately 10.9 million new cancer cases, 6.7 million cancer deaths, and 22.4 million persons surviving from cancer diagnosed in the previous 5 years. In 2020, the world's population is projected to increase to 7.5 billion and will experience 15 million new cancer cases and 12 million cancer deaths. This perspective on advances, challenges, and future directions in cancer epidemiology and prevention reviews the conceptual foundation for multistep carcinogenesis, causal mechanisms associated with chronic inflammation and the microenvironment of the cancer cell, and obesity, energy expenditure, and insulin resistance. Strategic priorities in global cancer control initiatives should embrace these fundamental concepts by targeting tobacco and alcohol consumption, the increasing prevalence of obesity and metabolic sequelae, and persistent microbial infections.     

Cervical Cancer Prevention and Early Detection; The Role of Nurse and Midwives

Worldwide 31% of cancers in women are in the breast or uterine cervix. Cancer of the uterine cervix is one of the ‍leading causes of cancer death among women. The estimated new cancer cervix cases per year is 500.000 of which ‍79% occur in the developing countries, where it is consistently the leading cancer and there are in excess of 233.000 ‍deaths from the disease. The major risk factors for cervical cancer include early age at first intercourse, multiple ‍sexual partners, low socioeconomic status, HSV, HPV infection, cigarette smoking and extended use of oral ‍contraceptives. Well organized and applied public education and mass screening programmes can substantially ‍reduce the mortality from cervical cancer and the incidence of invasive disease in the population. Women who are ‍health conscious are more likely to have used screening services (mammogram, pap-smear test) and performed ‍breast-self examination and genital hygiene. There are both opportunities and burdens for nurses and midwives ‍working in primary health care settings. This is a prime example of a role of public education in cancer prevention ‍with reference to population-based cancer screening programs. ‍     

Coordinated Research and the Question of an 'IARC' for the Asian-Pacific?

The stated goal of the APOCP/APJCP is to promote an increased awareness in all areas of cancer prevention ‍and stimulate practical intervention approaches. Whether this should be targeted solely through the publication ‍of the APJCP or also through activities in institutions independently capable of research has yet to be decided by ‍the membership. This will in fact be debated at the forthcoming First General Assembly Conference but we ‍have already argued earlier for an APOCP Training Centre/Practical Prevention Program Pilot Centre and ‍indeed made a practical start. Since the International Agency for Research on Cancer (IARC) and the Union ‍International Contra Cancrum (UICC) are already active in the Asian Pacific the question arises as to what ‍relationship the APOCP should aim for with these international bodies. If they had local offices sited conveniently ‍for efforts specific to this region of the world, coordination and the search for financial support would be greatly ‍facilitated. In particular, one could then envisage an expanded Asian country base for the IARC which would ‍allow greatly enhanced promotion of collaborative projects in our region, with a balanced mix of primary and ‍secondary prevention activities appropriate to the prevailing socioeconomic environments. Possibly under the ‍auspices of the Asian Pacific Federation of Organizations for Cancer Control and Research (APFOCC) through ‍the UICC, the APOCP could act as a local partner to an ‘IARC’ institute for the Asian Pacific. If this idea is ever ‍to be realised we must promote debate and establish concensus so that our voices can be heard. The question we ‍ask now is whether it should indeed be official policy of the APOCP?     

Estimation of Cancer Incidences in Aichi Prefecture: Use of a Model Area with Good Quality Registry Data

In Japan, local government is responsible for organization of population-based cancer registries and the quality ‍of the registration remains modest, mainly due to dependence on voluntary-based operations without legal obligations. ‍Aichi Prefecture cancer registry covers a large population, estimated at 7 million, and its quality has yet to reach the ‍level required internationally. The derived cancer incidences for Aichi Prefecture therefore tend to be underestimated. ‍In the present study we set up a model area, located in the central part of Aichi Prefecture, with a good quality of ‍registry data, covering a reasonable population, including both urban and rural areas. Our model area has typical ‍demographic features of Aichi Prefecture. ‍The materials were data on cancer incidence and deaths during the period of 1996-2000 in this model area of ‍Aichi prefecture, with a population of approximately one million, under the jurisdiction of three public health ‍centers, covering nine municipalities. The percentage of death certificated notified (DCN) cases for all sites was ‍around 14% and the incidence/death ratio was around 1.9. Estimated age-adjusted incidence rates were found to be ‍256.0 (per 100,000) for males and 177.6 for females, these values being 10~15 % higher than those generated using ‍data for the whole prefecture, and quite close to incidence rates in Japan estimated from the highest quality of data ‍available. It is suggested that the cancer incidence in the Aichi prefecture is indeed being underestimated and that ‍the actual figures may be closer to the estimates provided here. ‍     

