world cancer report - iarc

More documents

Recommendations

Info

, CANCER CONTROL IN A RURAL DISTRICT IN WESTERN INDIA The Tata Memorial Centre, Mumbai, India, is the apex body for cancer control in Western India and one of the major Comprehensive Cancer Centres in India. It has encouraged the initiative of a voluntary body called Ashwini Rural Cancer Research and Relief Society in cancer control in an industrially and educationally backward rural region of western India. The Society wished to organize a rural Comprehensive Cancer Centre in Barshi town in Solapur District, Maharashtra, to provide multidisciplinary services encompassing cancer prevention, early detection, treatment, pain relief and continuing care to the rural poor as well as to conduct community-oriented cancer control research. Thus the Nargis Dutt Memorial Cancer Hospital was set up in 1982. The Tata Memorial Centre, under the aegis of its rural cancer extension project, provided continuing technical assistance to organize and develop the clinical and community extension services of this hospital. A basic cancer surgical facility with an outpatient clinic and an operating theatre was first organized while the Tata Memorial Centre trained two surgeons in the principles and practice of surgical oncology, as well as other medical and paramedical personnel. A health education programme was initiated in the rural districts surrounding the hospital to create cancer awareness. Soon a histopathology and a cytology laboratory were established followed by endoscopy and radiological facilities. Ultrasound equipment was added in 1987. Thus basic diagnostic and surgical facilities were organized initially along with community awareness programmes. A population-based cancer registry to monitor cancer incidence in part of the rural district (Barshi, Paranda, Bhum Tehsils) served by the hospital was established in 1987 with assistance from the Indian Council of Medical Research. This 316 Cancer control started providing reliable cancer incidence data from rural India for the first time. The results from the registry revealed that cervical cancer was responsible for half of the cancer burden in women. Meanwhile the cancer awareness efforts culminated in an increasing proportion of women with cervical cancers diagnosed in earlier clinical stages as years passed. A radiotherapy facility with a Theratron Phoenix telecobalt unit, brachytherapy equipment, a treatment planning system and a radiation physics laboratory was initiated in 1992 with assistance from Ratan Tata Trust in Mumbai. A committed medical oncology service was inaugurated in 1995. A CT scanner was added in 1999. The technical staff for these facilities were trained by the Tata Memorial Centre. The Nargis Dutt Hospital initiated a non-randomized controlled intervention study in 1995 to evaluate the outcome of focused health education on the early detection of uterine cervical cancer, in collaboration with IARC. This initiative, now in its sixth year, has resulted in early detection and increased survival, followed by a non-significant reduction in death from cervical cancer in the district receiving health education as compared to the control district. The Hospital has now grown into a Comprehensive Cancer Centre with 80 inpatient beds and a patient dormitory, catering for the cancer care needs of approximately 8 million people living in the surrounding districts of Solapur, Osmanabad, Latur, Ahmed Nagar, Beed and Aurangabad in Maharashtra state, Western India. The institution is headed by a chairman and is staffed by two surgical oncologists, a radiation oncologist, a physician, two anaesthetists, a pathologist, three resident medical officers, an epidemiologist, two pathology/cytology technicians, three laboratory technicians, a physicist, three radiographers, twelve oncology nurses and some health workers. Around 1,400 new cancer patients are registered annually, and around 6,000 follow-up visits are carried out. The Fig. 7.11 The Nargis Dutt Memorial Cancer Hospital, Barshi. laboratories process around 1,700 specimens for histology, and around 4,000 radiological imaging procedures are carried out annually. Around 400 major and 550 minor cancer surgical procedures and around 400 endoscopic procedures are carried out annually. Around 700 patients receive radiotherapy and 500 receive some form of chemotherapy. In 1999, the Nargis Dutt Hospital initiated a randomized intervention trial involving 160,000 women to evaluate the comparative efficacy and cost-effectiveness of cervical screening approaches such as visual inspection with acetic acid, low intensity cervical cytology, and HPV testing in cervical cancer prevention in collaboration with the Tata Memorial Centre and IARC. The Nargis Dutt Hospital has grown into a major community cancer centre providing comprehensive cancer control services, encompassing detection, treatment and prevention services, to a large rural population in Central India. The programmes are financially sustained by the revenue generated by the Hospital, non-recurring government grants, research grants and voluntary donations. Services are provided free of charge or subsidized for approximately half of the registered patients. The rural cancer control model developed by the Tata Memorial Centre and the Nargis Dutt Hospital is ideal for replication in many low resource settings.
