Professional Documents
Culture Documents
National Cancer Control Programmes in Thailand
National Cancer Control Programmes in Thailand
in Thailand
Petcharin Srivatanakul
National Cancer Institute
Bangkok, Thailand
NCCP Thailand
13 August 1998:
1st National Cancer Control Committee
chaired by Prime Minister of Thailand
17 Feb 2000:
2nd National Cancer Control Committee meeting
chaired by Prime Minister of Thailand
2000-2001:
1st National Cancer Control Plan was established
2001-2006:
four most common cancers- Nation-wide cancer
prevention was implemented
The aim of cancer control is a reduction
in both the incidence and the mortality rates
of the disease.
The objectives of cancer control :
1. Cancer Informatics
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
5. Palliative care
6. Cancer research
Cancer Informatics
Chiang Mai
Lampang
3. Nakhon Phanom
4. Udon Thani
Prachuab Khiri Khan 5. Khon Kaen
6. Bangkok
7. Rayong
8. Prachuab Khiri Khan
9 Songkhla
Songkhla
Leading Cancers in Thailand, 1998-2000
Male Female
Liver and bile duct 33.4 Cervix uteri 24.7
Prostate 3.5
Skin 3.3
0 10 20 30 40 0 5 10 15 20 25 30 35 40
ASR (World)
Leading Cancers in Chiang Mai, 1998-2000
Male Female
Bronchus, lung 29.6 Cervix uteri 29.4
0 5 10 15 20 25 30 35 0 5 10 15 20 25 30 35
ASR (World)
Leading Cancers in Lampang, 1998-2000
Male Female
Bronchus, lung 53 Bronchus, lung 27.6
0 10 20 30 40 50 60 0 10 20 30 40 50 60
ASR (World)
Leading Cancers in Nakhon Phanom, 1998-2000
Male Female
Liver and bile duct 63.5 Liver and bile duct 31.1
0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70
ASR (World)
Leading Cancers in Udon Thani, 1998-2000
Male Female
Liver and bile duct 113.4 Liver and bile duct 49.8
ASR (World)
Leading Cancers in Khon Kaen, 1998-2000
Male Female
Liver and bile duct 78.4 Liver and bile duct 33.3
0 20 40 60 80 100 0 20 40 60 80 100
ASR (World)
Leading Cancers in Bangkok, 1998-2000
Male Female
Bronchus, lung 18.4 Breast 24.3
0 5 10 15 20 25 30 0 5 10 15 20 25 30
ASR (World)
Leading Cancers in Rayong, 1998-2000
Male Female
Bronchus, lung 25.1 Cervix uteri 28.5
0 5 10 15 20 25 30 0 5 10 15 20 25 30
ASR (World)
Leading Cancers in Prachuap Khiri Khan, 1998-2000
Male Female
Bronchus, lung 12.1 Cervix uteri 21.2
0 5 10 15 20 25 0 5 10 15 20 25
ASR (World)
Leading Cancers in Songkhla, 1998-2000
Male Female
Bronchus, lung 13.5 Cervix uteri 20.6
0 5 10 15 20 25 0 5 10 15 20 25
ASR (World)
Table
1990 1993 1996 1999 2002 2005 2008
The four principle cancers of Thailand
Liver
Lung 42.0% of all cancers in men
Cervix 54.2% of all cancers in women
Breast
National Cancer Control Programmes(NCCP) of Thailand
in the year 2000
Prevention
Early diagnosis
Treatment
Palliative Care
CANCER CONTROL
Priorities and strategies for the eight most common cancer worldwide1
Site of cancer2 Prevention Early Curative3 Pain relief and
diagnosis therapy palliative care
Liver ++ - - ++
Lung ++ - - ++
Cervix + ++ ++ ++
Breast + ++ ++ ++
Stomach + - - ++
Colon / rectum + - + ++
Mouth / pharynx ++ + ++ ++
Oesophagus + - - ++
• minimizing or eliminating
exposure to carcinogenic agents