Trends in Liver Cancer,Sa Kaeo Province Thailand

Objective: To determine liver cancer trends in Sa Kaeo Province, Thailand. Methods: Death certificate (1993- ‍2003) and hospital records (1999-2003) were reviewed and compared to national averages and other provinces. ‍Results: According to data from death certificates, liver cancer mortality in Sa Kaeo Province increased from 3.1 to ‍26.1 per 100,000 population between 1993 and 2003. In Thailand overall rates increased from 9.0 to 19.8 per 100,000 ‍population between 1996 and 2003. According to electronic hospital records, the total number of patient encounters ‍(in-patient admissions and out-patient visits) for liver cancer in the two main hospitals in Sa Kaeo Province increased ‍56% (14% annually) between 1999 and 2003. The number of cases of hepatocellular carcinoma increased from 42 in ‍2001 to 73 in 2003, while the number of cases of cholangiocarcinoma showed little change. Conclusions: Thailand as ‍a whole and Sa Kaeo Province specifically have a high burden of liver cancer, which appears to have increased ‍substantially in the past 10 years. Demonstrating the impact of ongoing strategies aimed at reducing risk factors for ‍liver cancer, such as universal hepatitis B vaccination of infants, will require reliable data describing liver cancer ‍disease burden and etiology. Rapid investigations using available data from death certificates, electronic admissions ‍records, and patient charts can provide valuable insights on disease burden and trends.     

Programs for Asian Pacific Cancer Prevention in Response to the Four Strategic Directions of UICC for the New Millennium

The final goal of epidemiology is the establishment of prevention measures and the promotion of better human ‍health. The information we obtain through research needs to be substantially supplemented by comprehensive ‍knowledge of the standardized “global strategy”. To establish regional cancer control programs, we need basic data ‍on cancer incidence and mortality in the general populace gained from well-organized cancer registration and collection ‍of vital statistics. Cancer is a typical lifestyle related disease and we should define the risk and protective factors for ‍cancer in particular peoples. In general, lifestyle is established by long-term acquired culture in each ethnic group ‍and area, and we cannot easily transfer established cancer control programs from developed countries to other ‍states with a very different cultural background. We need to establish our own cancer control strategy that would be ‍accommodating our own physical and social environments. This was the reason why the Asia Pacific Organization ‍for Cancer Prevention ( APOCP) was set up to promote all aspects of cancer prevention across our own area of the ‍globe. The idea of a Practical Prevention Program (PPP) pilot center in Asia was a well-timed proposal and to now ‍promote the PPP, continuous grass route activity by core persons and institutions, accompanied by positive ‍participation of the general populace, is indispensable. The APOCP and the UICC should play central roles in providing ‍rear-area logistic support to promote local activities on cancer control. What we learn here in the Asian Pacific will ‍also be of great assistance to efforts in other areas of the world. ‍     

Burden of Lung Cancer Deaths due to Smoking for Men and Women in the WHO Western Pacific and South East Asian Regions