in the capitals/urban areas of four sub- Saharan African countries. Radiotherapy Radiotherapy services are capital-intensive requiring considerable outlay for equipment, buildings and other infrastructure, as well as for trained personnel. Proper maintenance and calibration of equipment are essential to ensure sustained delivery of good quality, safe treatment. It has been shown that the acquisition of these services is related to the per capita gross national income of countries, with some regional variations. The cost of initiating (average cost of a cobalt unit is US$ 500,000 and a linear accelerator costs US$ 1.2 million) and sustaining radiotherapy services, the lack of trained personnel (radiotherapists, radiation physicists and technicians) and the necessity of having allied oncology services (diagnosis, pathology and surgery), in a sound hospital environment have been major factors limiting the provision of adequate radiotherapy services in most developing countries, particularly in sub-Saharan Africa. In spite of significant expansion of radiotherapy services in the last decade, there is a major discrepancy in the availability of radiotherapy equipment between developing and developed countries [10,11]. For instance, Italy has more machines (200) than the whole of Africa (155). Currently, a total of 2,233 mega-voltage machines (671 linear accelerators and 1,562 cobalt machines) are available in developing countries, to serve a population of 5.5 billion people [12]. In contrast, 4,472 machines (3,902 linear accelerators and 670 cobalt machines) are available in developed countries, to serve a population of 1.5 billion people. As with other areas of cancer control, Africa is the least developed region in terms of available radiotherapy services [10]. A total of 155 radiotherapy machines are available in Africa, accounting for 7% of machines in the developing world. These are located in 23 of the 56 African countries, and Egypt, South Africa, Algeria, Tunisia, Morocco and Libya account for 80% of these (125 machines). At any given time, a proportion of the radiotherapy facilities in the 16 sub-Saharan countries, other than South Africa, may not be functioning due to equipment breakdown or lack of radiation source or lack of trained personnel. Many countries have inadequate or non-existent radiotherapy services. The rapid acquisition of comprehensive radiotherapy services is an unrealistic goal if there are limited technical and financial resources. It may be more prudent for some countries, particularly sub- Saharan countries, to form consortia to organize good quality, sustainable radiotherapy services in selected locations, which can thus be shared and subsidized by neighbouring countries. Indigenous production of cheap and robust radiotherapeutic equipment and radioactive sources is important in the context of setting up radiotherapy services in developing countries. Countries like Brazil, China and India have established some capabilities in this domain. Chemotherapy A WHO consultation has proposed a list of 24 essential cancer chemotherapeutic drugs: ideally 17 drugs should be available for the treatment of the 10 most common cancers and 8 others should be available only where the resources and facilities exist for the treatment of paediatric cancers and leukaemias [13]. These drugs are not widely available in most sub-Saharan African countries and in some Asian and South American countries. Where available, these drugs are not subsidized, and hence not within the reach of many needy cancer patients. Expensive drugs subject to import duties, together with the limited efficacy of these agents in the context of most disseminated cancers, are major impediments to the gradual development of cancer