Download Primary prevention

Primary prevention - tobacco
Education
Legislation
Schoolchildren from age 10 years
Promote peer-to-peer programmes
for adolescents
Mass education
Integrate with related messages
Use the influence of the media
Taxation
Regular price increases
Ban on advertising
Warning labels
Ban smoking in public places
Ban tobacco sales to minors
End subsides to tobacco
industry
Encourage alternative crops
in tobacco-growing areas
Regulate tobacco exports
National leadership
Promote domestic cooperation and advocacy by
both goverment and NGOs
Collaborate internationally on non-smoking
policies and reduction in tobacco trade
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - tobacco, cont´d
Process measures
>80 % of schoolchildren aged 10 years and over receive education
about smoking
>50 % of adults receive an anti-smoking message each year
>4 out of 9 legislative measures to control tobacco are implemented
Impact measures
>80 % of schoolchildren aged 10 years and over aware of hazards
of smoking
>50 % of adults aware that smoking causes lung cancer
>30 % of adult smokers intend to quit within one year
Outcome measures
Short term:
<30 % of adolescents are regular smokers
<50 % of adult males and <30 % of adult females smoke
Medium term: Reduction in incidence of diseases
Long term:
Reduction in mortality from diseases
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - diet
Education
Legislation
Schoolchildren from age 10 years
Mass education of adults
Link with other elements of a
healthy lifestyle
Integrate with related messages
Use the influence of the media
Change agricultural support to
reduce consumption of fat
and increase that of fruit
and vegetables
Regulate food preservation and
preparation
Label food with details of
nutrient content
National leadership
Promote interdisciplinary and interministerial
collaboration
Promote domestic and international
collaboration, by goverment, agricultural
industry, and NGOs
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - diet, cont´d
Process measures
>80 % of schoolchildren aged 10 years and over receive education
about good dietary practices
>50 % of adults receive publicity about diet and cancer each year
>1 legislative measure concerned with diet and health implemented
Impact measures
>80 % of schoolchildren aged 10 years and over aware of good dietary
practices
>50 % of adults aware of link between diet and cancer
Outcome measures
Short term:
>30 % of adults actively practising dietary modification
>30 % of adults exercise at least 3.5 hours each week
Medium term: Reduction in incidence of diseases
Long term:
Reduction in incidence of other cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - alcohol
Education
Legislation
Promote peer-to-peer
programmes for adolescents
Mass education
Professional education
Link with other elements of a
healthy lifestyle
Integrate with related messages
Use the influence of the media
Taxation
Change agricultural support to
reduce alcohol production
Warning labels
Regulate distilling industry
Legislate for non-consumption
of alcohol at work and
by drivers
National leadership
Promote interdisciplinary and interministerial
collaboration
Promote domestic and international
collaboration, by goverment, agricultural
industry, and NGOs
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - alcohol, cont´d
Process measures
>80 % of schoolchildren aged 10 years and over receive education on
hazards of drinking
>50 % of adults see an anti-alcohol publicity message each year
>2 anti-alcohol legislative measures introduced
Impact measures
>80 % of schoolchildren aged 10 years and over aware of hazards
of drinking
>50 % of adults aware of link between alcohol and cancer
Outcome measures
Short term:
>50 % of adults reducing their alcohol consumption
Medium term: Reduction in incidence of chirrhosis
Long term:
Reduction in incidence of cancers of the head and neck,
oesophagus, and liver
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - sunlight
Education
Legislation
Mass education
School education
Target health professionals
Link with other elements of a
healthy lifestyle
Target high-risk groups
Use the influence of the media
Regulate agents that deplete
the ozone layer
Require employers to provide
protection for workers
at risk
Regulate solariums
Promote standards for
protective devices
National leadership
Promote interdisciplinary and interministerial
collaboration
Promote domestic and international
collaboration with goverments and NGOs
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - sunlight, cont´d
Process measures
>80 % of schoolchildren aged 10 years and over receive education on
hazards of sun exposure
>50 % of adults see educational message about hazards of sun
exposure each year
Impact measures
>80 % of schoolchildren aged 10 years and over aware of hazards
of sun exposure
>50 % of adults aware of link between cancer and sun exposure
Adopt regulations to ban use of chemicals that damage the ozone layer
Outcome measures
Short term:
>50 % of adults actively moderating their sun exposure
monitor thickness of ozone layer and UV radiation level
Medium term: Reduction in incidence of sun-damaged skin
Long term:
Reduction in incidence of skin cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention –
occupational hazards
Education
Disseminate information to
employers
Educate employees about
hazardous chemicals
Professional education of
physicans who care for
workers
Integrate with related messages
on occupational health and
safety
Legislation
Introduce ILO
recommendations
Introduce "right to know"
legislation for workers
Regulate exposure of workers
to known carcinogens
Require employers to
introduce protective
measures
Introduce regular inspection
National leadership
Promote tripartite (government / labour / industry)
collaboration
Establish government occupational safety and
health agencies
Promote workers´compensation financed by
industry
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - occupational hazards, cont´d
Process measures
>50 % of workers receive an educational message about workplace
health and safety
>50 % of employers contacted about workplace health and safety
Impact measures
>50 % of workplaces establish a joint health and safety committee
>80 % of hazardous chemicals in industry clearly identified as to
toxicity or carcinogenicity
Outcome measures
Short term:
<10 % of workers exposed to known carcinogens in the
workplace
Medium term: None
Long term:
Reduction in incidence of occupationally induced
cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - viral hepatitis B
Education
Legislation
Mass education on need for and
effectivness of HBV
vaccination
Education of parents on need to
vaccinate children early
Education of high-risk groups
Integrate with other
vaccination programmes
Standardization of biological
effectiveness of vaccines
Free vaccination
National leadership
Promote interdisciplinary and interministerial
collaboration
Promote domestic and international
collaboration, especially at the public health
department level
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Primary prevention - viral hepatitis B, cont´d
Process measures
>70 % of adults of parental age receive educational message about
vaccination against HBV
>80 % of primary health care workers receive educational message
about HBV vaccination
Impact measures
HBV vaccination incorporated into EPI
>70 % of children under 1 year of age vaccinated against HBV
Outcome measures
Short term:
None
Medium term: Reduction in incidence of viral hepatitis B
Reduction in HBV carriers to <10 % of adults
Long term:
Reduction in incidence of primary liver cancer
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention downstaging for cancer of the cervix
Detectable preclinical phase (DPCP)
Dysplasia



