1. Diet and cancer risk Part II Cancer prevention and guidelines Dr. Sahar M. Sabbour Prof. Public Health, Faculty of Medicine ASU sabbour_s@hotmail.com HEPHS ll (2013-2015) Improving The Quality Of Higher Education In Public Health Sciences

2. Learning objectives Learners should : 1.Define what is a national cancer control program and its strategy 2.Be oriented with some existing programs in cancer prevention. 3.Be oriented with the global guidelines in cancer prevention.

3. The prevention of cancer worldwide is one of the most pressing challenges facing scientists and public health policy-makers, among others. At least one-third of all cancer cases are preventable. Prevention offers the most cost- effective long-term strategy for the control of cancer. learn more http://www.who.int/cancer/prevention/en/ Introduction

4. It is a public health program designed to reduce the number of cancer cases and deaths and improve quality of life of cancer patients. How? Through implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, and palliation, making the best use of available resources. http://www.who.int/cancer/nccp/en/ What do you know about national cancer control program?

5. 1.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. 2.It aims on preventing cancers or early detection of cases. 3.It aims to provide possible comfort to patients with advanced disease. Source: http://www.who.int/cancer/nccp/en/ Aims of Cancer Control program

6. Functions of a Cancer Control Program.. The core functions of the control program are  to set norms and standards,  promote surveillance,  encourage evidence based prevention,  early detection, treatment  palliative tailored to the different socioeconomic settings. Source: http://www.who.int/cancer/en/

7. Strategy for cancer prevention Four broad approaches for controlling cancer in countries include: 1.Primary prevention 2.Early detection and secondary prevention 3.Diagnosis and treatment 4.Palliative care

8. Are their available interventions to decrease the risk of cancer? WHO cancer control program addresses: Tobacco Tobacco Free Initiative Alcohol use Global strategy to reduce harmful use of alcohol Diet and physical activity WHO global strategy on diet, physical activity and health DELIVERING CERVICAL CANCER PREVENTION IN THE DEVELOPING WORLD, Nov 2011 http://www.womendeliver.org/assets/CervicalCancer_final.pdf http://www.womendeliver.org/assets/CervicalCancer_final.pdf

9. Example: Reproductive Health Global program Protecting women from cervical cancer PATH protecting women from cervical cancer Cervical cancer is a largely preventable disease, yet it kills about 270,000 women each year, mostly in low- and middle-income countries. (See the map in the previous presentation Part I, GLOBOCAN, 2008) Source: http://sites.path.org/rh/recent-reproductive-health-projects/cervical-cancer/ http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027766.pdf

10. Activities of the program: 1.Precancer screening using visual methods 2.Scaling up HPV DNA testing 3.Effective, appropriate treatment of precancerous lesions 4.Estimating costs 5.Cervical Cancer Vaccine project The screening methods used are effective, simple, safe, rapid, affordable, easy and inexpensive called visual inspection with acetic acid (VIA). Protecting women from cervical cancer..

11. Cervical Cancer Vaccine project From 2006 to 2012, PATH conducted demonstration projects in four low- to middle- income countries—India, Peru, Uganda, and Vietnam—to provide evidence for decision- making about public-sector introduction of human papillomavirus (HPV) vaccines. Protecting women from cervical cancer..

12. GUIDELINES IN CANCER PREVENTION

13. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention WHO recommendations AICR’s Recommendations for Cancer Prevention CDC cancer objectives

14. Summary guidelines in 2012 include: Achieve and maintain a healthy weight throughout life. Be physically active. Eat a healthy diet, with an emphasis on plant foods. If you drink alcohol, limit your intake. What are the American Cancer Society (ACS) Guidelines? http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/full

15. Increase access to affordable, healthy foods in communities, places of work, and schools Decrease access to and marketing of foods and drinks of low nutritional value, particularly to youth Provide safe, enjoyable, and accessible environments for physical activity in schools and workplaces and for transportation and recreation in communities ACS recommendations for Community Action Public, private, and community organizations should work together at national, state, and local levels to apply policy and environmental changes

