Cancer Registries in the Middle East & North Africa Joe B. - - PowerPoint PPT Presentation

Cancer Registries in the Middle East & North Africa

Joe B. Harford, Ph.D. Center for Global Health National Cancer Institute harfordj@nih.gov

Summary of Presentation

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Cancer registry is a means and NOT an end with the ultimate goal of cancer registry being to enhance cancer control & cancer research

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The Middle East Cancer Consortium (MECC) is an example of regional cooperation in cancer registry

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NCI has invested in MECC since 1996 especially in the areas of creation & adoption of standards and training

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Cancer registry in the Middle East and North Africa (MENA) is woefully inadequate but progress is being made

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MECC has contributed to the expansion of cancer registry in Turkey, and a MECC registry has been selected by IARC as the site for a regional hub within its GICR initiative

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MECC’s cancer registry activities have also led to a major initiative in palliative care in the region

Activity is NOT Enough

“Never mistake activity with accomplishment.” Basketball

Coaching Legend John Wooden

Cancer Registries & Cancer Control

“The cancer registry is essential to cancer control, and cancer control is essential to (the survival of) the cancer registry.”

Armstrong, B.K.

Cancer Causes & Control 3:569 (1992)

Bruce Armstrong’s 6 X 9 Grid on the Role of Cancer Registries in Cancer Control (IACR, 1992)

Screening Primary Prevention Early Diagnosis Treatment Survivors’ Issues Palliative Care

Cancer Control

Basic Research Development of Intervention Evaluation of Intervention Situation Analysis Awareness Raising Program Planning Program Implementation Program Monitoring Future Planning Basic Research Development of Intervention Evaluation of Intervention Situation Analysis Awareness Raising Program Planning Program Implementation Program Monitoring Future Planning Role of Cancer Registry: Central (34/54) Support (9/54)

Cancer Causes & Control 3:569

5 Steps of Cancer Control Planning “Failing to plan is planning to fail” ! Assess needs and capacity ! Decide approach to planning ! Develop the plan ! Implement the plan ! Evaluate the plan

= Where cancer registries particularly assist

The Middle East Peace Process Formed the Backdrop for MECC in 1996

MECC Members:

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Cyprus

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Egypt

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Israel

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Jordan

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Palestinian Authority

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Turkey

Amman Bethlehem Gaza City Nicosia Jerusalem Izmi r

MECC-Affiliated Cancer Registries Began Cooperation in 1996

Tant a

MECC flagship registries submitting data for Ci5 Vol. X: Cyprus, Egypt (Gharbiah), Israel, Jordan, Turkey (Izmir) MECC flagship registries not submitting data for Ci5 Vol. X: West Bank, Gaza Other MENA registries submitting data for Ci5 Vol. X “Second Generation” registries of MECC members submitting data for Ci5 Vol. X

Cancer Registries of the MENA Region

www.mecc.cancer.gov MECC Cancer Registries Engage in Regional Cooperation With Common Standards

87 pages 78 pages

MECC Monograph Chapters

Overview and Summary Data Esophageal Cancer Stomach Cancer Colorectal Cancer Liver and Intrahepatic Bile Duct Cancer Lung Cancer Laryngeal Cancer Breast Cancer Cervix and Corpus Uterine Cancer Ovarian Cancer Urinary Bladder Cancer Brain and Other Central Nervous System Cancer Thyroid Cancer Lymphoma and Leukemia Each chapter compares cancer rates among populations and poses relevant research questions.

Breast Cancer Incidence Rates

SEER Israel - Jews Cyprus Egypt Israel - Arabs Jordan

Although the average age for breast cancer is younger in Arab populations, breast cancer in women under 35 is very rare in all populations and not higher in Arab women.

Chance of Breast Cancer in a Given Decade of Life: U.S.-White vs. Egypt

0.43 0.41 1.56 1.08 2.87 1.31 4.11 1.11 4.85 0.86 0.43 0.43 0.41 0.41 1.56 1.56 1.08 1.08 2.87 2.87 1.31 1.31 4.11 4.11 1.11 1.11 4.85 4.85 0.86 0.86 30-39 40-49 50-59 60-69 70-79 30-39 30-39 40-49 40-49 50-59 50-59 60-69 60-69 70-79 70-79 1 2 3 4 5 1 1 2 2 3 3 4 4 5 5 U.S.-White Egypt (Tanta) Egypt (Tanta) U.S.-White

Age Group Pe rce nt

Data from NCI SEER & Gharbiah Cancer Registry

Most recommendations in U.S. start mammographic screening at age 50yr

Source: Harford JB, Lancet Oncol. 2011 Mar;12(3):306- 12.

Bladder Cancer in Egypt

1980 2005 1980 1980 2005 2005 20 40 60 80 20 20 40 40 60 60 80 80 Squamous Transitional Transitional Squamous

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Bladder cancer associated with infection by Schistosoma haematobium tends to be squamous cell carcinoma

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Bladder cancer associated with tobacco use tends to be transitional cell carcinoma

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MECC “Flagship” registry at Izmir submitting data for Ci5 Vol. X “Second Generation” registries of Turkey submitting data for Ci5 Vol. X

In Ci5 Vol. IX

Cancer Registries of Turkey

Site of the IARC regional hub within its GICR initiative

The 3 Most Significant Features of Cancer in MENA

“Where can I go in this desert to find out about how to prevent cancer or detect it early enough so that it won’t kill me?”

1. Late Diagnosis 2. Late Diagnosis 3. Late Diagnosis

MECC Monograph on Palliative Care

U.S. Egypt U.S. U.S. Egypt Egypt 20 40 60 80 20 20 40 40 60 60 80 80 Early Late Unknown Unknown Late Early

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Breast Cancer

MECC Cancer Registry Project Executive Committee

Hoda Anton-Culver UC Irvine, Registry Steering Committee Chair Kevin Ward & John Young Emory University, Responsible for Registry Training Joe Harford NCI Liaison Michael Silbermann MECC Executive Director

Report commissioned by OIA/NCI & produced in 2007 with support of NCI and ACS

“Registries require sustained commitments and trained personnel”

Today’s Presentation Was Intended to Highlight the “Tip of the Iceberg”

For more details on any aspect of the presentation, contact: Joe B. Harford, PhD NCI Center for Global Health harfordj@nih.gov