CANCER REGISTRATION IN DEVELOPING COUNTRIES: THE AIRTUM-EUROMED EXPERIENCE. XVII Convegno AIRTUM Bolzano, 20 marzo 2013

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1 CANCER REGISTRATION IN DEVELOPING COUNTRIES: XVII Convegno AIRTUM Bolzano, 20 marzo 2013 THE AIRTUM-EUROMED EXPERIENCE Diego Serraino Epidemiologia e Biostatistica Registro Tumori del Friuli Venezia Giulia IRCCS Centro di Riferimento Oncologico, Aviano

2 INTRODUCTION CANCER REGISTRATION IN OCCUPIED PALESTINIAN TERRITORIES CANCER REGISTRATION IN ALGERIA FROM REGISTRATION TO ANALYTICAL INVESTIGATIONS EUROMED CANCER REGISTRY PROGRAM Diego Serraino IRCCS CRO Aviano

3 EUROMED CANCER REGISTRY PROGRAM 2008: The Euromed Cancer Registries Network project was promoted by the Italian Ministry of Health in collaboration with AIRTUM after specific activities promoted by few Italian cancer registries 2009, the Italian MOH approved and financed for the first year AIRTUM for conducting program 2010, the Italian MOH financed for the second year AIRTUM for continuing the program 2011, the Italian MOH financed the Italian Health Institute (istituto Superiore di Sanità, Rome, ISS) for continuing -in collaboration with AIRTUM- the third year of the Euromed program deadline May, 2013

4 EUROMED CANCER REGISTRY: AIMS General: Contributing to support the control of the spread of neoplastic diseases in limited resource Countries facing the Mediterranean rim. Specific: Improving the quality of data from the cancer registries active in Mediterranean Countries and the information flows; training the personnel for data collection, use of standard statistical software use statistical models

5 GLOBOCAN 2008 (IARC) - Incidence and mortality rates NORTHERN AFRICA, MEN

6 GLOBOCAN 2008 (IARC) - Incidence and mortality rates NORTHERN AFRICA, WOMEN

7 EUROMED: PARTICIPATING CENTRES SETIF CANCER REGISTRY, ALGERIA IZMIR CANCER REGSITRY, TURKEY MALTA NATIONAL CANCER REGISTRY, MALTA NATIONAL CANCER REGISTRY, AND RESEARCH CHILDREN S CANCER HOSPITAL, CAIRO - EGYPT REGISTRES DES CANCERS DE RABAT, AND REGISTRE DU CANCER DU GRAND CASABLANCA, -MOROCCO BENGHAZI CANCER REGSITRY, LYBIA STATISTICAL OFFICER OF CYPRUS HEALTH MONITORING, CYPRUS JORDAN CANCER REGISTRY WEST BANK AND GAZA, - OCCUPIED PALESTINIAN TERRITORIES REGISTRE DU CANCER DE LA TUNISIE CENTRALE, TUNISIE

8 Population : West Bank 49.3% women Gaza Strip <15 years = 48.8% 0-4 years, largest group: 19% >65 years : 2.5% Health personnel: 1533 physicians 3621 nurses 1427 others Health informatics: The WHO has described the PNA s Health Information System (HIS) as incomplete, fragmented, unreliable, and outdated.