chemotherapy in health services. It is impossible and unrealistic to subsidize cancer chemotherapeutic drugs in view of the extremely limited total health care resources available for cancer control in developing countries. Indigenous production of these drugs will go a long way in decreasing the costs of cancer chemotherapy. Currently, only a few developing countries, such as Brazil, China, Cuba, India, South Korea and South Africa, produce a sufficiently wide range of cancer chemotherapeutic drugs to have a great impact on costs. Basic facilities for diagnosis and chemotherapy are available in the tertiary care centres in most other developing Fig. 7.9 A technician at a microtome, preparing histological slides in Luanda, Angola. Pathology laboratories are limited in many regions of sub- Saharan Africa. countries in Asia and South America. However, these are often restricted to urban centres, causing accessibility problems for rural populations. Comprehensive care Comprehensive Cancer Centres, providing preventive, diagnostic, therapeutic, supportive and follow-up cancer care under one roof, are an important and effective organizational level in the delivery of cancer care, and are usually tertiary care centres. In most developed countries, cancer care is predominantly delivered through such centres established in different regions to cater for a defined population catchment area. Establishment and maintenance of Comprehensive Cancer Centres require considerable financial and technical resources. These Centres serve as apex bodies for cancer control in large regions, if sufficient attention is paid to incorporating extension services such as preventive oncology, community participation, palliative care (particularly in the home), and continuing follow-up care. In fact, some of the best models of cancer control activities in developing countries have been built around regional Comprehensive Cancer Centres, which have developed and directly implemented regional cancer control programmes (e.g. India, Thailand, Viet Nam, Peru). Such Centres are being increasingly developed in health services in Asia and Latin America, whereas there are few in Africa. More than 70% of the patients diagnosed Cancer control in developing countries 317
Page 2 and 3:
WORLD HEALTH ORGANIZATION WHO OMS I
Page 4 and 5:
WORLD CANCER REPORT Editors Bernard
Page 6 and 7:
CONTENTS Foreword 9 1 The global bu
Page 8 and 9:
The global burden of cancer Cancer
Page 10 and 11:
Fig. 1.2 Incidence and mortality of
Page 12 and 13:
Central and Southern Europe differ
Page 14 and 15:
Incidence of cancer in South Centra
Page 16 and 17:
from documentation of disease to a
Page 18 and 19:
TOBACCO SUMMARY >In addition to lun
Page 20 and 21:
Fig. 2.3 Smoking by children is inc
Page 22 and 23:
Cancers positively Sex Standardized
Page 24 and 25:
PHARMACOLOGICAL APPROACHES TO SMOKI
Page 26 and 27:
level the dose—response relations
Page 28 and 29:
lipoprotein-associated cholesterol,
Page 30 and 31:
Agent Cancer site/cancer Main indus
Page 32 and 33:
Industry, occupation Cancer site/ca
Page 34 and 35:
to occupational exposures in develo
Page 36 and 37:
Air pollutant WHO Air Quality Guide
Page 38 and 39:
der cancer of the order of 50% is p
Page 40 and 41:
AFLATOXIN B 1 HEPATITIS VIRUS (chro
Page 42 and 43:
Fig. 2.30 Correlation between regio
Page 44 and 45:
MEDICINAL DRUGS SUMMARY > Certain d
Page 46 and 47:
Drug or drug combination Cancer IAR
Page 48 and 49:
Agent or substance Cancer site/canc
Page 50 and 51:
sources of electromagnetic fields [
Page 52 and 53:
CHRONIC INFECTIONS SUMMARY > Infect
Page 54 and 55:
Infection Subclinical Mutagenic fac
Page 56 and 57:
TUMOURS ASSOCIATED WITH HIV/AIDS Ap
Page 58 and 59:
DIET AND NUTRITION SUMMARY > Up to
Page 60 and 61:
