1. Associated Web sites CustomizableMaps The Atlas On-Line

2. Web site address http://www.nci.nih.gov/atlas http://www.nci.nih.gov/atlas Web site address http://www.nci.nih.gov/atlas http://www.nci.nih.gov/atlas

4. Riyadh Qaseem Northern Al-jouf Hail Tabouk Medina Makkah Baha Aseer Jazan Eastern Najran

5. Control and Prevention of Neoplasm of Neoplasm

6. ObjectivesObjectives ä You should be capable to point out the most common neoplasm in different age groups classifying them by geographical areas. ä You will be capable to identify risk factors associated with the most common types of neoplasm and applying prevention strategy.

7. Categories of Cancer Causation Environment - + Genes + -

8. International Variation in Cancer Incidence

9. Cancer in KSA ä In general, in KSA almost all known cancers have been seen to occur, though with some variations. ä Most of the previous epidemiological studies on cancer in the kingdom had been based on reports from different regions. ä It is only recently during the past 8 years that a National Tumor Registry has taken over this task of collecting information from all over Saudi Arabia.

10. Ten Most Common Cancers in Saudi Arabia ä Breast 8.8% ä liver7.5% ä Leukemia7.5% ä NHL7.3% ä Colorectal5.5% ä Thyroid 5.2% ä Lung4.7% ä CNS 3.9% ä Stomach3.8% ä Bladder3.5% National Cancer Registry, 1999

11. Cancer in KSA: Source: KSA National Cancer Registry For the total Saudi population, the most common ten cancers are(1994-1996): ä Female breast cancer (8.8%), ä Liver cancer (7.5%), ä Leukemia (7.5%), ä Non-Hodgkin's lymphoma (7.3%) ä Colorectal cancer (5.5%). ä Thyroid cancer (5.2%), ä Lung cancer (4.7%) ä Nervous system cancer (3.9%) ä Stomach cancer (3.8%) and ä Urinary bladder cancer (3.5%)

12. MALES (8791) 1) 1)Liver (10.3%) 2) 2)NHL (8.5%) 3) 3)Leukemia (8.1%) 4) 4)Lung (7%) 5) 5)Colorectal (5.8%) 6) 6)Stomach (5.5%) 7) 7)Bladder (5.4%) 8) 8)Prostate (5.3%) 9) 9)CNS (4.6%) 10) 10)Hodgkin’s Disease (3.9%) FEMALES (7503 ) 1) 1)Breast (19.1%) 2) 2)Thyroid (8.8%) 3) 3)Leukemia (6.7%) 4) 4)NHL (5.9%) 5) 5)Colorectal (5.4%) 6) 6)Ovary (4.3%) 7) 7)Liver (4.1%)) 8) 8)Carvix (3.8%) 9) 9)CNS (3.5%) 10) 10)Stomach (3.5%) The ten most common cancers for Saudis by sex, 1994-1996 National Cancer Registry, 1999

13. Riyadh Qaseem Northern Al-jouf Hail Tabouk Medina Makkah Baha Aseer Jazan Eastern Najran Alhsa only 41.2 % 7.6 % 8.4 % 18.2 % 9.6 %

14. Thyroid Cancer in Saudi Arabia 1994-1996 ä 883 cases (3.5/100000 population) ä 5.4% of all newly diagnosed cancers ä 2nd most common in females,14th in males ä Male: female ratio 1:2.9 ä Mean age 49.8 yrs in Males, 40.8 yrs in females ä Most common in: u Hail7/100000 u Riyadh5.8/100000 u Qassim3.8/100000 National Cancer Registry, 1999

16. HOW TO CONTROL CANCER Putting Science into Practice

17. THE AIM OF CANCER CONTROL Reduction of Cancer Incidence, Morbidity & Mortality by: ä Prevention ä Early Diagnosis ä Treatment ä Palliative Care

18. THE W.H.O. PUBLIC HEALTH MODEL FOR CANCER CONTROL MODEL THE W.H.O. PUBLIC HEALTH MODEL FOR CANCER CONTROL MODEL ä Assess the magnitude of the cancer problem ä Evaluate possible strategies for cancer control ä Choose priorities for initial cancer control activities of prevention, screening, therapy and palliative care ä Set measurable cancer control objectives