Average
age:
~13

18
Carcinoma
in situ

Onset of
sexual
activity
Invasive
cancer
35

Birth
Death
50 year
Exam inations here
unlikely to find cancers
Examinations here
are cost-effective
~8 % of cancers
~92 % of cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention downstaging for cancer of the cervix, cont´d
Process measures
>80 % of women aged 35 - 59 years receive education on ca of the cervix
>80 % of primary health care workers informed of the benefits of
downstaging for cancer of the cervix
Impact measures
>80 % of women aged 35 - 59 years examined at least once
Outcome measures
Short term:
>30 % of cervical cancers discovered by examination
Medium term: >30 % reduction in proportion of cases of invasive
cervical cancer with advanced (stage II+) disease
Long term:
>30 % reduction in cervical cancer mortality
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention cytology screening for cancer of the cervix
Detectable preclinical phase (DPCP)
Dysplasia


18

Average
age:
~13

Carcinoma
in situ

Onset of
sexual
activity
Invasive
cancer
35

Birth
Death
50 years
Screening here
encounters the
dysplasia swamp
Screening here
has maximum
cost-effectiveness
~8 % of cancers
~92 % of cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention cytology screening for cancer of the cervix, cont´d
Process measures
>80 % of women aged 35 - 59 years informed about screening for
cancer of the cervix
>80 % of primary health care workers instructed in taking cervical
smears
Impact measures
>80 % of women aged 35 - 59 years screened at least once
Outcome measures
Short term:
>30 % reduction in proportion of cases of invasive
cervical cancer with advanced (stage II+) disease
Medium term: >30 % reduction in incidence of invasive cervical ca
Long term:
>30 % reduction in cervical cancer mortality
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention downstaging for oral cancer
Detectable preclinical phase (DPCP)
Leukoplakia
Erythroplakia 
Submucous
fibrosis


Average
~12
age:

Carcinoma
in situ

Onset of
tobacco
habit
Invasive
cancer
Death
45 years
35
18

Birth
Examinations here
unlikely to find cancers
Exam inations here
are cost-effect ive
~8 % of cancers
~92 % of cancers
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention downstaging for oral cancer, cont´d
Process measures
>80 % of tobacco smokers and chewers receive education on
examining their own mouths
>80 % of primary health care workers informed of the need to
examine the mouths of tobacco smokers and chewers
Impact measures
>80 % of tobacco smokers and chewers aged 35 - 54 examined at
least once
Outcome measures
Short term:
>30 % of oral cancers discovered by examination
Medium term: >30 % reduction in proportion of cases of invasive
oral cancer with advanced (stage II+) disease
Long term:
>30 % reduction in oral cancer mortality
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention screening for cancer of the breast
Detectable preclinical phase (DPCP)

25
In situ cancer
40


Average
age:

Small
invasive
cancers

Onset of
disease
process
50
Screening here
has not been shown
to be effective
Large

Birth
Death
cancers
60 years
Screening here
has maximum
cost-effectiveness
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Secondary prevention screening for cancer of the breast, cont´d
Process measures
>80 % of women aged 40 years or over receive information on breast
cancer screening
>80 % of primary health care workers informed about the guidelines
for breast cancer screening
Impact measures
>80 % of women aged 40 years or over receive a single physical
examination and are taught breast self-examination
>70 % of women aged 50 - 69 years screened
Outcome measures
Short term:
>30 % of breast cancer detected by screening
Ratio of cancers detected at first screen three times
expected incidence
Medium term: >15 % reduction in proportion of cases of invasive
breast cancer with advanced (stage II+) disease
Long term:
>15 % reduction in breast cancer mortality
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Treatment
Surgery
Radiotherapy
Localized (early) disease
Locally extensive disease
Potentially curative therapy
(integrate with screening)
Curative or palliative therapy,
depending on tumour type
and resources avaliable
Chemotherapy
Disseminated (advanced) disease
Palliative treatment and care
NCCP WHO 1995
Regional tumour registry, Lund October 1995
Treatment, cont´d
Process measures
>50 % of adults informed about the availability of curative treatment
for cancer
>80 % of primary health care workers instructed about institutions
where patients can receive potentially curative therapy
Guidelines for therapy made available to all cancer specialists
Impact measures
>70 % of primary health care workers refer patients to institutions
where potentially curative therapy is available
>20 % of patients receive potentially curative therapy
Outcome measures
Short term:
>50 % of cancer patients survive more than 1 year
Medium term: >30 % of cancer patients survive more than 5 years
Long term:
>10 % decrease in cancer mortality attributable to
curative therapy
NCCP WHO 1995
Regional tumour registry, Lund October 1995