Cancer Prevention in Egypt : What can be done in

low income countries

Hussein M. KhaledProf. of Medical Oncology

Dean, National Cancer Institute

Cairo , Egypt

By:

Cancer Prevention in Egypt : What can be done in

low income countries

• Magnitude of the Problem• Causes of the Growing Cancer Burden• Obstacles to Progress in the Global Fight against Cancer• Local Strategies to Overcome These Obstacles

Cancer Prevention in Egypt : What can be done in

low income countries

• Magnitude of the Problem• Causes of the Growing Cancer Burden• Obstacles to Progress in the Global Fight against Cancer• Local Strategies to Overcome These Obstacles

EGYPT

Gharbia Population–based registry, 1999 report

Site R.F % ASIR*1. 1. Bladder2. 2. Liver3. 3. NHL4. 4. Lung5. 5. Colon

Rectum

15.413.010.98.23.9

26.321.315.014.05.6

5 Most Common sites of cancer Egypt, 1999-2001, Males

*ASIR: / 100,000

Site R.F % ASIR*1. 1. Breast2. 2. NHL3. 3. Liver4. 4. Colon

Rectum5. 5. Ovary

37.68.04.13.73.7

49.610.76.05.25.0

*ASIR: / 100,000

5 Most Common sites of cancer Egypt, 1999-2001, Females

The National Cancer Institute

 Cairo University

www.nci.edu.eg

Cairo University National Cancer Institute

Most common sites in

Males Females

3

3

3

7

5

6

8

10

10

17

3

3

3

3

4

6

8

11

11

16

2

3

4

4

5

6

9

10

12

17

0 5 10 15 20

Bones

Larynx

Skin

Soft tissue

Colorectal

Lung

Leukemia

Lymphoma

Liver

Bladder

Percent of cases

2003

2002

2001

2

3

6

4

4

4

5

6

5

35

2

3

2

4

4

4

4

7

6

38

2

3

3

4

4

4

5

6

6

38

0 10 20 30 40 50

Thyroid

Cervix

Soft tissue

Liver

Colorectal

Ovary

Bladder

Lymphoma

Leukemia

Breast

Percent of cases

2003

2002

2001

Cancer Prevention in Egypt : What can be done in

low income countries

• Magnitude of the Problem• Causes of the Growing Cancer Burden• Obstacles to Progress in the Global Fight against Cancer• Local Strategies to Overcome These Obstacles

Preventing Cancer in the Developing WorldCauses of the Growing Cancer Burden

Aging populations Impact of infectious diseases

Increased tobacco use

Nutrition and lack of physical activity

Preventing Cancer in the Developing WorldAging Populations

2050

2000

1950

5% 10% 15% 20%

Percentage of global population 60 and older

Preventing Cancer in the Developing WorldAging Populations

0

1

2

3

4

5

6

2005 2020

65+

55-64

15-54

New cancer cases (in millions) by age, 2005 , 2020

Preventing Cancer in the Developing

World

• Infectious Agents

0%

20%

40%

60%

80%

100%

Developed Developing

New cancer cases due to infectious agents

This year, as many as 1.5 million people will die of cancers that

could have been prevented with a pill, a shot, or a Pap test.

Preventing Cancer in the Developing World• Tobacco

0

2

4

6

8

10

2000 2030

DevelopingNations

DevelopedNations

Annual deaths from tobacco

This year, the tobacco industry will knowingly and willfully addict 33 million children to its products

Preventing Cancer in the Developing

WorldNutrition and

PhysicalActivity

• This year, more than one billion people, including 17 million children, are overweight

worldwide.• In many emerging markets,

changing work habits and

growing wealth have led to

the adoption of “Western”

lifestyle behaviors.

These result in higher risk

of several cancers, including

colorectal, prostate, and breast.

