Cancer Control in the EMR
Dr. Haifa Madi
Director, Health Protection and Promotion
WHO/EMRO
Noncommunicable Diseases

About 47% of the regions’ disease burden
expressed as DALY is due to NCDs.

Chronic diseases accounted for 52% of deaths in
EMR.

This burden is likely
to rise

Cancer
Chronic
lung
Diseases
Diabetes
Heart disease
and stroke
Shared preventable risk factors:




Tobacco use
Unhealthy diet
Physical inactivity
Harmful use of alcohol
Other
NCDs
Physical
inactivity
Unhealthy
diets
Smoking
Deaths by cause in the world
Noncommunicable diseases:
Infectious diseases:
HIV/AIDS 4.9%
Tuberculosis 2.4%
Heart disease
30.2%
Malaria 1.5%
Total:
58Million
Cancer
15.7%
Diabetes
1.9%
Other chronic diseases
15.7%
(WHO, 2005)
Other
Infectious
Diseases
20.9%
Injuries 9.3%
Cancer in the EMR
1. Cancer is the 4th cause of death and it kills more
than HIV, malaria and TB together.
2. The burden of cancer will increase with aging and
unhealthy lifestyle and the EM region will witness the
highest and fastest increase in the coming years.
(100% and 180%)*.
40% of cancers can be prevented
40% of cancers can be detected early and cured.
20% of cancer can be managed by palliative therapy
*Source: [Rastogi et al. 2004].
Increase in Deaths From Cancer In the next 15
years
104%
World
Latin American and
Caribean
144%
Sub-Saharan Africa
140%
180%
Middle Eastern
0%
50%
100%
150%
INCREASE IN DEATHS FROM CANCER (%)
INCREASE IN CANCER DEATH BY THE YEAR 2020 (From Rastogi et al 2004)
200%
Cancer Incidence and Mortality in the EM
Region By Gender
Bladder
Breast
Lung
Cervix
Children Cancer
In the EM region, the
most common children
cancers are blood
cancers
Incidence & Mortality of
children cancer in the
EM region compared to
that in western
countries
Screening &Early Detection
In the EM region, the vast majority of cancer are
diagnosed at an advanced stage when cure is
improbable even with the best treatment.
Stage
Breast cancer
Cervical cancer
U. S.
of
diagnosis
Egypt
U. S.
Egypt
Localized 65%
25.5%
58 %
35.9 %
Regional
30%
58%
33 %
53.2 %
Distant
5%
16.5%
9%
10.9 %
ia
1
0.5
0
Morphine consumption in western countries is around 50 mg/capita
A
BA
H
A
RA
IN
O
N
IS
I
US
A
RA
LI
A
AN
1.5
LE
B
2
TU
N
2.5
CA
NA
D
AU
ST
3
morphine consumption (mg/capita)
3.5
U
JO AE
R
D
AN
SA
U
DI
Q
AT
A
KU R
W
AI
T
SY
I
R
R
A
IA
N N
M AR
O
R AB
O
C
C
O
EG
YP
T
LI
BY
YE A
PA ME
KI N
ST
AN
LE
IS
BA IA
N
BA O N
H
RA
IN
O
M
AN
N
il
y
az
ib
am
TU
N
ru
ga
Br
U
morphione consumption (mg/capita)
Morphine consumption
70
60
50
40
30
20
10
0
Cancer programmes in EM Countries

Cancer programmes in EM countries is
characterized with lack of reliable
comprehensive data, insufficient human and
financial resources to cover the needs in many
EM countries, and multidisciplinary
management of cases is not instituted.

In almost all countries, cancers are detected at
an advanced stage which increases cost and
mortalities.

Access to treatment and palliative care is
limited in many countries of the Region
Cancer Risk Factors
Prevalence of Smoking among Adults
60
51
48
50
41.5
37.8
40
34.6
39.13
30
24.7
24.1
19.9
19.7 19.8
20
12.5
10
6.9
8.9
7
4.3
3
2.2
0.7
2.9
k
da
n
Su
ar
Q
at
n
Ira
an
/U
rb
yp
t
t
wa
i
Ku
ria
Sy
Eg
Pa
Sa
ud
i
Ar
ab
ia
n
rd
a
Jo
Ira
q
0
adult male
adult female
Currently Smoke Cigarettes, youth 13-15*
*Source is the GTYTS data in EMR MS
B
W
S
G
IR
Q
KU
W
LE
B
O
M
A
Q
AT
SA
A
SU
D
SY
R
UA
E
YE
M
R
JO
Y
EG
BA
H
20
18
16
14
12
10
8
6
4
2
0
Currently use Other Tobacco forms (Shisha), youth 13-15*
45
40
35
30
25
20
15
10
5
*Source is the GTYTS data in EMR MS
B
W
G
S
UA
E
YE
M
SU
D
SY
R
LE
B
O
M
A
Q
A
T
SA
A
IR
Q
KU
W
BA
H
EG
Y
JO
R
0
Never Smoker Likely to Initiate Smoking Within a year (13-15 yr)
40
35
30
25
20
15
10
5
*Source is the GTYTS data in EMR MS
B
W
G
S
M
YE
U
A
E
R
SY
SU
D
SA
A
T
Q
A
LE
B
O
M
A
IR
Q
K
U
W
JO
R
EG
Y
0
Countries Ratified the FCTC

ALL EMR countries, Except

Morocco

Tunisia

Afghanistan

Somalia

Palestine

tobacco use - responsible
for 1.8 million cancer
deaths per year (60% of
these deaths occur in lowand middle-income
countries);
Main Issues with Tobacco

Tobacco consumption is an epidemic.

There are other components to it than only
cigarettes. Shisha is a rising problem.

Yet there are opportunities:
1. FCTC implementation (countries that have
moved into stronger legislations are all FCTC
parties).
2. Even countries that are not FCTC parties can
implement the internationally known
evidence based interventions for tobacco
control.
Evidence based cost effective interventions
for tobacco control (FCTC AND MPOWER)
1.
Taxation increase (GCC countries- potentially
Yemen, EGY, PAK and Iran)*.
2.
Tobacco free public places (BAH-UAE- EGY- IRAJOR).
3.
Pictorial Health Warnings (JOR-EGY-IRA-DJIGCC**).
4.
Banning of ALL types of tobacco promotion (EGYIRA-YEM-KUW-DJI-SUD-BAH-UAE-QAT).
*WHO recommendation is to increase taxes to 70% of retail price.
**GCC adopted the PHW specification but yet to choose the Image.
Thank You