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

2. 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

3. Trend of cancer mortality

4. Five leading cancer sites

5. Age-adjusted incidence and mortality
Cervical cancer

6. Coverage of Pap smear

7. Age adjusted incidence and mortality
Breast cancer

8. Age adjusted incidence and mortality
male oral cancer

9. The prevalence of betel nut chewing

10. 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）

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

12. 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).

13. National Cancer Control
Five- year Program

14. 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.

15. 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％

16. 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

17. 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).

18. 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.

19. 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.

20. 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
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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. 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.

27. 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).

28. Thank you for your attention