Fig. 2.54 The age-adjusted mortalit
Page 62 and 63:
OVERWEIGHT, OBESITY AND PHYSICAL AC
Page 64 and 65:
IMMUNOSUPPRESSION SUMMARY >Persiste
Page 66 and 67:
Fig. 2.64 Cancer following immunosu
Page 68 and 69:
Syndrome Gene Location Cancer site/
Page 70 and 71:
viduals, confirmation of a gene def
Page 72 and 73:
REPRODUCTIVE FACTORS AND HORMONES S
Page 74 and 75:
PHYTO-ESTROGENS AND CANCER PEVENTIO
Page 76 and 77:
Indicator Number of oral contracept
Page 79 and 80:
Mechanisms of tumour development Th
Page 81 and 82:
The stages in tumorigenesis have be
Page 83 and 84:
PRECURSOR LESIONS IN CHEMOPREVENTIO
Page 85 and 86:
CARCINOGEN ACTIVATION AND DNA REPAI
Page 87 and 88:
adducts, a few weeks or months for
Page 89 and 90:
I Reactive oxygen species Methylati
Page 91 and 92:
which remove the mismatched bases,
Page 93 and 94:
Common human oncogenes Many common
Page 95 and 96:
product of the RB1 gene (pRb) and a
Page 97 and 98:
ates a molecular bridge between p53
Page 99 and 100:
potential cancer genes altered thro
Page 101 and 102:
One of the earliest genes to be ide
Page 103 and 104:
Regulation of the cell cycle and co
Page 105 and 106:
CELL-CELL COMMUNICATION SUMMARY > C
Page 107 and 108:
Connexin genes and tumour suppressi
Page 109 and 110:
APOPTOSIS SUMMARY > The term apopto
Page 111 and 112:
Caspase-8 Caspase-3 c-FLIP Procaspa
Page 113 and 114:
ways. Several options are under inv
Page 115 and 116:
INVASION AND METASTASIS SUMMARY > T
Page 117 and 118:
laminin, entactin and also heparan
Page 119 and 120:
Target Example of agent Comments Ad
Page 121 and 122:
organs, and to respond to local gro
Page 123 and 124:
TOBACCO CONTROL SUMMARY > Tobacco-i
Page 125 and 126:
Region Deaths due to % of total dea
Page 127 and 128:
ipated, is primarily attributable t
Page 129 and 130:
smoke. This may be achieved in part
Page 131 and 132:
there is no evidence for the effica
Page 133 and 134:
industries, processes and occupatio
Page 135 and 136:
stoves arises in rural areas of dev
Page 137 and 138:
Climbing plants on trellis at end r
Page 139 and 140:
HEPATITIS B VACCINATION SUMMARY > P
Page 141 and 142:
Fig. 4.17 Chronic active HBV-associ
Page 143 and 144:
HUMAN PAPILLOMAVIRUS VACCINATION SU
Page 145 and 146:
Vaccine Site of trial Number of pat
Page 147 and 148:
prolonged use. Similar drugs, that
Page 149 and 150:
aspirin and other non-steroidal ant
Page 151 and 152:
SCREENING FOR BREAST CANCER SUMMARY
Page 153 and 154:
Fig. 4.35 Cumulative mortality from
Page 155 and 156:
SCREENING FOR PROSTATE CANCER SUMMA
Page 157 and 158:
Fig. 4.39 Poster designed for an an
Page 159 and 160:
is around 10% for cancer (out of ev
Page 161 and 162:
45 with one positive rehydrated FOB
Page 163 and 164:
eing based on (i) time trends in th
Page 165 and 166:
Fig. 4.48 Women at a clinic in Indi
Page 167 and 168:
SCREENING FOR ORAL CANCER SUMMARY >
Page 169 and 170:
India will provide useful informati
Page 171 and 172:
cer incidence following cure of inf
Page 173 and 174:
100 50 25 10 5 2.5 1 Japan Males Fe
Page 175 and 176:
Human cancers by organ site Maligna
Page 177 and 178:
tobacco smoking: age at start, aver
Page 179 and 180:
diagnosis is usually confirmed by h
Page 181 and 182:
is frequent and survival rates are
Page 183 and 184:
Fig. 5.14 Physician reading digital
Page 185 and 186:
Markers of prognosis in breast canc
Page 187 and 188:
cer in the contralateral breast (Ch
Page 189 and 190:
100 50 25 10 5 2.5 1 Japan Chile Po
Page 191 and 192:
depends on staging. Small intramuco
Page 193 and 194:
Fig. 5.30 A diet rich in fresh frui
Page 195 and 196:
ane protein involved in cell adhesi
Page 197 and 198:
LIVER CANCER SUMMARY > About 560,00
Page 199 and 200:
Fig. 5.39 A woman in the Gambia pre
Page 201 and 202:
REFERENCES 1. Ferlay J, Bray F, Par
Page 203 and 204:
