Cancer Integrated Prevention and Control in Shanghai Wei Lu MD, MPH,PhD Shanghai Institutes of Preventive Medicine weiloo@scdc.sh.cn
Shanghai Overview Demography ( 2003 ) Total residents 13,417,700 Sex ratio 1.01:1(M/F) Aging rate ( 60yrs) 18.98% Birth rate 4.28 Death rate 7.52 Natural increase rate -3.24 Floating population 4,987,900
Health indices (2004) Average life expectancy 80.29 years old Infant death rate 3.78 Maternal death rate 10.79/100,000
Leading Causes of Death Others 25% Cardial Vascular Diseases 32% Respirotory Diseases 14% Cancer 29%
Cancer Incidence in Shanghai
Cancer care facilities 3-level general health care network, including more than 400 hospitals and community health service centers. The first-level facilities are all the community health service centers providing predominantly primary health care. The second-level facilities are the district hospitals, most of which have a Cancer Department. The third-level facilities are all the municipal hospitals and the Shanghai Cancer Hospital. Most of the second- and third-level facilities provide radiotherapy, cancer surgery and chemotherapy services.
The Crude incidence trend during past 30 years 400 350 300 250 200 150 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 imcidence(1/100,000) year male female total
Registry Data in 2002 Male Female Total New cases 23,036 18,426 41,462 Crude incidence 344.49 279.20 312.06 Died cases 16,803 10,749 27,552 Crude mortality 251,28 162.88 207.37 Cancer account for 28.79%of total death
Incidence Cases of Different Cancer Category Lung 5354 2172 Stomach 3491 1884 Breast 0 3177 Liver 2749 1082 Colon 1467 1441 Rectum 1166 1013 Esophagus 1107 385 Bladder 812 236 Pancreas 767 676 Prostate gland 767 0 Brain and other nervous system 572 717 Cervix uteri 0 666 6000 5000 4000 3000 2000 1000 0 1000 2000 3000 4000 Male Female
Death Cases of Different Cancer Categoty Lung 4873 1992 Stomach 2668 1454 Breast 0 767 liver 2542 1045 Esophagus 1062 378 Pancreas Colon Rectum 760 718 620 523 686 691 Brain and other nervous system 340 286 Prostate gland 300 0 Bladder 308 113 Cervix uteri 0 293 6000 5000 4000 3000 2000 1000 0 1000 2000 3000 Male Female
Survival Case Up to end of year 2002: Survival cases: 116,776, account for 0.88% of the city population 31.77% of total cases survive over 5 years Among these survival cases,mostly are breast (18.60 %),stomach, colon,rectum and bladder cancer.
Predictive estimation Shanghai will be on ageing surge in 2015 proportion over 60 yr. will be 25% over 65 yr. 20% The situation will continue to 2050 Cancer, CVD and other chronic diseases will be a bomb-like increasing
Cancer prediction Cancer incidence in 2015 will be over 400/100,000, and new cases will be over 50,000 per year. Survival cases will reach over 200,000 yearly, account for 1.5% of city population. Data in 2002 tell us: increasing speed of cancer is underestimated so far.
Common Risk Factors Ageing Dietary habit Tobacco use Infectious Disease Alcohol Intake Obesity
Ageing population Shanghai already entered the ageing society, proportion over 60 yr. is 18.25%; over 65 yr. is 14.04% Cancer incidence of 60 yr. and over is 1108.15/10 万 ; of 65 yr. and over is 1255.98/10 万
Cancer incidence by different age groups in 2002 cases 8000 7000 6000 5000 4000 3000 2000 1000 2000 1800 1600 1400 1200 1000 800 600 400 200 incidence 0 0 1-5- 10-15- 20-25- 30-35- 40-45- 50-55- 60-65- 70-75- 80-85 age groups 0 cases incidence
Dietary habit Westernizing dietary Grain food and dietary fiber reduced. Calories and fat intake increased
Tobacco using Smoking rate among urban male reach to 66%, among rural male 80% Smoking rate among 15~18 adolescent is over 10% There is an increase trend of female smoking Incidence and mortality of lung cancer in male is ranked first cancer category. Second hand smoking is common to women.
