Brazil'–'Canada'Cancer' Surveillance'Collabora3ve' Where'Sand'Meets'Snow:'' Mutual'Learning's'Across'Con3nents*' ' *'L.Mery'and'M.'Rebelo'on'behalf'of'the'' Brazil'–'Canada'Cancer'Collabora3ve' ' 29'August'2012' UICC'Congress'
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 2% Outline' • Context% • Context% • Brazil%and%Canadian%Cancer%Registry%Systems% • Objec>ves%for%the%Collabora>on%% • Results%to%date:%% • Selected%Areas%of%Common%Issues% • Standards;%Capacity;%and%Integra>on;%% • Unique%Country%Perspec>ves%% opera>ons% UICC,%Montreal,%August%2012%%%
Context:%Cancer%Registry%Systems% Canada' Brazil '' • Origins%with%local%registries% • Origins%with%provincial%registries% • Origins%with%local%registries% • Origins%with%provincial%registries% (1960s),%evolving%to%a%strategy% (1935):%legislated%responsibility% for%na>onal%coordina>on%by% yielding%popula>on%coverage%%% INCA%(1970%–%1980s)% • Na>onal%incidence%and% • Na>onal,%collated%by%Sta>s>cs% mortality%es>mates%(1990s)% were%set%as%a%goal%to%plan% Canada:%tumour%based,% were%set%as%a%goal%to%plan% 1969[1991;%person%based,% na>onal%and%state%level% 1992+% forma>on%of%the%Registry% ac>ons,%leading%to%the% forma>on%of%the%Registry% Associa>on% • Common%standards;%comprised% Associa>on% of%many%sources%and%derived% from%mul>ple%methods%that%are% cancer%registry%(PCBR%/%HBCR)% individual%to%each%province%/% with%varying%completeness%% across%private%/%public%systems% territory% with%varying%completeness%% • Efforts%focused%on%linkage%and% • Distributed%accountability% • Efforts%focused%on%linkage%and%
Cancer information in Brazil: current performance State-of-the art of Brazilian Population-Based Cancer Registries ( PBCR ) The background of Brazilian PBCR Boa Vista 60’s ..... 2 * 70’s ..... 2 80’s ..... 2 * Belém - 1987 * Manaus Fortaleza - 1971 * 90’s ..... 9* Teresina** * After 2000 ..... 15 * Natal - 1996 * Joao Pessoa * Recife - 1967 * Palmas Current situation: from 32 * Aracaju - 1998 * PBCR implemented, 27 are active Salvador - 1996 Cuiaba 19 in capital cities * Distrito Federal - 1996 * 1 federal capital * Goiania 1986 6 cities are not capital Belo Horizonte * * * * Campo Grande Barretos Vitoria – 1999** 1 state cancer registry (State of * * Jau - 2005 * São Paulo - 1969 Roraima) Campinas - 1991 * * Santos Curitiba - 1997 22 PBCR with available information * * * Florianopolis** Santa Rosa - 2005 Caxias do Sul - 2005 (19 with more than 3 years) * Porto Alegre - 1973 On implantion process( ): On implantion process( ): * * 21 PBCR receive government financial support with Barretos, Santos, Boa Vista Barretos, Santos, Boa Vista resources from Health Surveillance Secretariat (SVS) US$ 500,000 by year ( the resources are distributed in according by PBCR population size) Source: INCA/Conprev/ Cancrer Information Division
HBCRBRAZIL: national centralized database for HBCRs Web system, free, multi-platform, flexible, easily maintained and developed with free software - * for consolidation of data from HBCR * HBCR data exported will go encrypted to ensure the integrity and confidentiality and confidentiality State A SisBasepop Web SisBasepop Web P HBCRBrasil B C R Data from Hospital Based Cancer Registries HBCRBrasil P Technical B Reports C R P State B B C R HBCRBrasil H B C R *%30[70%%%from%HBCR%databases%are% transferred%automa>cally%to%PBCR%system%% Source: INCA/Conprev/ Division of Cancer Information
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 6% Cancer'Registry'Process'in'Canada' Level% Ac>vity% Iden>fica>on% Hospital %%/ % of%new%cases% laboratory% Record%% Provincial%%/%Territorial%% consolida>on%% Cancer%Registries% +%diagnos>c% … .. %confirma>on%% Record%% consolida>on%% Na>onal:%% +%mortality%% Sta>s>cs%Canada%% follow[up% The%Canadian%Cancer%Registry% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 7% Objec>ves%for%the%%Collabora>on% 1. To%share%knowledge%and%approaches%in%cancer%registra>on%and%surveillance% To%establish%partnerships%to%promote%epidemiological%studies%based%on%informa>on%produced% • by%cancer%registries % 2. To%assess%cancer%registry%programs%(including%%hospital,%regional%and%na>onal)% in%order%to%provide%recommenda>ons%for%future%enhancements;%%%% To%examine%jointly%the%feasibility%of%assistance%that%would%facilitate%the%linkage%the%cancer% • registries%database%with%others%health%databases% To%develop%and%strengthen%HBCR%and%PBCR%structure%to%ensure%regular%collec>on%for%follow[up% • data%to%perform%survival%studies%% 