Certain Possible Uncertain Age Andr
Page 205 and 206:
Management The dramatic division be
Page 207 and 208:
TUMOUR NORMAL Gastrula PGC 2n Impri
Page 209 and 210:
CANCERS OF THE FEMALE REPRODUCTIVE
Page 211 and 212:
Fig. 5.62 Five-year relative surviv
Page 213 and 214:
Inheritance of high-penetrance gene
Page 215 and 216:
invasive malignant. Malignant germ
Page 217 and 218:
OESOPHAGEAL CANCER SUMMARY >Cancer
Page 219 and 220:
Fig. 5.76 A radiographic view of an
Page 221 and 222:
with a stent; laser recannulation,
Page 223 and 224:
Fig. 5.82 Risk of bladder cancer am
Page 225 and 226:
Partial cystectomy is appropriate f
Page 227 and 228:
poorly known since hypopharyngeal c
Page 229 and 230:
Fig. 5.92 Oral leukoplakia with mil
Page 231 and 232:
LYMPHOMA SUMMARY > Malignant lympho
Page 233 and 234:
T Fig. 5.101 Nuclear magnetic reson
Page 235 and 236:
Fig. 5.106 Five-year relative survi
Page 237 and 238:
Fig. 5.109 The immediate aftermath
Page 239 and 240:
A B Fig. 5.113 Acute myeloid leukae
Page 241 and 242:
Fig. 5.118 Five-year relative survi
Page 243 and 244:
Fig. 5.120 Age-specific incidence a
Page 245 and 246:
Hereditary condition Mode of inheri
Page 247 and 248:
MELANOMA SUMMARY > Approximately 13
Page 249 and 250:
Fig. 5.131 Primary melanoma with a
Page 251 and 252:
THYROID CANCER SUMMARY > Cancer of
Page 253 and 254:
Papillary carcinoma RET/PTC TRK BRA
Page 255 and 256:
KIDNEY CANCER SUMMARY > Cancer of t
Page 257 and 258: Stage Clear cell carcinoma Papillar
Page 259 and 260: TUMOURS OF THE NERVOUS SYSTEM SUMMA
Page 261 and 262: ing the optic tract, brain stem and
Page 263 and 264: mut = mutant p53 wt = wildtype p53
Page 265 and 266: SURGICAL ONCOLOGY SUMMARY > Surgica
Page 267 and 268: Year Radical mastectomy (%) Modifie
Page 269 and 270: TELEMEDICINE The prospects for tele
Page 271 and 272: Equipment Energy 50% depth dose App
Page 273 and 274: CANCER EDUCATION IN MEDICAL COURSES
Page 275 and 276: Fig. 6.10 Crystals of cisplatin: mo
Page 277 and 278: Responsiveness Cancer (in decreasin
Page 279 and 280: Most of the world’s most common c
Page 281 and 282: treatment of cancer. The problems l
Page 283 and 284: duction. It is clear that tumour ce
Page 285 and 286: REHABILITATION SUMMARY > Rehabilita
Page 287 and 288: cer and its associated disability.
Page 289 and 290: REFERENCES 1. Garden FH, Gillis TA
Page 291 and 292: Cancer pain relief varies and in so
Page 293 and 294: EMERGING ISSUES IN PALLIATIVE CARE
Page 295 and 296: Cancer control The negative impact
Page 297 and 298: priority to cancer control activiti
Page 299 and 300: Prevention of cancer Every country
Page 301 and 302: - Assessing the magnitude of the ca
Page 303 and 304: high-risk women. Further details on
Page 305 and 306: ecords departments are either rudim
Page 307: THE INTERNATIONAL AGENCY FOR RESEAR
Page 311 and 312: in the overall cancer strategy. WHO
Page 313 and 314: 68% 1955 1975 1995 2025 32% 40% by
Page 315 and 316: Fig. 7.15 A grandfather at work in
Page 317 and 318: Fig. 7.17 Main causes of death in d
Page 319 and 320: Contributors and Reviewers Sources
Page 321 and 322: Dr Vera Luiz da Costa e Silva Tobac
Page 323 and 324: Georgia Moore Centers for Disease C
Page 325 and 326: REVIEWERS Dr Sandra E. Brooks 405 W
Page 327 and 328: 2.53 T. Norat and E. Riboli, IARC 2
Page 329 and 330: Gastroenterology, 118(2 Suppl 1): S
Page 331 and 332: 5.106 & 5.107 IARC/SEER/Osaka Cance
Page 333 and 334: 4.17 R. Lambert, IARC/Adapted from
Page 335 and 336: Brain cancer, see nervous system tu
Page 337 and 338: Fibroblast growth factor (FGF), 117
Page 339 and 340: Microarray, 240 Micronutrients, 65,
Page 341 and 342: S Saccharin, 64, 85 Salicin, 153 Sa
show all

world cancer report - iarc

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?