Introduction: Eighty percent of all smokers live in low and middle-income countries of the Asia Pacificregion but actual estimates of the burden of disease due to smoking in the region have yet to be quantified.Methods: The burden of lung cancer due to smoking for all countries in the WHO Western Pacific and SouthEast Asian regions was calculated from the population attributable fractions (PAFs). Nationally representativesex-specific prevalences of smoking were obtained from the World Health Organization, MEDLINE and/ornational government documents and hazard ratios (HR) for lung cancer due to smoking in Asian and non-Asianpopulations were obtained from published data. The HR and prevalence were then used to calculate PAFs forlung cancer deaths due to smoking, by gender and by country. Results: The national prevalence of smoking in theAsia Pacific region ranged from 18-65% in men and from 0-50% in women. The fraction of lung cancer deathsattributable to smoking ranged from 0-40% in Asian women and from 21-49% in Asian men. In ANZ, PAFs wereas high as 80% for women and 68% for men. Future estimates of the burden of smoking-related lung cancer inAsia were obtained by assuming a continuation of current smoking habits in these populations. Extrapolatingthe higher HR from the ANZ region to Asia, resulted in an increase in the PAFs to 4-90% in women and from62-85% in men. Conclusion: The current burden of lung-cancer due to smoking in the Asia-Pacific region issubstantial accounting for up to 50% of deaths from the disease in men and up to 40% in women dependingon the country. If current smoking habits in Asia remain unchanged then the number of people dying fromsmoking-related lung cancer over the next couple of decades is expected to double. It is known that the majorityof lung cancer is due to smoking. This is the first paper to systematically compare current burdens of lung cancerdeaths due to smoking in countries in the Western Pacific and South East Asia and by gender. Findings fromthis paper demonstrate the number of lung cancer deaths that could be prevented if the prevalence of smokingwas eliminated.     

The 4th JICA Training Course,Community-based Cancer Prevention (Epidemiological Approach)

The present training course was programmed by the Division of Epidemiology and Prevention, Aichi Cancer Center ‍Research Institute, Japan, and has been annually conducted since 1999, supported by the Japan International Cooperation ‍Agency (JICA) (Takezaki 2001). This course targets doctors and public health workers who are responsible for communitybased ‍cancer prevention in developing countries to promote comprehensive procedures focusing mainly on primary but also ‍including secondary prevention of cancer. ‍ Cancer is the leading cause of deaths in developed countries, while communicable diseases are still major causes of ‍mortality in developing countries (WHO 2000). However, the relative burdenn of cancer deaths is also increasing in developing ‍countries, with economic development and elongation of the life span (Walgate 1984; Chackiel 1999). Boffetta and Parkin ‍have estimated cancer to account for 13 percent of the annual deaths in adults of developing countries (Boffetta and Parkin ‍1994). Limitations of medical facilities and equipment in developing countries underly the necessity to stress prevention as ‍an indispensable measure for cancer control (Mikheev et al. 1994). However, human resources concerning cancer prevention ‍are limited, and encouragement should be given as the first priority as regards to cancer prevention. ‍The Japanese Government extends official development assistance (ODA) to developing countries to support self-help ‍efforts that will lead to economic progress and a better life for their citizens. Since its foundation in 1974, JICA has implemented ‍Japan's technical cooperation under the ODA programme. Currently, JICA conducts such activities as training, dispatch of ‍experts, provision of equipment, project-type technical cooperation, development studies, dispatch of cooperation volunteers ‍(JOCV), and survey and administration of capital grant aid programs. The present training program for overseas participants ‍is one of JICA's fundamental technical cooperation activities for developing countries. Participants come from overseas in ‍order to obtain knowledge and technology in a wide variety of fields. The objectives of the JICA training programs are: 1) ‍to contribute to the development of human resources who will promote the advancement of developing countries, and 2) to ‍contribute to the promotion of mutual understanding and friendship. ‍ The present report concentrates on revised contents with this 4th course and includes a commentary on its advantages ‍and disadvantages. ‍     

Social Inequalities in Cancer with Special Reference to South Asian Countries

There are major differences in cancer burden across socioeconomic classes, as is evident from the data for cancer ‍incidence and mortality from Greater Mumbai, India. Changes over time are also evident and recently there has ‍been a clear shift to increasing breast cancer particularly in well-educated women, who conversely are at much ‍lower risk of cervical cancer. With infection-related and tobacco-related cancers, programs of prevention and early ‍detection will yield desirable results only if it is associated with a program directed towards elimination of poverty, ‍illiteracy and restoring social inequality. Similarly education must play a role in combatting diet-related neoplasia ‍but here the target population may differ, requiring a specific awareness of psychological profiles.     