The Prevalence of smoke in Shanghai during 2001-2004 80% Male% Female% Total Smoking Rate(%) 60% 40% 20% 0% 15-25- 35-45- 55-65- 75-85- Age Group Data Source:Health Document of Shanghai
Infectious diseases High prevalence of HBV infection High incidence of liver cancer HBsAg positive rate is about 10% in general population Cervix uteri cancer increasing is related with HPV infection Nasopharyngeal cancer and EB virus
Alcohol intake Alcohol over intake among male residents is 18% No effective measures take over alcohol over intake in Shanghai so far
Obesity High calories, high fat and less fiber food intake. Lack of exercise and sedentary habit. Prevalence of sedentary habit reach to 30%, over-weight 19%,obesity 6% Obesity among students reach to 11%
Priorities of cancer prevention and control Tobacco control Balanced dietary, physical exercise and body-weight control. Alcohol control Reduce intake salt and preserved foods
Priorities of cancer prevention and control (Cont.) Since 1992, EPI has included HB vaccine among infants in China. The coverage of HBV of infants is over to 99.8% in Shanghai. Encourage adults accept HBV immunization. Hygiene habit in daily life Safety sexual behavior to protect HPV infection.
Priorities of cancer prevention and control (Cont.) Environmental protection Vehicle pollution control Industrial pollution control Food hygiene and safety Drinking water quality improving
Priorities of cancer prevention and control (Cont.) Early detection Knowledge and recognition Cost-benefit and effective screening method improving Cancer strategy Breast Cervical Colon and rectum Stomach Liver BSE mammogram Pap smear Fecal occult blood test, flexible sigmoidoscopy, Colonoscopy Endoscopy Liver function, alpha-fetoprotein (AFP) ultrasonography
SCDC Shanghai Institute of Preventive Medicine Division for for Health Information Dept Dept of of Health Statistics Dept Dept of of IT IT Administration Central library for Disease Division for Infectious Control&Prevention Dept Dept of of Epidemic Prevention Dept of &Vaccine Dept of Immunization Management Dept Dept of of Vector Control & Prevention Dept Dept of of Disinfection Dept Dept of of TB TB Control & Prevention Dept Dept of of Parasitosis Control&Prevention Dept Dept of of HIV/AIDS,STD Control & Prevention Division for for Non- Non- Communicable Diseases Control & Prevention Dept Dept of of Noncommunicable Diseases Prevention Non- Dept Dept of of Cancer Control & Prevention Dept of of Injury Prevention Dept of of School Health Division for for Environmental & Occupational Health of Food Dept of Safety of Nutrition Dept of Dept Dept of of Environmental Health & Safety Research Dept of of Occupational Health & Toxic Control Dept. of of Gene Rearch Dept. of of Toxical Rearch Central Labs Food Health and Safety Lab Environmental Health Lab Lab Microbiology Lab Dept of of Toxicology Lab Lab of of Experimental Animal Division for for Health Service Office of of Preventive Physical Examination Office of of Physical Medical Examination for for Drivers Dept Dept of Occupational of Physical Examination SCDC Professional Infrastructure
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3-Level Network for Disease Prevention and Control in Shanghai Municipal Government Municipal Health Bureau SCDC District Government District Health Bureau District CDCs Community Administration Community Health Service Center Administrative relationship Community School Hospital Company Professional supervision relationship
Surveillance Network for Infectious Disease SCDC District & county CDCs Hospitals Passive Surveillance System Surveillance Sites Active Surveillance System
Challenge and Opportunity Shanghai long term strategy of prevention and control of non-communicable diseases Preventive network of cancer prevention Health education Tobacco use and other risk factor control Cancer surveillance and registry Early detection QOL of survival cases and palliative care Multi-section cooperation and whole society participation