16. 1. BODY FATNESS 2. PHYSICAL ACTIVITY 3. FOODS AND DRINKS THAT PROMOTE WEIGHT GAIN 4. PLANT FOODS 5. ANIMAL FOODS 6. ALCOHOLIC DRINKS 7. PRESERVATION, PROCESSING, PREPARATION 8. DIETARY SUPPLEMENTS Special Recommendation 1 BREASTFEEDING Special Recommendation 2 CANCER SURVIVORS Food, Nutrition, Physical activity and the Prevention of Cancer: A Global Perspective, AICR, 2007 American Institute for Cancer Research AICR recommendations for cancer prevention

17. RECOMMENDATIONS for Cancer Prevention AICR, 2007 1. BODY FATNESS: Be as lean as possible within the normal range of body weight 2. PHYSICAL ACTIVITY: Be physically active as part of everyday life 3. FOODS AND DRINKS THAT PROMOTE WEIGHT GAIN: Limit consumption of energy-dense foods, Avoid sugary drinks

18. 4. PLANT FOODS Eat mostly foods of plant origin 5. ANIMAL FOODS Limit intake of red meat and avoid processed meat 6. ALCOHOLIC DRINKS: Limit alcoholic drinks

19. 7. PRESERVATION, PROCESSING, PREPARATION Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes). 8. DIETARY SUPPLEMENTS: Aim to meet nutritional needs through diet alone

20. Two special recommendations 1. BREASTFEEDING Mothers to breastfeed; children to be breastfed 2. CANCER SURVIVORS: Follow the recommendations for cancer prevention http://www.dietandcancerreport.org/cancer_resource_center/downloads/summary/eng lish.pdf

21. CDC: HEALTHY PEOPLE 2010 CANCER OBJECTIVES 1.Reduce the overall cancer death rate. 2.Reduce the lung cancer death rate. 3.Reduce the breast cancer death rate. 4.Reduce the death rate from cancer of the uterine cervix. 5.Reduce the colorectal cancer death rate. 6.Reduce the oropharyngeal cancer death rate. 7.Reduce the prostate cancer death rate. 8.Reduce the rate of melanoma cancer deaths. 9.Increase the proportion of persons who use at least one of the following protective measures that may reduce the risk of skin cancer: avoid the sun between 10 a.m. and 4 p.m., wear sun- protective clothing when exposed to sunlight, use sunscreen with a sun-protective factor (SPF) of 15 or higher, and avoid artificial sources of ultraviolet light.

22. 9a. (Developmental) Increase the proportion of adolescents in grades 9 through 12 who follow protective measures that may reduce the risk of skin cancer. 9b. Increase the proportion of adults aged 18 years and older who follow protective measures that may reduce the risk of skin cancer. 10. Increase the proportion of physicians and dentists who counsel their at-risk patients about tobacco use cessation, physical activity, and cancer screening. 11. Increase the proportion of women who receive a Pap test. 12. Increase the proportion of adults who receive a colorectal cancer screening examination 13. Increase the proportion of women aged 40 years and older who have received a mammogram within the preceding 2 years. 14. Increase the number of States that have a statewide population-based cancer registry that captures case information on at least 95 percent of the expected number of reportable cancers. 15. Increase the proportion of cancer survivors who are living 5 years or longer after diagnosis. Source: http://www.healthypeople.gov/document/Word/Volume1/03Cancer.dochttp://www.healthypeople.gov/document/Word/Volume1/03Cancer.doc

23. http://www.who.int/cancer/nccp/en/ http://www.who.int/cancer/prevention/en/ Food, Nutrition, Physical activity and the Prevention of Cancer: A Global Perspective, AICR, 2007 http://sites.path.org/rh/recent-reproductive-health-projects/cervical- cancer/ http://sites.path.org/rh/recent-reproductive-health-projects/cervical- cancer/ A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies. CDC, 2004 http://onlinelibrary.wiley.com/doi/10.3322/caac.20140/full http://www.healthypeople.gov/document/Word/Volume1/03Cancer.doc Sources