1. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - tobacco Education Schoolchildren from age 10 years Promote peer-to-peer programmes for adolescents Mass education Integrate with related messages Use the influence of the media Legislation Taxation Regular price increases Ban on advertising Warning labels Ban smoking in public places Ban tobacco sales to minors End subsides to tobacco industry Encourage alternative crops in tobacco-growing areas Regulate tobacco exports National leadership Promote domestic cooperation and advocacy by both goverment and NGOs Collaborate internationally on non-smoking policies and reduction in tobacco trade

2. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - tobacco, cont´d Process measures >80 % of schoolchildren aged 10 years and over receive education about smoking >50 % of adults receive an anti-smoking message each year >4 out of 9 legislative measures to control tobacco are implemented Impact measures >80 % of schoolchildren aged 10 years and over aware of hazards of smoking >50 % of adults aware that smoking causes lung cancer >30 % of adult smokers intend to quit within one year Outcome measures Short term:<30 % of adolescents are regular smokers <50 % of adult males and <30 % of adult females smoke Medium term:Reduction in incidence of diseases Long term:Reduction in mortality from diseases

3. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - diet Education Schoolchildren from age 10 years Mass education of adults Link with other elements of a healthy lifestyle Integrate with related messages Use the influence of the media Legislation Change agricultural support to reduce consumption of fat and increase that of fruit and vegetables Regulate food preservation and preparation Label food with details of nutrient content National leadership Promote interdisciplinary and interministerial collaboration Promote domestic and international collaboration, by goverment, agricultural industry, and NGOs

4. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - diet, cont´d Process measures >80 % of schoolchildren aged 10 years and over receive education about good dietary practices >50 % of adults receive publicity about diet and cancer each year >1 legislative measure concerned with diet and health implemented Impact measures >80 % of schoolchildren aged 10 years and over aware of good dietary practices >50 % of adults aware of link between diet and cancer Outcome measures Short term:>30 % of adults actively practising dietary modification >30 % of adults exercise at least 3.5 hours each week Medium term:Reduction in incidence of diseases Long term:Reduction in incidence of other cancers

5. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - alcohol Education Promote peer-to-peer programmes for adolescents Mass education Professional education Link with other elements of a healthy lifestyle Integrate with related messages Use the influence of the media Legislation Taxation Change agricultural support to reduce alcohol production Warning labels Regulate distilling industry Legislate for non-consumption of alcohol at work and by drivers National leadership Promote interdisciplinary and interministerial collaboration Promote domestic and international collaboration, by goverment, agricultural industry, and NGOs

6. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - alcohol, cont´d Process measures >80 % of schoolchildren aged 10 years and over receive education on hazards of drinking >50 % of adults see an anti-alcohol publicity message each year >2 anti-alcohol legislative measures introduced Impact measures >80 % of schoolchildren aged 10 years and over aware of hazards of drinking >50 % of adults aware of link between alcohol and cancer Outcome measures Short term:>50 % of adults reducing their alcohol consumption Medium term:Reduction in incidence of chirrhosis Long term:Reduction in incidence of cancers of the head and neck, oesophagus, and liver

7. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - sunlight Education Mass education School education Target health professionals Link with other elements of a healthy lifestyle Target high-risk groups Use the influence of the media Legislation Regulate agents that deplete the ozone layer Require employers to provide protection for workers at risk Regulate solariums Promote standards for protective devices National leadership Promote interdisciplinary and interministerial collaboration Promote domestic and international collaboration with goverments and NGOs

8. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - sunlight, cont´d Process measures >80 % of schoolchildren aged 10 years and over receive education on hazards of sun exposure >50 % of adults see educational message about hazards of sun exposure each year Impact measures >80 % of schoolchildren aged 10 years and over aware of hazards of sun exposure >50 % of adults aware of link between cancer and sun exposure Adopt regulations to ban use of chemicals that damage the ozone layer Outcome measures Short term:>50 % of adults actively moderating their sun exposure monitor thickness of ozone layer and UV radiation level Medium term:Reduction in incidence of sun-damaged skin Long term:Reduction in incidence of skin cancers

9. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention – occupational hazards Education Disseminate information to employers Educate employees about hazardous chemicals Professional education of physicans who care for workers Integrate with related messages on occupational health and safety Legislation Introduce ILO recommendations Introduce "right to know" legislation for workers Regulate exposure of workers to known carcinogens Require employers to introduce protective measures Introduce regular inspection National leadership Promote tripartite (government / labour / industry) collaboration Establish government occupational safety and health agencies Promote workers´compensation financed by industry

10. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - occupational hazards, cont´d Process measures >50 % of workers receive an educational message about workplace health and safety >50 % of employers contacted about workplace health and safety Impact measures >50 % of workplaces establish a joint health and safety committee >80 % of hazardous chemicals in industry clearly identified as to toxicity or carcinogenicity Outcome measures Short term:<10 % of workers exposed to known carcinogens in the workplace Medium term:None Long term:Reduction in incidence of occupationally induced cancers

11. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - viral hepatitis B Education Mass education on need for and effectivness of HBV vaccination Education of parents on need to vaccinate children early Education of high-risk groups Legislation Integrate with other vaccination programmes Standardization of biological effectiveness of vaccines Free vaccination National leadership Promote interdisciplinary and interministerial collaboration Promote domestic and international collaboration, especially at the public health department level

12. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Primary prevention - viral hepatitis B, cont´d Process measures >70 % of adults of parental age receive educational message about vaccination against HBV >80 % of primary health care workers receive educational message about HBV vaccination Impact measures HBV vaccination incorporated into EPI >70 % of children under 1 year of age vaccinated against HBV Outcome measures Short term:None Medium term:Reduction in incidence of viral hepatitis B Reduction in HBV carriers to <10 % of adults Long term:Reduction in incidence of primary liver cancer

13. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - downstaging for cancer of the cervix

14. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - downstaging for cancer of the cervix, cont´d Process measures >80 % of women aged 35 - 59 years receive education on ca of the cervix >80 % of primary health care workers informed of the benefits of downstaging for cancer of the cervix Impact measures >80 % of women aged 35 - 59 years examined at least once Outcome measures Short term:>30 % of cervical cancers discovered by examination Medium term:>30 % reduction in proportion of cases of invasive cervical cancer with advanced (stage II+) disease Long term:>30 % reduction in cervical cancer mortality

15. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - cytology screening for cancer of the cervix

16. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - cytology screening for cancer of the cervix, cont´d Process measures >80 % of women aged 35 - 59 years informed about screening for cancer of the cervix >80 % of primary health care workers instructed in taking cervical smears Impact measures >80 % of women aged 35 - 59 years screened at least once Outcome measures Short term:>30 % reduction in proportion of cases of invasive cervical cancer with advanced (stage II+) disease Medium term:>30 % reduction in incidence of invasive cervical ca Long term:>30 % reduction in cervical cancer mortality

17. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - downstaging for oral cancer

18. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - downstaging for oral cancer, cont´d Process measures >80 % of tobacco smokers and chewers receive education on examining their own mouths >80 % of primary health care workers informed of the need to examine the mouths of tobacco smokers and chewers Impact measures >80 % of tobacco smokers and chewers aged 35 - 54 examined at least once Outcome measures Short term:>30 % of oral cancers discovered by examination Medium term:>30 % reduction in proportion of cases of invasive oral cancer with advanced (stage II+) disease Long term:>30 % reduction in oral cancer mortality

19. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - screening for cancer of the breast

20. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Secondary prevention - screening for cancer of the breast, cont´d Process measures >80 % of women aged 40 years or over receive information on breast cancer screening >80 % of primary health care workers informed about the guidelines for breast cancer screening Impact measures >80 % of women aged 40 years or over receive a single physical examination and are taught breast self-examination >70 % of women aged 50 - 69 years screened Outcome measures Short term:>30 % of breast cancer detected by screening Ratio of cancers detected at first screen three times expected incidence Medium term:>15 % reduction in proportion of cases of invasive breast cancer with advanced (stage II+) disease Long term:>15 % reduction in breast cancer mortality

21. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Treatment Surgery Localized (early) disease Potentially curative therapy (integrate with screening) Radiotherapy Locally extensive disease Curative or palliative therapy, depending on tumour type and resources avaliable Chemotherapy Disseminated (advanced) disease Palliative treatment and care

22. NCCP WHO 1995 Regional tumour registry, Lund October 1995 Treatment, cont´d Process measures >50 % of adults informed about the availability of curative treatment for cancer >80 % of primary health care workers instructed about institutions where patients can receive potentially curative therapy Guidelines for therapy made available to all cancer specialists Impact measures >70 % of primary health care workers refer patients to institutions where potentially curative therapy is available >20 % of patients receive potentially curative therapy Outcome measures Short term:>50 % of cancer patients survive more than 1 year Medium term:>30 % of cancer patients survive more than 5 years Long term:>10 % decrease in cancer mortality attributable to curative therapy