The Challenges of Constructing a National Staging Strategy: An Asian Perspective Anne W. M. Lee Pamela Youde Nethersole Eastern Hospital Hong Kong �
Disclosure I have No conflict of interest to declare �
Asia 30% of earth’s total land area 60% of world’s total population Sovereign states 48 recognized states 6 partial/ unrecognized states 6 dependent/ other territories
Incidence ncidence Rat ate e of of All ll Cancer ancers: : Asia ia < Dev eveloped eloped Count ountries ies
Total No. of Cancer Patients Asia > Europe (except prostate cancer)
TNM Global Advisory Group Germany/Austria/Switzerland, Italy, Poland Spain, UK Belgium, France, Hungary, Canada Ireland, Netherlands, Russia, Sweden Japan USA India Singapore Brazil Argentina/ South Africa Latin America Australia/New Zealand
Attempts to Create a National TNM Staging Committee in China Preparatory Committee Official Committee August 2010 Pending approval
Challenges National Staging Strategy in Asia Need? Implementation? Interests? Knowledge?
Objectives of Staging • To aid clinician in planning of treatment • To give indications of prognosis • To assist in evaluation of results • To support cancer control activities • To enable sharing of experience • To contribute to continuing research
Appropriate staging is fundamental for guiding appropriate clinical management Best possible treatment outcome & Minimal unwarranted waste TNM staging is basically applicable & needed in Asia
Cancers Specifically Prevalent in Asia Stomach Liver Esophagus Nasopharynx Globocan 2008
Continual Improvement of TNM Staging for Nasopharyngeal Cancer Lee, IJC 1999 Lee, Clin Oncol 2004 Lee, Oral Oncol 2012
Staging Systems in Hong Kong (2010) by FY Cheung UICC/AJCC-7 th UICC/AJCC-6 th Others Ed Ed Lung 100 0 0 Breast 100 0 0 Colorectal 83 17 0 Prostate 67 33 0 Gynecology 67 0 33 (FIGO) Head & Neck 100 0 0 Liver 83 0 50 (BCLC) Stomach 100 0 0 Esophagus 100 0 0 Lymphoma 100 0 0
Staging Systems in Mainland China (2010) by GL Jiang UICC/AJCC Chinese Others Lung 100 0 0 Breast 95 20 0 Colorectal 90 10 0 Prostate 95 10 0 Gynecology 10 0 90 (FIGO) Nasopharynx 81 52 0 Liver 80 25 0 Stomach 95 24 0 Esophagus 100 20 0 Lymphoma 70 25 5
Challenges National Staging Strategy in Asia Need ! Constructing Step for Interests ! Implementation Knowledge !
1. Engaging All Key Professionals • Academic exchange to develop best staging system • Advocacy for national & international unification
2. Getting Government Recognition/ Support To establish National Committee in China Invitation by UICC (Mar 2010) ↓ Preparatory Committee (Aug 2010) ↓ Approval by Chinese Anti-Cancer Association ↓ Approval by China Association for Science & Technology ↓ Application by Chinese Anti-Cancer Association ↓ Approval by Ministry of Civil Affairs (Aug 2012 - Pending government approval for establishment)
3. Int 3. ntegrating ing Na National ional Staging ging Strategy wit ith h Cancer ancer Regis gistry Targets: 2020 • Sustainable delivery systems to ensure effective cancer control in all countries • Improve measurement of global cancer burden & impact of cancer control interventions
Challenge: hallenge: NO NOT all all Asian ian States es ha have e Cancer ancer Regis gistry IARC – Cancer Incidence in 5 Continents Volume IX
Asian Cancer Registries India China South East Asia Korea & Japan IARC – Cancer Incidence in 5 Continents Volume IX
Population covered by the National/Regional Central Cancer Registries Population covered by the National/Regional Central Cancer Registries Population covered by the National/Regional Central Cancer Registries Population covered by National Central Cancer Registries China India Japan Korea Hong Singapore Kong Total population (M) 1306 1210 128 48 7 4 No. of cancer registries 222 23 11 11 1 1 Population covered (%) 15 30 34 60 100 100
Cancer ancer wit ith h Stage age Capt aptur ure e ≥ 70% 70% Hong Kong Cancer Registry 2008 Colorectal Breast Un-stage Cervix Corpus Ovary Un-staged Un-staged Un-staged
Stage Capture in other Major Cancers Hong Kong Cancer Registry 2008 Stage Nasopharynx Stomach Thyroid Lung Esophagus Prostate I 4% 14% 31% 9% 3% 0.0% II 12% 8% 3% 2% 13% 3% III 27% 14% 5% 18% 18% 1% IV 18% 23% 9% 37% 20% 11% Unknown 17% 39% 42% 32% 43% 75% Pending 23% 2% 10% 0.2% 3% 9% Ho’s to be converted to UICC � 2007 ������ Based on cancer cases in 2007
4. Advocating Universal Cancer Staging System TNM Cancer Staging & Prognostic Factors Project
5. Expanding National Cancer ancer Staging ging Commit ommittee ee to o All ll States es Germany/Austria/Switzerland, Italy, Poland Spain, UK Belgium, France, Hungary, Canada Ireland, Netherlands, Russia, Sweden Japan USA India Singapore Brazil Argentina/ South Africa Australia/New Zealand Latin America
Constructing a National Staging Strategy 1. Educating/ engaging all key professionals 2. Getting government recognition & support 3. Integrating staging strategy with cancer registry 4. Advocating universal cancer staging system 5. Engaging all states in setting staging strategy
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