Cancer Prevention in Egypt : What can be done in low income countries

2. Cancer Prevention in Egypt : What can be done in low income countries By: Hussein M. Khaled Prof. of Medical Oncology Dean, National Cancer Institute Cairo , Egypt

3. Cancer Prevention in Egypt : What can be done in low income countries Magnitude of the Problem Causes of the Growing Cancer Burden Obstacles to Progress in the Global Fight against Cancer Local Strategies to Overcome These Obstacles

4. Cancer Prevention in Egypt : What can be done in low income countries Magnitude of the Problem Causes of the Growing Cancer Burden Obstacles to Progress in the Global Fight against Cancer Local Strategies to Overcome These Obstacles

6. EGYPT Gharbia Population–based registry, 1999 report

7. 5 Most Common sites of cancer Egypt, 1999-2001, Males *ASIR: / 100,000

8. 5 Most Common sites of cancer Egypt, 1999-2001, Females *ASIR: / 100,000

9. The National Cancer InstituteCairo Universitywww.nci.edu.eg Cairo University National Cancer Institute

10. Most common sites in Males Females

11. Cancer Prevention in Egypt : What can be done in low income countries Magnitude of the Problem Causes of the Growing Cancer Burden Obstacles to Progress in the Global Fight against Cancer Local Strategies to Overcome These Obstacles

12. Preventing Cancer in the Developing World • Aging populations • Impact of infectious diseases • Increased tobacco use • Nutrition and lack of physical activity Causes of the Growing Cancer Burden

13. Preventing Cancer in the Developing World Aging Populations 2050 2000 1950 5% 10% 15% 20% Percentage of global population 60 and older

14. Aging Populations Preventing Cancer in the Developing World New cancer cases (in millions) by age, 2005 , 2020

15. Preventing Cancer in the Developing World • Infectious Agents This year, as many as 1.5 million people will die of cancers that could have been prevented with a pill, a shot, or a Pap test. New cancer cases due to infectious agents

16. Preventing Cancer in the Developing World This year, the tobacco industry will knowingly and will fully addict 33 million children to its products • Tobacco Annual deaths from tobacco

17. Preventing Cancer in the Developing World • This year, more than one billion people, including 17 million children, are overweight worldwide. Nutrition and PhysicalActivity • In many emerging markets, • changing work habits and • growing wealth have led to • the adoption of “Western” • lifestyle behaviors. • These result in higher risk • of several cancers, including • colorectal, prostate, and breast.

18. Cancer Prevention in Egypt : What can be done in low income countries Magnitude of the Problem Causes of the Growing Cancer Burden Obstacles to Progress in the Global Fight against Cancer Local Strategies to Overcome These Obstacles

19. Obstacles to Progress in the Global Fight against Cancer • Data quality • Lack of cancer registries • Weak infrastructures • Low public awareness of cancer • Poor utilization of cancer screening

20. Overcoming Obstacles to Progress in the Global Fight against Cancer • The scourge of tobacco • Overburdened treatment centers • Lack of hospice facilities • Insufficient financial support

21. Cancer Prevention in Egypt : What can be done in low income countries Magnitude of the Problem Causes of the Growing Cancer Burden Obstacles to Progress in the Global Fight against Cancer Local Strategies to Overcome These Obstacles

22. Main Strategies NCI , Cairo University • Management: Diagnosis and Treatment • Cancer Registry • Education: Training and degree-granting programs • Research: Basic science, Population, and Clinical studies of National Interest • Prevention and early detection

23. I. A Network of National Cancer Control Centers • National Cancer Institute. • M.O.H. 8 cancer centres. • Oncology departments of other 14 universities. • Non Governmental Organizations.

24. Cancer Control in Egypt

25. EGYPT Gharbia Population–based registry, 1999 report

26. III. Education: Training • Educating doctors throughout Egypt who serve in various health care sectors via its visiting residency programs. • Continuing education programs, and staff visits to satellite clinics. • Journal of the National Cancer Institute

27. Education; Training & Certification (cont.)

28. Education: degree-granting programs • NCI offers academic degrees in various oncology specialties, including :

29. IV. Examples of cancers of National Interest at NC-Cairo University(research groups’ activities) • Bladder cancer--- large number of patients • Breast cancer --- early detection • Lung cancer---- reflects tobacco and pollution problems • Liver cancer--- reflects hepatitis infection • Colorectal cancer--- unusual young-onset ( Currently 18 ongoing national and international research projects)

30. International collaborations of NCI-Cairo Universities Examples of Collaborators • European Organization for Research and Treatment of Cancer EORTC. • International Union Against Cancer UICC • World Health Organization WHO. • International Atomic Energy Agency IAEA. • International network for cancer treatment & research INCTR. • National Cancer Institute, Bethesda, USA.

31. V. Prevention and Early Detection • Active programs in cancer prevention and early detection through public education.

32. Prevention and Early Detection • Active programs in cancer prevention and early detection through public education.

33. Schistosomiasis After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

34. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

35. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

36. After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

37. Control of Schistosomiasis in Egypt Less chance of re-infection Lower prevalence of Schistosomiasis Mass Treatment Less infested Snails Less ova in urine fter: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

38. Prevalence of schistosomiasis in Egypt: 1935-2003

39. Relative Frequency of Bladder Cancer, NCI 1975-2002

40. What to do for Bladder Cancer ? Continue with the Schistosomiasis Control Initiative that combats schisto among school-age children After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

41. Etiologic Factors of HCC

42. Prevalence of HBV

43. Action needed • Study of the viral etiology of HCC and the role played by HBV and HCV (possibly a multinational comparative study). • HBV vaccination specially children and high risk groups. • Proper follow up of hepatitis patients, specially cirrhotic for early detection of HCC.

44. HBV Immunization

45. Smashing the smoking epidemic After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

46. Smashing the smoking epidemic After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

47. Asbestosis Mokhtar,N. 2003

48. Pollution

50. Overcoming Obstacles to Progress in the Global Fight against Cancer Developing nations have two powerful assets to help them overcome these obstacles: • Strong family ties and support • A lower costs health care delivery