Cancer Prevention in Egypt : What can be done in

low income countries

• Magnitude of the Problem• Causes of the Growing Cancer Burden• Obstacles to Progress in the Global Fight against Cancer• Local Strategies to Overcome These Obstacles

Obstacles to Progress in the Global Fight

against Cancer

Data quality Lack of cancer registries Weak infrastructures Low public awareness of cancer Poor utilization of cancer screening

Overcoming Obstacles to Progress in the

Global Fight against Cancer

The scourge of tobacco Overburdened treatment centers Lack of hospice facilities Insufficient financial support

Cancer Prevention in Egypt : What can be done in

low income countries

• Magnitude of the Problem• Causes of the Growing Cancer Burden• Obstacles to Progress in the Global Fight against Cancer• Local Strategies to Overcome These Obstacles

Main Strategies

NCI , Cairo University

• Management: Diagnosis and Treatment• Cancer Registry• Education: Training and degree-

granting programs• Research: Basic science, Population,

and Clinical studies of National Interest• Prevention and early detection

I. A Network of National Cancer Control

Centers

• National Cancer Institute.

• M.O.H. 8 cancer centres.

• Oncology departments of other 14 universities.

• Non Governmental Organizations.

Cancer Control in Egypt

EGYPT

Gharbia Population–based registry, 1999 report

III. Education: Training

• Educating doctors throughout Egypt who serve in various health care sectors via its visiting residency programs.

• Continuing education programs, and staff visits to satellite clinics.

• Journal of the National Cancer Institute

Education; Training & Certification (cont.)

Education: degree-granting programs

• NCI offers academic degrees in various oncology specialties, including :

Doctoral degrees in No of degrees awarded until May 2006

Surgical oncology 72

Adult & pediatric medical oncology 42

Radiotherapy, 23

Pathology 24

Clinical pathology, and 100

Cancer biology 23

Anesthesia & pain management 30

Master's degree in pain control 29

IV. Examples of cancers of National Interest at

NC-Cairo University

(research groups’ activities)• Bladder cancer--- large number of patients• Breast cancer --- early detection • Lung cancer---- reflects tobacco and pollution problems• Liver cancer--- reflects hepatitis infection• Colorectal cancer--- unusual young-onset ( Currently 18 ongoing national and international

research projects)

International collaborations of NCI-Cairo

Universities

Examples of Collaborators• European Organization for Research and

Treatment of Cancer EORTC.• International Union Against Cancer UICC

• World Health Organization WHO.

• International Atomic Energy Agency IAEA.

• International network for cancer treatment & research INCTR.

• National Cancer Institute, Bethesda, USA.

V. Prevention and Early Detection

• Active programs in cancer prevention and early detection through public education.

Prevention and Early Detection

• Active programs in cancer prevention and early detection through public education.

After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

Schistosomiasis

After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

After: Nabil El-Bolkainy, MD, PhD, Professor of Pathology, NCI Cairo

Control of Schistosomiasis in Egypt

Mass Treatment

Less infested

Snails

Less chance of

re-infection Lower prevalence of Schistosomiasis

Less ova in urine

fter: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

Prevalence of schistosomiasis in Egypt: 1935-2003

0

5

10

15

20

25

30

35

40

1980 1985 1990 1995 2000 2005

%

Relative Frequency of Bladder Cancer,

NCI 1975-2002

*

*

*

*

*

*

*

**

*

*

* *

*

*

1975-85 1990 1995 2000

Year

0

5

10

15

20

25

30

351975-94 1998-2002* *

What to do for Bladder Cancer ?

Continue with the Schistosomiasis Control Initiative that combats schisto among school-age children

                                             

After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

Etiologic Factors of HCC

Prevalence of HBV

Action needed

• Study of the viral etiology of HCC and the role played by HBV and

HCV (possibly a multinational comparative study).

• HBV vaccination specially children and high risk groups.

• Proper follow up of hepatitis patients, specially cirrhotic for early detection of HCC.

HBV Immunization

Smashing the smoking epidemic

After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

Smashing the smoking epidemic

After: Amal Samy Ibrahim, MD, DrPH, Professor of Epidemiology, NCI Cairo

Asbestosis

Mokhtar,N. 2003

Pollution

Overcoming Obstacles to Progress in the

Global Fight against Cancer

Developing nations have two powerful assets to help them overcome these obstacles:

Strong family ties and support A lower costs health care delivery

National Cancer Institute Cairo University

Thank youThank you

200 years ago2006