World Cancer Day 4
February 2009
Cancer is a leading cause of death around the world. WHO estimates that 84 million people will die of cancer between 2005 and 2015 without intervention.
Each year on 4 February, WHO joins with the sponsoring International Union Against Cancer to promote ways to ease the global burden of cancer. Preventing cancer and raising quality of life for cancer patients are recurring themes.
Cancer control: knowledge into action
WHO guide for effective programmes
In 2005, 7.6 million people died of cancer. More than 70% of those deaths occured in low and middle income countries. WHO has developed a series of six modules that provides practical advice for programme managers and policy-makers on how to advocate, plan and implement effective cancer control programmes, particularly in low and middle income countries.
The WHO guide is a response to the World Health Assembly resolution on cancer prevention and control (WHA58.22), adopted in May 2005, which calls on Member States to intensify action against cancer by developing and reinforcing cancer control programmes.
National cancer control programmes
A well-conceived, well-managed national cancer control programme lowers cancer incidence and improves the life of cancer patients, no matter what resource constraints a country faces.
A national cancer control programme is a public health programme designed to reduce the number of cancer cases and deaths and improve quality of life of cancer patients, through the systematic and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources. A comprehensive national cancer programme evaluates the various ways to control disease and implements those that are the most cost-effective and beneficial for the largest part of the population. It promotes the development of treatment guidelines, place emphasis on preventing cancers or detecting cases early so that they can be cured, and provide as much comfort as possible to patients with advanced disease.
National Cancer Control Programmes, policy and managerial guidelines, published in 2002, provides an updated framework for policy development and programme management that can be adapted to socioeconomic and cultural contexts in all countries. This document provides information on planning, implementation, management and evaluation to help policy-makers and programme managers make the most efficient use of the available resources develop feasible, equitable, sustainable, and effective national cancer control programmes.
Cancer prevention
At least one-third of all cancer cases are preventable. Prevention offers the most cost-effective long-term strategy for the control of cancer.
Tobacco is the single largest preventable cause of cancer in the world today. It causes 80-90% of all lung cancer deaths, and about 30% of all cancer deaths in developing countries, including deaths from cancer of the oral cavity, larynx, oesophagus and stomach. A comprehensive strategy including bans on tobacco advertising and sponsorship, tax increases on tobacco products, and cessation programmes can reduce tobacco consumption in many countries. The WHO Framework Convention on Tobacco Control, adopted in May 2003, aims to curb tobacco-related deaths and disease.
- Tobacco Free Initiative
Dietary modification is another important approach to cancer control. There is a link between overweight and obesity to many types of cancer such as oesophagus, colorectum, breast, endometrium and kidney. Diets high in fruits and vegetables may have a protective effect against many cancers. Conversely, excess consumption of red and preserved meat may be associated with an increased risk of colorectal cancer. In addition, healthy eating habits that prevent the development of diet-associated cancers will also lower the risk of cardiovascular disease.
Regular physical activity and the maintenance of a healthy body weight, along with a healthy diet, will considerably reduce cancer risk. National policies and programmes should be implemented to raise awareness and reduce exposure to cancer risk factors, and to ensure that people are provided with the information and support they need to adopt healthy lifestyles.
- WHO global strategy on diet, physical activity and health
Infectious agents are responsible for almost 22% of cancer deaths in the developing world and 6% in industrialized countries. Viral hepatitis B and C cause cancer of the liver; human papilloma virus infection causes cervical cancer; the bacterium Helicobacter pylori increases the risk of stomach cancer. In some countries the parasitic infection schistosomiasis increases the risk of bladder cancer and in other countries the liver fluke increases the risk of cholangiocarcinoma of the bile ducts. Preventive measures include vaccination and prevention of infection and infestation.
- Infectious diseases health topics
Exposure to ionizing radiation is also known to cause to certain cancers. Excessive solar ultraviolet radiation increases the risk of all types of cancer of the skin. Avoiding excessive exposure, use of sunscreen and protective clothing are effective preventive measures.