9 are the Health major in causes the Occupied of morbidity Palestinian and mortality Territory 3in the occupied f care, high indirect cost in loss of production, and much societal erosclerotic Cardiovascular disease namely, diseases, diabetes hypertension, mellitus, diabetes and cancer mellitus, in the similar occupied to those Palestinian neighbouring territory countries. The urbanisation and Abdullatif Husseini, Niveen M E Abu-Rmeileh, Nahed Mikki, Tarik M Ramahi, Heidar Abu Ghosh, Nadim Barghuthi, Mohammad Khalili, terranean diet to an increasingly western-style diet is associated Espen Bjertness, Gerd Holmboe-Ottesen, Jak Jervell tive effect of the traditional diet. Rates of cancer seem to be lower Heart disease, cerebrovascular disease, and cancer are the major causes of morbidity and mortality in the occupied ding causes Palestinian territory, of death resulting being a high direct lung cost of care, cancer high indirect in cost Palestinian loss of production, men and much and societal stress. The rates of the classic risk factors for atherosclerotic disease namely, hypertension, diabetes mellitus, d the tobacco health-care smoking, and dyslipidaemia are system to high this and similar epidemic to those in neighbouring is inadequate. countries. The urbanisation A large and continuing nutritional change from a healthy Mediterranean diet to an increasingly western-style diet is associated nsive with curative reduced activity, care obesity, outside and a loss of the protective the area. effect of the Effective traditional diet. Rates comprehensive of cancer seem to be lower than those in neighbouring countries, with the leading causes of death being lung cancer in Palestinian men and nd the breast health-care cancer in women. system The response of should society and the be health-care redesigned system to this to epidemic address is inadequate. these A large ping ed in and onia heart se of ease, 2005 t half with proportion of health-care expenditure is on expensive curative care outside the area. Effective comprehensive prevention programmes should be implemented, and the health-care system should be redesigned to address these diseases. Introduction Over the past century, and like many other developing countries, an epidemiological transition has occurred in Palestine. 1,2 The main causes of death were malaria and tuberculosis at the start of the 20th century, 3,4 pneumonia and enteritis by the middle of the century, with heart disease emerging as the third most important cause of death, 5 and heart disease, cerebrovascular disease, diabetes mellitus (mostly type 2), and cancer in 2005 (fi gure 1). Together, these diseases account for about half the total deaths in the occupied Palestinian territory, with the highest proportion occurring in adults. 6,7 Despite the intractable confl ict and associated economic uncertainty and instability, the general improvement in the standard of living and medical advances have resulted in diminution of communicable diseases as a public-health hazard. 1 Infectious diseases now account for less than 10% of total mortality rate 6,8 11 and the rates of pulmonary tuberculosis and AIDS are low. 6 Communicable diseases are a serious problem only in children (<4 years; fi gure 2). One in ten people living in the occupied Palestinian territory and two-thirds of those older than 60 years had at least one chronic disease according to the 2006 Palestinian family health survey. 7 This pattern is similar to changes elsewhere in the world. 13,14 In 2005, chronic diseases were estimated to account for 72% of total global burden of diseases in people aged 30 years and older, and 80% of deaths related to chronic diseases were expected to occur in low-income and middle-income countries. 15 In 2004, chronic diseases were estimated to account for 47% of disease burden in the eastern Mediterranean region, and were expected to reach 60% by The chronic diseases and risk factors that are causing a public-health concern in the occupied Palestinian territory are similar to those in other Arab countries (table 1). 6,7,17 20,23 25 The response to this chronic-disease epidemic has been limited to the few providers and donors who have understood the magnitude of this challenge. We review here the burden of the major chronic diseases in the occupied Palestinian territory. according to the 2006 Palestinian family health survey. 7 This pattern is similar to changes elsewhere in the world. 13,14 In 2005, chronic diseases were estimated to account for 72% of total global burden of diseases in people aged 30 years and older, and 80% of deaths related to chronic diseases were expected to occur in low-income and middle-income countries. 15 In 2004, chronic diseases were estimated to account for 47% of disease burden in the eastern Mediterranean region, and were expected to reach 60% by The chronic diseases and risk factors that are causing a public-health concern in the occupied Cardiovascular disease Good data for the epidemiology of cardiovascular diseases in the occupied Palestinian territory are scarce. Routine data gathered by the Ministry of Health and obtained Lancet 2009; 373: Published Online March 5, 2009 DOI: /S (09) See Comment page 985 This is the third in a Series of five papers on health in the occupied Palestinian territory Lancet 2009; 373: Published Online March 5, 2009 DOI: /S (09) See Comment page 985 Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (A Husseini PhD, N M EAbu-Rmeileh PhD, N Mikki MD); Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway (N Mikki, Prof EBjertness PhD, Prof GHolmboe-Ottesen PhD, Prof JJervell PhD); Council on Middle East Studies, Yale University, New Haven, CT, USA (Prof T M Ramahi MD); Chronic Diseases Centre, Palestinian Medical Relief This is the third in a Series of five papers on health in the occupied Palestinian territory Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory (A Husseini PhD, N M EAbu-Rmeileh PhD, N Mikki MD); Institute of General Practice and Community Medicine, University of Oslo, Oslo, Norway (N Mikki, Prof EBjertness PhD, Prof GHolmboe-Ottesen PhD, Prof JJervell PhD); Council on Middle East Studies, Yale University, New Haven, CT, USA (Prof T M Ramahi MD); Chronic Diseases Centre, Palestinian Medical Relief Society, Ramallah, occupied Palestinian territory (H A Ghosh MPH); Department of Non-communicable diseases, Ministry of Health, Ramallah, occupied Palestinian territory (N Barghuthi MPH); United Nations Relief and Works Agency, East Jerusalem, occupied Palestinian territory (M Khalili MPH); and Tibet University Medical College, Lhasa, China (Prof EBjertness) Correspondence to:

10 Health in the Occupied Palestinian Territory 3 Cardiovascular diseases, diabetes mellitus, and cancer in the occupied Palestinian territory Abdullatif Husseini, Niveen M E Abu-Rmeileh, Nahed Mikki, Tarik M Ramahi, Heidar Abu Ghosh, Nadim Barghuthi, Mohammad Khalili, Espen Bjertness, Gerd Holmboe-Ottesen, Jak Jervell Heart disease, cerebrovascular disease, and cancer are the major causes of morbidity and mortality in the occupied Palestinian territory, resulting in a high direct cost of care, high indirect cost in loss of production, and much societal stress. The rates of the classic risk factors for atherosclerotic disease namely, hypertension, diabetes mellitus, tobacco smoking, and dyslipidaemia are high and similar to those in neighbouring countries. The urbanisation and continuing nutritional change from a healthy Mediterranean diet to an increasingly western-style diet is associated with reduced activity, obesity, and a loss of the protective effect of the traditional diet. Rates of cancer seem to be lower than those in neighbouring countries, with the leading causes of death being lung cancer in Palestinian men and breast cancer in women. The response of society and the health-care system to this epidemic is inadequate. A large proportion of health-care expenditure is on expensive curative care outside the area. Effective comprehensive prevention programmes should be implemented, and the health-care system should be redesigned to address these diseases. Introduction Over the past century, and like many other developing countries, an epidemiological transition has occurred in Palestine. 1,2 The main causes of death were malaria and tuberculosis at the start of the 20th century, 3,4 pneumonia and enteritis by the middle of the century, with heart disease emerging as the third most important cause of death, 5 and heart disease, cerebrovascular disease, diabetes mellitus (mostly type 2), and cancer in 2005 (fi gure 1). Together, these diseases account for about half the total deaths in the occupied Palestinian territory, with the highest proportion occurring in adults. 6,7 Despite the intractable confl ict and associated economic uncertainty and instability, the general improvement in the standard of living and medical advances have resulted in diminution of communicable diseases as a public-health hazard. 1 Infectious diseases now account for less than 10% of total mortality rate 6,8 11 and the rates of pulmonary tuberculosis and AIDS are low. 6 Communicable diseases are a serious problem only in children (<4 years; fi gure 2). One in ten people living in the occupied Palestinian territory and two-thirds of those older than 60 years had at least one chronic disease Search strategy and selection criteria We used Medline ( ) to identify potentially relevant scientifi c reports, with search terms Palestine, chronic diseases, diabetes, cardiovascular diseases, hypertension, cancer, West Bank, Gaza, and occupied Palestinian territory. All publications were in English. Additionally, we searched for books about chronic diseases in the occupied Palestinian territory. Other sources of information included reports of the World Bank and other funding agencies. according to the 2006 Palestinian family health survey. 7 This pattern is similar to changes elsewhere in the world. 13,14 In 2005, chronic diseases were estimated to account for 72% of total global burden of diseases in people aged 30 years and older, and 80% of deaths related to chronic diseases were expected to occur in low-income and middle-income countries. 15 In 2004, chronic diseases were estimated to account for 47% of disease burden in the eastern Mediterranean region, and were expected to reach 60% by The chronic diseases and risk factors that are causing a public-health concern in the occupied Palestinian territory are similar to those in other Arab countries (table 1). 6,7,17 20,23 25 The response to this chronic-disease epidemic has been limited to the few providers and donors who have understood the magnitude of this challenge. We review here the burden of the major chronic diseases in the occupied Palestinian territory. Cardiovascular disease Good data for the epidemiology of cardiovascular diseases in the occupied Palestinian territory are scarce. Routine data gathered by the Ministry of Health and obtained from the national surveys done by the Palestinian Central Bureau of Statistics are the main sources of information for these diseases (panel; table 2) Furthermore, hardly any reliable data are available for the occupied Palestinian territory about the nature, treatment, and outcomes of cardiovascular diseases. Hypertension, diabetes mellitus, and tobacco smoking are the main risk factors for cardiovascular disease. They result in substantial direct morbidity and mortality. More data are available for these conditions than for others. Few data are available for dyslipidaemia the fourth modifi able major risk factor. These risk factors together with poor dietary habits, Vol 373 March 21, 2009 Lance Publis March DOI:1 6736( See C This is of five occup Instit Publi Unive Pales (A Hu N M E N Mik Gene Comm Unive Norw Prof E Prof G Prof J Midd Unive USA ( Chron Pales Socie Pales (H A G of No disea Rama territ Unite Work occup (M Kh Unive Lhasa Corre Dr Ab of Com Birzei POBo territo abdu

