Cancer Prevention in Taiwan Bureau of Health Promotion Department of Health Taiwan

The Statistics of Cancer the first leading cause of death since 1982 Crude incidence 265/105 (59,116), 2000 Crude mortality 141/105 (31,554), 2000 Direct medical cost : $ 0.7 billion dollars annually (NHI), 2002

Trend of cancer mortality

Five leading cancer sites

Age-adjusted incidence and mortality Cervical cancer

Coverage of Pap smear

Age adjusted incidence and mortality Breast cancer

Age adjusted incidence and mortality male oral cancer

The prevalence of betel nut chewing

Proportion of CIS and Invasive Ca Cervical cancer (1992-1998) year In-situ Ca Case No.（%） Invasive Ca 1992 1,060（31.1） 2,350（68.9） 1993 971（29.8） 2,291（70.2） 1994 1,169（35.2） 2,150（64.8） 1995 1,297（35.9） 2,312（64.1） 1996 1,987（43.3） 2,601（56.7） 1997 2,409（48.3） 2,575（51.7） 1998 3,095（52.5） 2,796（47.5）

Priorities and strategies for cancer Prevention Primary Screen Curative Tx Palliative Care Lung ＋＋ － Stomach ＋ Breast Colorectal Cervix Oralpharynx Liver

Future Burden of Cancer ( 2020 ) Cancer mortality will continue to increase; The number of new cancer cases per year will increase to 100,000 (from 60,000). Incidence of all cancers will increase to 410/105 (from 265/105).

National Cancer Control Five- year Program

Goals of NCCP To slow down the increase of the age-adjusted mortality rate of all cancers, especially breast cancer, oral cancer and colon-rectum cancer. To reduce the age-adjusted mortality rate of cervical cancer to 3.9/105; to reduce the proportion of invasive cervical cancer to all cervical cancer to 35%.; To increase the male five-year survival rate of all cancers by 1%; to increase the female five-year survival rate of all cancers by 2%; To improve the approval rate of patients for the medical care of cancer.

Objectives of NCCP 17.5％ 17％ 74.8％ 80％ 55.6％ 60％ 2.8％ 20％ 19.9％ 35％ Itemized Goals 2003 2009 Improve the public’s anti-cancer capabilities Smoking rate see Tobacco Hazards Control Plan Betel nut chewing rate (male adults) 17.5％ 17％ Obese population see National Nutrition Improvement Program Improve coverage rates of major cancer screenings Cervical cancer (women 30-69) 74.8％ 80％ (three-year screening rate for women 30-69) 55.6％ 60％ Breast cancer (women 50-69) 2.8％ 20％ Oral cavity cancer (smoking or betel nut chewing persons 20 and above) 19.9％ 35％ Colon-rectum cancer (general public 50-69) 1.3％ 30％

Strategy 1 Building Healthy Lifestyles & Reducing Risks of Cancer Promotion of tobacco hazards control plan Promotion of betel nut hazards control Promotion of cancer prevention diet Promotion of hepatitis control Promotion of HPV prevention and control plan

Promotion of Betel Nut Hazards Control To recommend practicable plans for the control and taxation of betel nut; to establish legal sources and financial basis for the control of betel nut; To build up partnership for the control of betel nut hazards; to develop NGOs; To continue to supervise betel nut managers to label health warnings on packs; To strengthen education through mass media on betel nut hazards, and to conduct preventive intervention projects among specific groups (schools, worksites, army, and communities of high betel nut use).

Promotion of HPV Prevention and Control Plan To improve the public’s awareness of the relationship between HPV and cervical cancer; to promote safe sexual behavior; To set up epidemiological data on HPV infection in Taiwan and also KAP data of women on HPV; To participate in international HPV vaccine development research; to recommend the promotion of immunization programs.

Strategy 2 Promotion of Cancer Screening for Early Detection and Early Treatment Establishing evidence-based screening models; Including screening in the health promotion services of the National Health Insurance; Improving alertness to the early symptoms of some common cancers; Reducing obstacles; improving coverage rate of screening; Establishing an effective referral and follow-up system for positive cases; Establishing a quality monitoring system for screening; Establishing databanks of screening.

Cancer Screening Programs Target Policy The year of beginning Cervical cancer Women aged 30 and above Pap smear (once/year) 1990 (BHP) July 1995 (NHI) Breast cancer High-risk women aged 50-69 Mammography (once/year for women with family history; once every three years for other high-risk women) July 2002 (BHP) Oral cancer Smoking or betel nut chewing persons aged 18 and above Examination of oral cavity mucus (once/3 years) 1999 (BHP) Colon-rectum cancer General public aged 50-69 FOBT (once/year) July 2003 (BHP) Liver cancer By findings of liver cancer screenings, to conduct abdominal ultra-sound screening for hepatitis B carriers for persons 40 and above.

Strategy 3 To improve hospital accountability To promote evidence-based medicine consensus on the diagnosis and treatment of cancer; To realize management of cancer diagnosis and treatment in hospitals, and to upgrade quality, safety, and “patient-oriented” medical care services To establish an assessment system for the medical care of cancer To make cancer care hospitals improve their quality; to make hospitals set up a mechanism for the realization of cancer care management.

Strategy 4 To Consolidate and mobilize Community Resources for preventive and supportive Services To support cancer-related public-interest civic groups, and to establish a collaborative mechanism between governmental and NGOs; To overall plan the allocation of service resources and contents to meet the needs of the target population.

Strategy 5 To Promote Hospice Care and Improve the Quality of Life of Patients To promote education to make people understand the meaning of hospice care; To set up a hospice care network accessible to those in need; To improve the quality of hospice care; To train cancer care-associated medical personnel in hospice care; To develop different reasonable payment schedules for hospice care.

Strategy 6 To Establish Cancer Databanks, to Continue to Monitor and Assess the Cancer Control Plan To establish and manage cancer control- associated databanks; To set up a quality improvement mechanism for the reporting of cancer information To set up a cancer control information management center; to publish major information.

Strategy 7 To Consolidate Cancer Research through a Cancer Research Center To set up by regulations a cancer research center in the National Health Research Institutes to formulate national research and development directions for cancer, and to consolidate research resources; To promote the “three-step five-level” research of cancer; To plan for the establishment of a research utilization mechanism and a feedback to policy making mechanism.

Strategy 8 To Establish a Long-Term Manpower Development Policy To regulate qualifications of service providers; To assess the manpower demands and current supply; To provide on-job training and advanced training overseas; To supervise relevant medical associations to set up professional licensure systems for special demands of cancer care; To include communication skills, and concepts of holistic care and hospice in the education.

Budget and human resources in our division There are currently 17 members in our division, one chief, one senior executive officer, other are distributed in three sections. In year 2005, we will invest about 14 million dollars in cancer control (if the five-year program is approved, there will be 115 million dollars invested).

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