- Ultraviolet radiation
Asbestos can cause lung cancer; aniline dyes have been linked to bladder cancer; and benzene can lead to leukaemia. The prevention of certain occupational and environmental exposure to these and other chemicals is another important element in preventing cancer.
- Occupational health
Screening and early detection of cancer
Early detection of cancer greatly increases the chances for successful treatment.
There are two major components of early detection of cancer: education to promote early diagnosis and screening.
Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis. Increased awareness of possible warning signs of cancer, among physicians, nurses and other health care providers as well as among the general public, can have a great impact on the disease. Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, and chronic hoarseness. Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.
Screening refers to the use of simple tests across a healthy population in order to identify individuals who have disease, but do not yet have symptoms. Examples include breast cancer screening using mammography and cervical cancer screening using cytology screening methods, including Pap smears. Screening programmes should be undertaken only when their effectiveness has been demonstrated, when resources (personnel, equipment, etc.) are sufficient to cover nearly all of the target group, when facilities exist for confirming diagnoses and for treatment and follow-up of those with abnormal results, and when prevalence of the disease is high enough to justify the effort and costs of screening.
Based on the existing evidence, mass population screening can be advocated only for breast and cervical cancer, using mammography screening and cytology screening, in countries where resources are available for wide coverage of the population. Several ongoings studies are currently evaluating low cost approaches to screening that can be implemented and sustained in low-resource settings. For example visual inspection with acetic acid may prove to be an effective screening method for cervical cancer in the near future. More studies that evaluate low cost alternative methods to mammography screening, such as clinical breast examination, are needed.
Treatment
The primary objectives of cancer treatment are cure, prolongation of life, and improvement of the quality of life.
An national cancer control programme should therefore establish guidelines for integrating treatment resources with programmes for screening and early diagnosis, and provide therapeutic standards for the most important cancers in the country.
Treatment may involve surgery, radiation therapy, chemotherapy, hormonal therapy, or some combination of these. The most advanced forms of treatment may produce a 5-year survival rate of 75% or more for certain types of cancer, e.g. cancer of the uterine corpus, breast, testis, and melanoma. By contrast, survival rates in cancer of the pancreas, liver, stomach, and lung are generally less than 15%.
Some treatments require sophisticated technology that is available only in locations with substantial resources. Since the cost of establishing and maintaining such facilities is high, it is desirable that they should remain concentrated in relatively few places in a country to avoid draining resources that could valuably be devoted to other aspects of the work of an national cancer control programme.
Palliative care
Palliative care is an essential part of cancer control and can be provided relatively simply and inexpensively. Palliative care for children represents a special, albeit closely related field to adult palliative care.
Palliative care for children is the active total care of the child's body, mind and spirit, and also involves giving support to the family. It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease. Health providers must evaluate and alleviate a child's physical, psychological, and social distress. Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited. It can be provided in tertiary care facilities, in community health centres and even in children's homes.
Palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement.
Palliative care
* provides relief from pain and other distressing symptoms;
* affirms life and regards dying as a normal process;
* intends neither to hasten or postpone death;
* integrates the psychological and spiritual aspects of patient care;
* offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement;
* uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
* will enhance quality of life, and may also positively influence the course of illness;
* is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
In most of the world, the majority of cancer patients are in advances stages of cancer when first seen by a medical professional. For them, the only realistic treatment option is pain relief and palliative care. Effective approaches to palliative care are available to improve the quality of life for cancer patients.
The WHO ladder for cancer pain is a relatively inexpensive yet effective method for relieving cancer pain in about 90% of patients.
Sources:
http://www.who.int/mediacentre/events/annual/world_cancer_day/en/index.html
http://www.who.int/cancer/modules/en/index.html
http://www.who.int/cancer/nccp/en/
http://www.who.int/cancer/prevention/en/
http://www.who.int/cancer/detection/en/
http://www.who.int/cancer/treatment/en/
http://www.who.int/cancer/palliative/en/