11 CANCER REGISTRATION IN GAZA, 2010 Cases registered in 2010 Men= 427, (53,8/ ) Women= 504, (65,9/ ) Most common sites in men: Lung Leukemia Colorectum Lymphomas Prostate Most common sites in women: Breast Colorectum Leukemia Lymphomas Thyroid

12 CANCER REGISTRATION IN ALGERIA, WILLAYA OF SETIF

13 S E T I F C A N C E R SETIF ALGERIA POPULATION: Men (50.1%) 7.7%, >54 years inhabitants Women 8.6%, >54 years R E G I S T R Y

14 INCIDENCE OF MOST COMMON CANCER SITES, SETIF, MEN Site/type Number of yearly diagnoses Incidence rate (STD, x ) Lung ,7 17,3 Colon-rectum 69 11,6 11,4 Bladder 58 10,2 9,6 Prostate 43 8,2 7,1 Nasopharynx 41 5,8 6,8 Stomach 35 6,6 5,8 Larynx 34 6,4 5,6 Non-Hodgkin lymphomas 26 3,7 4,1 Central nervous system 24 3,5 3,8 Leukemias 16 2,8 2,6 %

15 INCIDENCE OF MOST COMMON CANCER SITES, SETIF, WOMEN Site/type Number of yearly diagnoses Incidence rate (STD, x ) Breast ,2 43,4 Colon-rectum 68 11,4 8,8 Thyroid 46 6,4 5,9 Cervix 44 7,7 5,7 Gallbladder, biliary tract 28 4,7 3,6 Non-Hodgkin lymphomas 28 4,1 3,6 Lung 24 4,0 3,1 Central nervous system 24 3,3 3,1 Nasopharynx 20 3,0 2,6 Stomach 17 2,9 2,2 %

16 INCIDENCE OF MOST COMMON CANCER SITES, SETIF, I N 120 C I 100 D E 80 N C 60 E R A T E S YEAR Men Women Breast, W Lung, M

17 E U R OMED/AIRTUM P R OGRAM: H OSPITA L _ B ASED C A S E - C ONTROL S T U D Y ON RISK FA C TORS F OR S E L E CTED CANCER SITES, SETIF CANCER R E GISTRY Types/sites of interest : Breast, female Prostate Bladder Nasoharyngeal cancer Liver and biliary tract cancers Colon-rectum Non-Hodgkin lymphoma

18 EUROMED/AIRTUM PROGRAM: HOSPITAL_BASED CASE -CONTROL STUDY ON RISK FACTORS FOR SELECTED CANCER SITES, SETIF CANCER REGISTRY Risk factors investigated: Socio-demographic Personal habits: Smoking Diet Physical activity Alcohol consumption Familiarity and reproductive Occupation Medical history