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The Challenges of Constructing a National Staging Strategy: An - - PowerPoint PPT Presentation
The Challenges of Constructing a National Staging Strategy: An - - PowerPoint PPT Presentation
The Challenges of Constructing a National Staging Strategy: An Asian Perspective Anne W. M. Lee Pamela Youde Nethersole Eastern Hospital Hong Kong Disclosure I have No conflict of interest to declare Asia 30% of earths total
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Asia
30% of earth’s total land area 60% of world’s total population Sovereign states 48 recognized states 6 partial/ unrecognized states 6 dependent/ other territories
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Incidence ncidence Rat ate e of
- f All
ll Cancer ancers: : Asia ia < Dev eveloped eloped Count
- untries
ies
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Total No. of Cancer Patients Asia > Europe (except prostate cancer)
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TNM Global Advisory Group
Canada USA Germany/Austria/Switzerland, Italy, Poland Spain, UK Japan Brazil Argentina/ Latin America Belgium, France, Hungary, Ireland, Netherlands, Russia, Sweden India Singapore Australia/New Zealand South Africa
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Attempts to Create a National TNM Staging Committee in China
Preparatory Committee August 2010 Official Committee Pending approval
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Challenges
National Staging Strategy in Asia
Need? Interests? Knowledge? Implementation?
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Objectives of Staging
- To aid clinician in planning of treatment
- To give indications of prognosis
- To assist in evaluation of results
- To support cancer control activities
- To enable sharing of experience
- To contribute to continuing research
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Appropriate staging is fundamental for guiding appropriate clinical management
Best possible treatment outcome & Minimal unwarranted waste
TNM staging is basically applicable & needed in Asia
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Cancers Specifically Prevalent in Asia
Stomach Liver Esophagus Nasopharynx
Globocan 2008
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Continual Improvement of TNM Staging for Nasopharyngeal Cancer
Lee, IJC 1999 Lee, Clin Oncol 2004 Lee, Oral Oncol 2012
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Staging Systems in Hong Kong (2010)
by FY Cheung
UICC/AJCC-7th Ed UICC/AJCC-6th Ed Others Lung 100 Breast 100 Colorectal 83 17 Prostate 67 33 Gynecology 67 33 (FIGO) Head & Neck 100 Liver 83 50 (BCLC) Stomach 100 Esophagus 100 Lymphoma 100
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Staging Systems in Mainland China (2010)
by GL Jiang
UICC/AJCC Chinese Others Lung 100 Breast 95 20 Colorectal 90 10 Prostate 95 10 Gynecology 10 90 (FIGO) Nasopharynx 81 52 Liver 80 25 Stomach 95 24 Esophagus 100 20 Lymphoma 70 25 5
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Challenges
National Staging Strategy in Asia
Need ! Interests ! Knowledge ! Constructing Step for Implementation
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- 1. Engaging All Key Professionals
- Academic exchange to
develop best staging system
- Advocacy for national &
international unification
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To establish National Committee in China
Invitation by UICC (Mar 2010) ↓ Preparatory Committee (Aug 2010) ↓ Approval by Chinese Anti-Cancer Association ↓ Approval by China Association for Science & Technology ↓ Application by Chinese Anti-Cancer Association ↓ Approval by Ministry of Civil Affairs
(Aug 2012 - Pending government approval for establishment)
- 2. Getting Government Recognition/ Support
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Targets: 2020
- Sustainable delivery systems to ensure effective
cancer control in all countries
- Improve measurement of global cancer burden &
impact of cancer control interventions
3.
- 3. Int
ntegrating ing Na National ional Staging ging Strategy wit ith h Cancer ancer Regis gistry
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Challenge: hallenge: NO NOT all all Asian ian States es ha have e Cancer ancer Regis gistry
IARC – Cancer Incidence in 5 Continents Volume IX
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Asian Cancer Registries
IARC – Cancer Incidence in 5 Continents Volume IX
China India Korea & Japan South East Asia
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Population covered by National Central Cancer Registries
Population covered by the National/Regional Central Cancer Registries Population covered by the National/Regional Central Cancer Registries Population covered by the National/Regional Central Cancer Registries
China India Japan Korea Hong Kong Singapore Total population (M) 1306 1210 128 48 7 4
- No. of cancer registries
222 23 11 11 1 1 Population covered (%) 15 30 34 60 100 100
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Cancer ancer wit ith h Stage age Capt aptur ure e ≥70% 70%
Un-stage
Colorectal Breast Cervix
Un-staged
Ovary
Un-staged
Corpus
Un-staged
Hong Kong Cancer Registry 2008
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Stage Capture in other Major Cancers
Stage Nasopharynx Stomach Thyroid Lung Esophagus Prostate I
4% 14% 31% 9% 3% 0.0%
II
12% 8% 3% 2% 13% 3%
III
27% 14% 5% 18% 18% 1%
IV
18% 23% 9% 37% 20% 11%
Unknown
17% 39% 42% 32% 43% 75%
Pending
23% 2% 10% 0.2% 3% 9%
2007 Based on cancer cases in 2007
Hong Kong Cancer Registry 2008
Ho’s to be converted to UICC
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TNM Cancer Staging & Prognostic Factors Project
- 4. Advocating Universal Cancer
Staging System
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- 5. Expanding National Cancer
ancer Staging ging Commit
- mmittee
ee to
- All
ll States es
Canada USA Germany/Austria/Switzerland, Italy, Poland Spain, UK Japan Brazil Argentina/ Latin America Belgium, France, Hungary, Ireland, Netherlands, Russia, Sweden India Singapore Australia/New Zealand South Africa
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Constructing a National Staging Strategy
- 1. Educating/ engaging all key professionals
- 2. Getting government recognition & support
- 3. Integrating staging strategy with cancer registry
- 4. Advocating universal cancer staging system
- 5. Engaging all states in setting staging strategy