Cancer Control in the EMR

Dr. Haifa Madi

Director, Health Protection and Promotion

WHO/EMRO

Noncommunicable Diseases

About 47% of the regions’ disease burden expressed as DALY is due to NCDs.

Chronic diseases accounted for 52% of deaths in EMR.

This burden is likely

to rise

Shared preventable risk factors:

Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol

Chronic

lungDiseases

Heart disease and stroke

DiabetesCancer

Physical inactivity

Unhealthy diets

Smoking

Other NCDs

Noncommunicable diseases:

Heart disease30.2%

Cancer15.7%

Diabetes1.9%

Other chronic diseases15.7%

Infectious diseases:HIV/AIDS 4.9%

Tuberculosis 2.4%

Malaria 1.5%

OtherInfectiousDiseases

20.9%

Injuries 9.3%

Total:58Million

Deaths by cause in the world

(WHO, 2005)

Cancer in the EMR

1. Cancer is the 4th cause of death and it kills more than HIV, malaria and TB together.

2. The burden of cancer will increase with aging and unhealthy lifestyle and the EM region will witness the highest and fastest increase in the coming years. (100% and 180%)*.

40% of cancers can be prevented40% of cancers can be detected early and cured.20% of cancer can be managed by palliative therapy

*Source: [Rastogi et al. 2004].

180%

140%

144%

104%

0% 50% 100% 150% 200%

Middle Eastern

Sub-Saharan Africa

Latin American andCaribean

World

Increase in Deaths From Cancer In the next 15 years

INCREASE IN DEATHS FROM CANCER (%)

INCREASE IN CANCER DEATH BY THE YEAR 2020 (From Rastogi et al 2004)

Cancer Incidence and Mortality in the EM Region By Gender

Breast

Cervix

Bladder

Lung

Children Cancer

Incidence & Mortality of children cancer in the EM region compared to that in western countries

In the EM region, the most common children cancers are blood cancers

Screening &Early Detection In the EM region, the vast majority of cancer are diagnosed at an advanced stage when cure is improbable even with the best treatment.

Stage

of diagnosis

Breast cancer Cervical cancer

U. S. Egypt U. S. Egypt

Localized 65% 25.5% 58 % 35.9 %

Regional 30% 58% 33 % 53.2 %

Distant 5% 16.5% 9 % 10.9 %

Morphine consumption

0

0.5

1

1.5

2

2.5

3

3.5

mo

rph

ion

e c

on

sum

ptio

n (

mg

/ca

pita

)

Morphine consumption in western countries is around 50 mg/capita

0

10

20

30

40

50

60

70

mor

phin

e co

nsum

ptio

n (m

g/ca

pita

)

Cancer programmes in EM Countries Cancer programmes in EM countries is

characterized with lack of reliable comprehensive data, insufficient human and financial resources to cover the needs in many EM countries, and multidisciplinary management of cases is not instituted.

In almost all countries, cancers are detected at an advanced stage which increases cost and mortalities.

Access to treatment and palliative care is limited in many countries of the Region

Cancer Risk Factors

Prevalence of Smoking among Adults

41.5

5148

37.834.6

24.119.9

24.7

6.9 78.9

30.7

12.5

4.32.2 2.9

19.7

39.13

19.8

0

10

20

30

40

50

60

Iraq

Jord

anSau

di A

rabi

a

Syria

Kuwai

tEgy

ptPak

/ Urb

an Iran

Qatar

Sudan

adult male

adult female

Currently Smoke Cigarettes, youth 13-15*

0

24

68

10

1214

1618

20

*Source is the GTYTS data in EMR MS

Currently use Other Tobacco forms (Shisha), youth 13-15*

0

5

10

15

20

25

30

35

40

45

*Source is the GTYTS data in EMR MS

Never Smoker Likely to Initiate Smoking Within a year (13-15 yr)

0

5

10

15

20

25

30

35

40

EGYJO

RIR

QKUW

LEBOM

AQAT

SAASUD

SYRUAE

YEM GSW

B

*Source is the GTYTS data in EMR MS

Countries Ratified the FCTC

ALL EMR countries, Except

Morocco

Tunisia

Afghanistan

Somalia

Palestine

tobacco use - responsible for 1.8 million cancer deaths per year (60% of these deaths occur in low- and middle-income countries);

Main Issues with Tobacco Tobacco consumption is an epidemic.

There are other components to it than only cigarettes. Shisha is a rising problem.

Yet there are opportunities:

1. FCTC implementation (countries that have moved into stronger legislations are all FCTC parties).

2. Even countries that are not FCTC parties can implement the internationally known evidence based interventions for tobacco control.

Evidence based cost effective interventions for tobacco control (FCTC AND MPOWER)

1. Taxation increase (GCC countries- potentially Yemen, EGY, PAK and Iran)*.

2. Tobacco free public places (BAH-UAE- EGY- IRA-JOR).

3. Pictorial Health Warnings (JOR-EGY-IRA-DJI-GCC**).

4. Banning of ALL types of tobacco promotion (EGY-IRA-YEM-KUW-DJI-SUD-BAH-UAE-QAT).

*WHO recommendation is to increase taxes to 70% of retail price.

**GCC adopted the PHW specification but yet to choose the Image.

Thank You