The burden of cancer in member countries of the Association of Southeast Asian Nations (ASEAN)

This paper presents the most recent data on cancer rates and the burden of cancer in the ASEAN region. Epidemiological data were sourced from GLOBOCAN 2008 and disability adjusted life years (DALYs) lost were estimated using the standard methodology developed within the World Health Organization's Global Burden of Disease study. Overall, it was estimated there were over 700,000 new cases of cancer and 500,000 cancer deaths in ASEAN in the year 2008, leading to approximately 7.5 million DALYs lost in one year. The most commonly diagnosed cancers were lung (98,143), breast (86,842) and liver cancers (74,777). The most common causes of cancer death were lung cancer (85,772), liver cancer (69,115) and colorectal cancer (44,280). The burden of cancer in terms of DALYs lost was highest in Laos, Viet Nam and Myanmar and lowest in Brunei, Singapore and the Philippines. Significant differences in the patterns of cancer from country to country were observed. Another key finding was the major impact played by population age distribution on cancer incidence and mortality. Cancer rates in ASEAN are expected to increase with ageing of populations and changes in lifestyles associated with economic development. Therefore, ASEAN member countries are strongly encouraged to put in place cancer-control health care policies, focussed on strengthening the health systems to cope with projected increases in cancer prevention, treatment and management needs.     

Incidence trends and projections for childhood cancer in Ontario

Studies of cancer incidence patterns and trends can provide useful measures of health burden and possible disease etiology, which can aid the planning of cancer care services. This report aims to characterize trends in incidence of childhood cancer, and to assess the implications of these trends by generating incidence projections to 2015. Cancer incidence data were obtained from the database of the Pediatric Oncology Group of Ontario (POGO), which has registered all cancer cases in Ontario since 1985. Annual incidence rates were calculated with census-based population estimates for the 1986-2001 period. Poisson regression models were used to analyze trends, and to calculate projected numbers of cases up to the year 2015. From 1986 to 2001, 5,163 cancer cases occurred among children aged 0-14. Leukemia, CNS tumors and lymphomas were the most common cancers. The number of incident cases increased by 14%, from 296 in 1986 to 336 in 2001. For all cancers, average annual age-standardized rates increased from 147 per million in 1991 to 157 per million in 2001. Over the next 15 years, the 0-14 year population is expected to decrease from 2.28 million in 2000 to 2.13 million in 2015. A marginally statistically significant trend in incidence was projected for all cancers combined (0.5% increase per year p < 0.10) and a statistically significant increase for lymphomas, (1.2% per year 95% CI = 0.0-3.9%). During this period, the number of cases of leukemia and CNS tumors is expected to remain relatively stable. The number of cases of all cancers is expected to increase by 8%, from the average of 320 in 1995 to approximately 347 in 2015. Understanding of these projections will facilitate health care resource planning.     

Predicting future cancer incidence by age,race, ethnicity,and sex

IntroductionCancer remains a substantial burden on society. Our objective was to update projections on the number of new cancer diagnoses in the United States by age, race, ethnicity, and sex through 2040.Materials and MethodsPopulation-based cancer incidence data were obtained using Surveillance, Epidemiology, and End Results (SEER) data. Population estimates were made using the 2010 US Census data population projections to calculate future cancer incidence. Trends in age-adjusted incidence rates for 23 cancer types along with total cancers were calculated and incorporated into a second projection model.ResultsIf cancer incidence remains stable, annual cancer diagnoses are projected to increase by 29.5% from 1.86 million to 2.4 million between 2020 and 2040. This increase outpaces the projected US population growth of 12.3% over the same period. The population of older adults is projected to represent an increasing proportion of total cancer diagnoses with patients ≥65 years old comprising 69% of all new cancer diagnoses and patients ≥85 years old representing 13% of new diagnoses by 2040. Cancer diagnoses are projected to increase in racial minority groups, with a projected 44% increase in Black Americans (from 222,000 to 320,000 annually), and 86% in Hispanic Americans (from 175,000 to 326,000 annually).DiscussionThe landscape of cancer care will continue to change over the next several decades. The burden of disease will remain substantial, and the growing proportion of older and minority patients with cancer remains of particular interest. These projections should help guide future health policy and research priorities.     

