1. Cancer Control in the EMR Dr. Haifa Madi Director, Health Protection and Promotion WHO/EMRO

2. 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 Shared preventable risk factors: Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Chronic lung Diseases Heart disease and stroke Diabetes Cancer Physical inactivity Unhealthy diets Smoking Other NCDs

3. Noncommunicable diseases: Heart disease 30.2% Cancer 15.7% Diabetes 1.9% Other chronic diseases 15.7% Infectious diseases: HIV/AIDS 4.9% Tuberculosis 2.4% Malaria 1.5% Other Infectious Diseases 20.9% Injuries 9.3% Total: 58Million Deaths by cause in the world (WHO, 2005)

4. 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].

5. Increase in Deaths From Cancer In the next 15 years INCREASE IN DEATHS FROM CANCER (%) INCREASE IN CANCER DEATH BY THE YEAR 2020 (From Rastogi et al 2004)

6. Cancer Incidence and Mortality in the EM Region By Gender Breast Cervix Bladder Lung

7. Children Cancer Incidence & Mortality of children cancer in the EM region compared to that in western countries In the EM region, the most common children cancers are blood cancers

8. 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 of diagnosis Breast cancerCervical cancer U. S.EgyptU. S.Egypt Localized65%25.5%58 %35.9 % Regional30%58%33 %53.2 % Distant5%16.5%9 %10.9 %

9. Morphine consumption Morphine consumption in western countries is around 50 mg/capita

10. 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

11. Cancer Risk Factors

12. Prevalence of Smoking among Adults

13. Currently Smoke Cigarettes, youth 13-15* *Source is the GTYTS data in EMR MS

14. Currently use Other Tobacco forms (Shisha), youth 13-15* *Source is the GTYTS data in EMR MS

15. Never Smoker Likely to Initiate Smoking Within a year (13-15 yr) *Source is the GTYTS data in EMR MS

16. 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 low- and middle-income countries);

17. 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.

18. 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- IRA- JOR). 3. Pictorial Health Warnings (JOR-EGY-IRA-DJI- GCC**). 4. Banning of ALL types of tobacco promotion (EGY- IRA-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.

19. Thank You