19. PRIMARY PREVENTION OF CANCER ä Tobacco Control ä Diet ä Control of Alcohol Consumption ä Occupation and Environment ä Infections (viruses and parasites) ä Reducing Sunlight Exposure ä Sexual and Reproductive Factors

20. PRIMARY PREVENTION Tobacco Control Tobacco Control Tobacco Control PRIMARY PREVENTION Tobacco Control Tobacco Control Tobacco Control ä Education ä Legislation ä National Leadership

21. PRIMARY PREVENTION DIET DIET PRIMARY PREVENTION DIET DIET ä Education ä Legislation ä National Leadership

22. PRIMARY PREVENTION Alcohol Alcohol PRIMARY PREVENTION Alcohol Alcohol ä Education ä Legislation ä National Leadership

23. PRIMARY PREVENTION Occupational Hazards Occupational Hazards Occupational Hazards PRIMARY PREVENTION Occupational Hazards Occupational Hazards Occupational Hazards ä Education ä Legislation ä National Leadership

24. PRIMARY PREVENTION Viral Hepatitis B Viral Hepatitis B Viral Hepatitis B PRIMARY PREVENTION Viral Hepatitis B Viral Hepatitis B Viral Hepatitis B ä Education ä Legislation (HBV vaccination)) ä National Leadership

25. PRIMARY PREVENTION Overexposure to Sunlight Overexposure to Sunlight Overexposure to Sunlight PRIMARY PREVENTION Overexposure to Sunlight Overexposure to Sunlight Overexposure to Sunlight ä Education ä Legislation ä National Leadership

27. Primary Prevention Sexual and Reproductive Factors ä Hormonal influences ä Sexually transmitted diseases

28. EARLY DETECTION Education

29. EARLY DETECTION Downstaging

30. Downstaging for Cervical Cancer Cervical Cancer Cervical Cancer

31. EARLY DETECTION Downstaging for Oral Cancer Oral CancerOral Cancer

32. EARLY DETECTION Screening

33. Screening for Cervical Cancer Cervical Cancer Cervical Cancer

34. EARLY DETECTION Screening for Breast Cancer Breast CancerBreast Cancer

35. EARLY DETECTION ä Stomach ä Colon and rectum ä Liver ä Lung ä Ovary ä Bladder ä Prostate ä Esophagus

36. TREATMENTTREATMENT ä Surgery ä Radiotherapy ä Chemotherapy and hormonal treatment

37. TREATMENTTREATMENT The Role of Surgery Surgery

38. TREATMENTTREATMENT The Role of Radiation Therapy Radiation Therapy

39. TREATMENTTREATMENT The Role of Chemotherapy Chemotherapy

40. TREATMENTTREATMENT The Role of Hormonal Therapy Hormonal TherapyHormonal Therapy

41. TREATMENTTREATMENT The Role of Biological Therapy Biological TherapyBiological Therapy

42. TREATMENTTREATMENT How Effective is Cancer Treatment ? Effective

43. TREATMENTTREATMENT ä Policies Policies u Treatment Policies u Referral Policies

44. PALLIATIVE CARE ä Palliative Medicine is the study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is the quality of life. ” Doyle et al (Eds). Oxford Textbook of Palliative Medicine. P3. Oxford University Press, Oxford, 1996. Palliative Medicine Palliative Medicine

45. Cancer Prevention and Control e.g.: GOALS Health authorities may consider 1. Cancer Registry 2. Public education 3. Surgical Courses

46. SUMMARY SUMMARY ä Cancer is a Disease of Lifestyle With Both Host Resistance and Genetic Components ä 60-80% of the Risk factors for Cancer are Avoidable ä Putting Science Into Practice Leads to a Public Health Approach for Cancer Control Which Integrates Prevention, Screening, Treatment and Palliation at the National Level

47. ObjectivesObjectives ä You should be capable to point out the most common neoplasm in different age groups classifying them by geographical areas. ä You will be capable to identify risk factors associated with the most common types of neoplasm and applying prevention strategy.