M 21.5 M 38.8
Sakhon F 18.0 F 13.2
Laos
Nakhon
M 27.9
F 11.3
M 73.2 Kong river
F 43.9
M 67.7 M 24.9
F 34.6 F 15.6
M 63.4
F 31.0
Plapak
M 200.1
M 200.1
F 104.1
F 104.1
M 106.0
F 53.2
M 79.9
M 136.5 F 43.7
Mukdahan F 54.3
M 59.4
F 28.1
Prevalence Intensity
of infection with Opisthorchis viverrini
in an area of high intensity in Thailand
Dimethyl
No tumor hamster nitrosamine
hamster
Opisthorchis
No tumor hamster viverrini
Cholangiocarcinoma
Thamavit et al, 1978
Life cycle of liver flukes
C: embryonated egg;
F: cercaria;
NPRO ( g / 12h )
NPRO ( g / 12h )
15 n = 23 n=5
20
10
10
n = 18 n = 36
5
0 0
-
ANTI - OV PRESENCE OF OV EGGS
Srivatanakul et Al. 1991
Chronic infection by viruses/bacteria/parasites Toxins
Cox-2 inhibitors
antioxidants
e.g. Aspirin, NSAIDS
Inflammation
Mutation
Carcinogenesis
Chronic inflammation leads to prolonged exposure of tissues to cancer-
causing agents produced within the body in response to infection or toxins
IARC
Strategies for primary prevention to control
Liver Cancer in Thailand:
Physical Exercise
Promoting dietary modification
to achieve a healthier diet
(or preventing change of diet to
more hazardous pattern).
LESS CONSUMPTION
Alcoholic drinks
Fatty food
Fry food
Grill food
Charred food
Fermented food
Salted food
Red meat
Cured and smoked meat
Food preservation (nitrate,nitrite)
MORE CONSUMPTION
EARLY ALTERED
BIOLOGICAL
INTERNAL BIOLOGICAL STRUCTURE/ CANCER
EXPOSURE EFFECTIVE
DOSE EFFECT FUNCTION
DOSE
High carcinogen Biomarkers DNA adducts Gene mutation
exposure for carcinogen Protein adducts
exposure Oncogene activation
O.V
Nitrosamine Tumor suppressor gene activation
Nitrate
Microsatellite instability
Lack of protective
(dietary) factors
SUSCEPTIBILITY
FACTORS
Lung cancer in different regions
1998 - 2000
Thailand 9.3
20.6
22.3
Chiang Mai 29.6
Lampang 27.6
53
3.7
Nakhon Phanom 7
8.3
Udon Thani 26.3 Female
0 10 20 30 40 50 60
ASR (World)
Anti – smoking campaigns
Government organizations :
Institute of Tobacco Consumption Control
Developing
Developed
IARC / WHO
Age-specific incidence rates of cervical cancer
100
10
0.1 Age
20 25 30 35 40 45 50 55 60 65 70+
Chiang Mai
1
0.75
0.5
0.25
0
0 12 24 36 48 60
Survival time in months
localized regional
Program 1 Program 2
Specific:
To evaluate reduction in incidence and
mortality rates from cervical cancer in the
province by means of an organised low
intensity cervical cytology programme.
To demonstrate the different aspects of the
programme implementation.
Considerations for Low-Resource Settings
and/or follow-up
Program Goal
cancer
Female
Target Women 80,000 in yrs
( - yrs) 6,000 in yr
Cumul
35-39 40-44 45-49 50-54 Total Cumul. Crude Risk Lower Upper
risk risk ratio lim. lim.
National Policy
Education andTraining
• Nurses, PHC Personnels for
Pap smear taking
• Re-training cytotechnicians
0 5 10 15 20 25 30
ASR (World)
Campaigns for early detection of breast cancer
Public awareness
Surgery
Radiotherapy
Chemotherapy
Hormonal Therapy
Combination Treatment
Palliative Care
Incurable cancer, palliative care deserves
high priority in cancer therapy