World Health Organization 28 May 2018 Prevention of cancer: policies and programmes for LMIC Susan Wang Ivan Ivanow Andreas Ullrich Geneva Switzerland WHO-IUMSP NCD PROGRAMME MANAGERS SEMINAR 2 - 7 JUNE 2014

Health system for cancer control

Behavioural Risks > Cancer Tobacco: oral, oesophagus, larynx, lung, bladder, kidney, stomach, cervix, Overweight /Obesity: breast, uterus, colorectal, pancreas, kidney Physical inactivity (independent RF): breast Alcohol: oral, oesophagus, larynx, breast,

Non behavioural risks Infections: HBV HPV, Shistosomiasis Helicobacter pylori, liver fluke. Carcinogens Radiation: ionizing, non-ionizing (UV) Reference: IARC http://monographs.iarc.fr/

Comprehensive tools for cancer prevention http://www.who.int/cancer/publications/cancer_control_prevention/en/

World Health Organization WHO's global NCD control Framework Surveillance Mapping the epidemic of NCDs Prevention Reducing the level of exposure to risk factors Management Strengthen health care for people with NCDs

The World Health Assembly 2013: NCD Resolution

The “cancer chapter” of the NCD action plan Every country with a national NCD strategy which includes: Behavioral risk reduction/ HPV/ HBV Cervical cancer screening Cancer registry

Impact Projections of the Global Action Plan The Lancet 3 May 2014

Four main non-communicable diseases BAU Achieving Targets Deaths avoided All cardiovascular diseases -18% 34 11 400 000; 15 900 000 All cancers -3% 7 2 400 000; 2 100 000 Chronic respiratory diseases -16% - 24 1 200 000; 2 500 000 Diabetes +11% - 5 1 100 000; 900 000 Total -10% - 21 16 100 000; 21 400 000

Summary Behavioural Risk Reduction alone will not achieve the 25x25 cancer control goal. Infectious /environmental factors are equally important. Comprehensive Cancer prevention = multiple entry points beyond the NCD action plan. Early detection + treatment: key element of additional contribution to 25 x 25 Goal

The way forward Community mobilisation Legislation Health care system (clinical prevention)

EU: The "11 Commandments" for cancer prevention: 1. Do not smoke; if you smoke, stop doing so. If you fail to stop, do not smoke in the presence of non-smokers. 2. Avoid Obesity. 3. Undertake some brisk, physical activity every day. 4. Increase your daily intake and variety of vegetables and fruits: eat at least five servings daily. Limit your intake of foods containing fats from animal sources. 5. If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man or one drink per day if you are a woman. 6. Care must be taken to avoid excessive sun exposure. It is specifically important to protect children and adolescents. For individuals who have a tendency to burn in the sun, active protective measures must be taken throughout life. 7. Apply strictly regulations aimed at preventing any exposure to known cancer-causing substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices. 8. Women from 25 years of age should participate in cervical screening. This should be within programmes with quality control procedures in compliance with “European Guidelines for Quality Assurance in Cervical Screening”. 9. Women from 50 years of age should participate in breast screening. This should be within programmes with quality control procedures in compliance with “European Guidelines for Quality Assurance in Mammography Screening”.10. Men and women from 50 years of age should participate in colorectal screening. This should be within programmes with built-in quality assurance procedures. 11. Participate in vaccination programmes against hepatitis B virus infection.