Cancer in the oldest old in the United States: Current statistics and projections

ObjectivesThe oldest old population in the US, defined as aged ≥ 85 years, is projected to double from 4.3 million in 2000 to 9.6 million in 2030. The purpose of this study was to assess the current and projected cancer burden in the oldest old.Materials and MethodsThis was a retrospective cohort study using the national Surveillance, Epidemiology, and End Results (SEER) tumor registry. Historical trends were assessed and projections were created for the top 10 cancers by incidence, and also by proportion of cancer deaths for those aged ≥ 85 years.ResultsCurrently, the oldest old experiences about 7% of annual new cancer cases and 14% of cancer deaths. The most common cancers by incidence per 100,000 people are colorectal (336), lung (297), breast (254), and prostate (165), while the leading causes of cancer deaths are lung (19%), colorectal (13%), prostate (9%), and breast (7%). The incidences of non-Hodgkin lymphoma, melanoma, bladder, lung, and pancreatic cancers have been increasing, while those of other cancers are stable or decreasing. A substantial proportion of the oldest old (24%) had prior primary cancers. If historical trends continue to 2030, we project that 9% of newly diagnosed cancer cases and 23% of cancer deaths annually will occur in the oldest old.ConclusionThe oldest old may have unique cancer incidence and mortality. To manage a projected major increase in the burden of cancer care, substantial investments in geriatric oncology research, education, and practice are needed.     

A million africans a year dying from cancer by 2030: What can cancer research and control offer to the continent?

In Africa, there were an estimated 681,000 new cancer cases and 512,000 deaths in 2008. Projections to 2030 show a startling rise, with corresponding figures of 1.27 million cases and 0.97 million deaths resulting from population growth and aging alone. The figures make no assumptions about incidence rates which may increase due to the further introduction of tobacco and a more westernized lifestyle. The current situation in many parts of Africa with respect to health care systems suggests that improved cancer treatment would be an insufficient response to this increasing burden. Much could be achieved through cancer prevention by applying current knowledge about major risk factors and the natural history of the disease. For example, vaccination against hepatitis B virus and human papilloma viruses would prevent the occurrence of two of the most common cancers in Africa, liver and cervix, respectively, in the long-term. Strong measures to prevent the widespread introduction of tobacco must be a priority. Early detection and treatment of cervical and breast cancers using approaches applicable now in Africa would provide immediate value, as would the management of human immunodeficiency virus (HIV) infection in respect to HIV-associated malignancies. In parallel, further research is needed into the causes of cancer and the barriers to implementation of promising prevention strategies. Underpinning all is the need for African governments to look forward and prioritize cancer through national cancer control plans, to invest in public health infrastructure and to ensure the adequate training and support for people in cancer prevention and control. Given this core commitment from within Africa, international partners can provide complementary support in a cooperation that permits action now to mitigate the impending tragedy of cancer in the continent of Africa.     

The JICA Training Course,Community-based Cancer Prevention for the Asian Pacific Countries,Fiscal Years 2004 and 2005 (Epidemiological Approach)

Communicable diseases are still major causes of deaths in developing countries. Cancer incidence, however, ‍increased 19% between 1990 and 2000, mainly in this same developing world (Stewart and Kleihaus, 2003), and ‍malignant neoplasms are now the second leading cause of mortality in these countries (WHO, 2003). Limitations of ‍medical facilities and equipment mean that prevention is indispensable for cancer control (Mikheev et al., 1994). ‍However, human resources concerning cancer prevention are limited, and encouragement of their development ‍should be taken as a first priority. To assist in this aim, the present training course was designed by the Division of ‍Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted ‍since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002; 2003; Wakai, ‍2004). The course targets doctors and public health workers who are responsible for community-based cancer ‍prevention in developing countries to promote the introduction of comprehensive procedures, focusing mainly on ‍primary prevention but also including screening for secondary prevention of cancer.     

Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030

Objective:Breast cancer was the most common cancer and the fifth cause of cancer deaths among women in China in 2015. The evaluation of the long-term incidence and mortality trends and the prediction of the future burden of breast cancer could provide valuable information for developing prevention and control strategies.Methods:The burden of breast cancer in China in 2015 was estimated by using qualified data from 368 cancer registries from the National Central Cancer Registry. Incident cases and deaths in 22 cancer registries were used to assess the time trends from 2000 to 2015. A Bayesian age-period-cohort model was used to project the burden of breast cancer to 2030.Results:Approximately 303,600 new cases of breast cancer (205,100 from urban areas and 98,500 from rural areas) and 70,400 breast cancer deaths (45,100 from urban areas and 24,500 from rural areas) occurred in China in 2015. Urban regions of China had the highest incidence and mortality rates. The most common histological subtype of breast cancer was invasive ductal carcinoma, followed by invasive lobular carcinoma. The age-standardized incidence and mortality rates increased by 3.3% and 1.0% per year during 2000–2015, and were projected to increase by more than 11% until 2030. Changes in risk and demographic factors between 2015 and 2030 in cases are predicted to increase by approximately 13.3% and 22.9%, whereas deaths are predicted to increase by 13.1% and 40.9%, respectively.Conclusions:The incidence and mortality of breast cancer continue to increase in China. There are no signs that this trend will stop by 2030, particularly in rural areas. Effective breast cancer prevention strategies are therefore urgently needed in China.     

Evaluation of Efficacy of Self Breast Examination for Breast Cancer Prevention: a Cost Effective Screening Tool

Breast cancer is the most prevalent neoplasm among females and every year the number of associated deaths ‍increases so that there is a dire need for implementation of cancer screening and early detection. A survey conducted ‍by various locally organised cancer registries indicated breast cancer to be the most prevalent cancer among females ‍and the second most common cause of cancer deaths among Pakistani women. Since Pakistani females do not generally ‍engage in screening practices we argue that nurses and lady health workers should team up to educate women for ‍the possible early detection of cancer using Self Breast Examination as a screening tool. In this paper, we attempt to ‍evaluate the primary efficacy of self breast examination as an early and cost effective cancer screening measure, and ‍to discuss the relation of community health nurses as well as the lady health workers to education of females of low ‍income countries such as Pakistan to possibly lower the cancer burden.     

The 5th JICA Training Course,Community-based Cancer Prevention (Epidemiological Approach)

Cancer is the leading cause of deaths in developed countries, while communicable diseases are still more important in ‍in developing countries (WHO 2000). Boffetta and Parkin have estimated cancer to account for 13 percent of the annual ‍deaths in adults of developing countries (Boffetta and Parkin 1994). However, relative distribution of cancer deaths increases ‍in developing countries, with economic development and longer life span (Walgate 1984; Chackiel 1999). Actually, the ‍magnitude of the differences in age-adjusted mortality rates of all sites but skin cancers between the more and less developed ‍countries (173.9 vs. 112.9 in males and 103.1 vs. 77.5 in females) is not so large, compared with the crude rates (257.6 vs. ‍82.3 in males and 189.7 vs. 63.8 in females) (Ferlay, 2001). Limitations of medical facilities and equipment in developing ‍countries lead means that prevention as an indispensable measure for cancer control (Mikheev et al. 1994). However, ‍human resources concerning cancer prevention are limited, and encouragement of their development should be taken as a ‍first priority . To assist in development of human resources concerning cancer prevention, the present training course was designed by ‍the Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Japan, and has been annually conducted ‍since 1999, supported by the Japan International Cooperation Agency (JICA) (Takezaki, 2001; 2002). This course targets ‍doctors and public health workers who are responsible for community-based cancer prevention in developing countries to ‍promote the introduction of comprehensive procedures, focusing mainly on primary prevention but also including secondary ‍prevention of cancer. ‍ The Japanese Government extends official development assistance (ODA) to developing countries to support self-help ‍efforts that will lead to economic progress and a better life for their citizens. Since its foundation in 1974, JICA has ‍implemented Japan's technical cooperation under the ODA programme. Currently, JICA conducts such activities as training, ‍dispatch of experts, provision of equipment, project-type technical cooperation, development studies, dispatch of cooperation ‍volunteers (JOCV), and surveys and administration of capital grant aid programs. Hosting training programs for overseas ‍participants is one of JICA's fundamental technical cooperation activities for developing countries. Participants come from ‍target countries to obtain knowledge and technology training in a wide variety of fields. The objectives of the JICA training ‍program are: 1) to contribute to the development of the human resources necessary to promote progress in developing ‍countries, and 2) to contribute to the promotion of mutual understanding and friendship. ‍The present report concerns revision of contents in this 5th course, with a commentary regarding improvements for the ‍next, second-phase course. ‍