3. To%iden>fy,%priori>ze%and%implement%specific%areas%for%joint%collabora>on% To%promote%a%workshop%in%Brazil%with%PBCR%and%representa>ves%of%the%State%Coordina>on%of% • HBCR%to%integrate%INCA’s%and%Canada%Teams;% To%establish%priori>es%based%on%Brazilian%burden%of%cancer,%resource%availability%and%health% • system%capacity%for%cancer%preven>on%and%control% % 4. To%foster%opportuni>es%for%training%through%workshops,%mentorship%and% educa>onal%exchanges% %To%establish%partnerships%in%training%on%cancer%informa>on%for%cancer%registries% • UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 8% Results:%Common%Issues% 1. Applica3on'of'Standards' (IARC)%forms%the%founda>on%in%coding,%training% Applica3on'of'Standards' • The%Interna>onal%Agency%for%Research%on%Cancer% (IARC)%forms%the%founda>on%in%coding,%training% material%and%analy>c%tools% • Benefits%of%na>onal%leadership%to%regions% • Interoperability%among%electronic%systems% Necessity%is%well%understood%but%involves%many% • stakeholders:%governments;%hospitals;%vendors;%…% Capturing%the%benefit%of%new%technologies%to%increase% • efficiency% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 9% Results:%Common%Issues%–%con’t Results:%Common%Issues%–% 2. Capacity' ascertainment%and%repor>ng% Capacity' • Challenges%in%mee>ng%the%demands%of%case% ascertainment%and%repor>ng% • Increasing%focus%on%new%clinical%elements,%requiring% new%data%fields%that%can%stretch%resources% • Analy>c%support%ohen%secondary%to%data%collec>on% • Training%and%staff%reten>on% • How%to%meet%the%needs?%Tools%to%assist%and%models%of% delivery%across%large%geographic%countries%%%% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 10% Results:%Common%Issues%–%con’t Results:%Common%Issues%–% 3. The'Integra3on'of'Surveillance'within' broader'cancer'control'community' • Demonstra>ng%and%explaining%the%poten>al%u>lity% of%surveillance%to%other%disciplines% • How%to%develop%the%requisite%rela>onships?% • Requirements%for%new%skill%sets%to%achieve% paradigm%shih% • Incorpora>on%of%knowledge%transla>on%to% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 11% Country%Perspec>ves% 1. Case'Ascertainment'and'Consolida3on'' Brazil%faces%a%significant%challenge%to%integrate% • hospital%with%popula>on%based%cancer%registries% (HBCRs%and%PBCRs,%respec>vely)% Issue%is%complex%and%results%in%part%from:%funding%models;% • health%care%delivery%systems%(combined%private%and% public);%and%lack%of%consistent%unique%iden>fiers% Popula>on%coverage%varies%across%two%countries% • Ranging%from%21%%to%near%complete%coverage%% • Differing%approaches%(and%results)%to%case%follow[up% • and%death%clearance% Highly%dependent%on%vital%sta>s>cs%records%and%record% • linkage% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 12% Country%Perspec>ves%–%con’t%(2)% 2. Cancer'Burden'' % UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 13% Country%Perspec>ves%–%con’t%(3)% Brazil: %% % % % Source :% Ferlay%J,%Shin%HR,%Bray%F,%Forman%D,%Mathers%C%and%Parkin%DM.% GLOBOCAN%2008%v1.2,%Cancer%Incidence%and%Mortality%Worldwide:%IARC%CancerBase%No.%10%[Internet].% Lyon,%France:%Interna>onal%Agency%for%Research%on%Cancer;%2010.%Available%from:%hpp://globocan.iarc.fr,%accessed%on%24%August%2012 % UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 14% Country%Perspec>ves%–%con’t Country%Perspec>ves%–% Canada: %% % % % Source :% Ferlay Source :% Ferlay%J,%Shin%HR,%Bray%F,%Forman%D,%Mathers%C%and% GLOBOCAN%2008%v1.2,%Cancer%Incidence%and%Mortality%Worldwide:%IARC% Parkin%DM.% CancerBase %No.%10%[Internet].% UICC,%Montreal,%August%2012%%%
Brazil%–%Canada%Cancer%Surveillance%Collabora>ve% 15% Country%Perspec>ves%–%con’t%(4)% 3. Other:' Canada’s%reliance%on%US%registry%efforts,% • especially%in%standard%development% Funding%models%for%remunera>on%of%data% • collec>on%(does%not%exists%in%Canada)%and%their% impact%on%overall%governance%of%registry%system% Brazil’s%crea>vity%in%the%delivery%of%training%and% • adop>on%of%standard%reference%material% UICC,%Montreal,%August%2012%%%
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