The$European$support$for$improvement$and$early$ - PowerPoint PPT Presentation

UICC$–$World$Cancer$Congress$2012$ $ ESO7EASO$SESSION$$ $ “An$European$support$to$Eurasia$and$Arab$World$$ to$improve$the$access$to$care” $ The$European$support$for$improvement$and$early$ detec6on$of$cancer$in$the$Caspian$region$ $$ $$Marco$Rosselli$Del$Turco$(Italy)$ $ Caspian$Region$Programme$Coordinator $ $ $ $ Wednesday$29$August$2012$7$Montreal$(Canada) $ $

THE$CASPIAN$REGION$PROGRAMME$ • Launched$in$2008$the$Caspian$Region$Programme$represents$ a$ new$ challenging$ ini6a6ve$ of$ the$ European$ School$ of$ Oncology$that$aims$to$create$a$specific$programme$for$those$ countries$ that$ are$ between$ Europe$ and$ Asia,$ in$ par6cular,$ Kazakhstan $ .$ • The$main$aim$is$to$focus$and$to$organise$teaching$educa6onal$ ac6vi6es$on$one$type$of$cancer$which$is$considered$a$priority$ issue$for$the$popula6on$of$each$country.$$

$$ $ $$$$$$KAZAKHSTAN$NaSonal$Screening$Programme$ $$ $ $$ • Breast$cancer$and$coloNrectal$screening$has$been$chosen$as$a$ priority$issue$for$Kazakhstan.$ $ • In$2008$we$were$invited$by$the$Na6onal$Cancer$Ins6tute$ (Prof.$Arzykulov)$,$through$Sanofi$Oncology,$to$coNoperate$for$ the$improvement$of$quality$of$$screening$and$treatment$of$ breast$cancer$in$ Kazakhstan.$ $

The$main$ques6ons$are:$ $ • $Is$breast$cancer$screening$an$oncological$$priority$in$kazakhstan?$ $ • $The$$improvement$of$quality$of$breast$cancer$screening$would$have$ $$$a$posi6ve$impact$also$on$breast$cancer$care?$ $ • $How$can$ESO$most$efficiently$support$the$Na6onal$Kazakhstan$ $ $$$health$system$in$this$field?$ $ $

The$main$ques6ons$were:$ $ • $Is$breast$cancer$screening$an$oncological$$priority$in$kazakhstan?$ $ • $The$$improvement$of$quality$of$breast$cancer$screening$would$have$ $$$a$posi6ve$impact$also$on$breast$cancer$care?$ $ • $How$can$ESO$most$efficiently$support$the$Na6onal$Kazakhstan$ $$$health$system$in$this$field?$ $ $ $

GLOBOCAN 2008 Breast$all$ages,$wNage$standardised$ incidence$$ Kazakhstan 36,4 Canada 83,2 $ $ $

GLOBOCAN 2008 Breast$all$ages,$wNage$standardised$ mortality$ $ Kazhkhstan 19,7 Canada 15,6 Georgia 19,7 $ $ $

The$main$ques6ons$were:$ $ • $Is$breast$cancer$screening$an$oncological$$priority$in$kazakhstan?$ $ • $World$–$age$adjusted$standardized$Mortality$rate$for$breast$cancer$ $$$in$Kazhakhstan$is$almost$the$half$$of$incidence$rate$$(19,7$vs$37,4),$ $$$whilst$in$North$N$Western$countries$as$Canada$is$about$one$fi`h$(15,6$vs$83,2)$ $ • $Although$popula6on$data$may$be$not$completely$exact$because$of$poor$$quality$ $$of$na6onal$cancer$registra6on,$a$low$5$–years$survival$is$expected$ $$(50N60$%$compared$to$80N90%$of$western$countries)$ $ $ $ • $The$impact$of$breast$cancer$screening$could$be$very$high$by$reducing$the$ $ $$$propor6on$of$advanced$cancers$ $ $ $$

No screening Estimated Observed Screening Estimated From

The$main$ques6ons$were:$ $ • $Is$breast$cancer$screening$an$oncological$$priority$in$kazakhstan?$ $ • $ The$$improvement$of$quality$of$breast$cancer$screening$would$have$ $$$a$posiSve$impact$also$on$breast$cancer$care?$ $ • $How$can$ESO$most$efficiently$support$the$Na6onal$Kazakhstan$ $$$health$system$in$this$field?$ $ $ $

. Kz National breast cancer screening is covering All female population 50-59 ys. (443,862 w/y) (estimated attendance 70-80%) 58 730 55 899 70000 48 241 45 856 60000 42 612 50000 27 236 27 014 24 284 40000 20 021 20 113 16 512 30000 13 581 13 009 11 597 11 660 7 497 20000 10000 0 г . Алматы Акмолинская Актюбинская Алматинская Атырауская Жамбылская Костанайская Мангистауская Павлодарская г . Астана ЗКО Карагандинская Кызылординская ЮКО СКО ВКО $ $ Fig.$1.$Distribu6on$of$the$women$examined$during$the$mammographic$$ screening$by$regions$for$2011$(form:$KZ$na6onal$report$2011)$ $

During$our$coNopera6on,$we$visited$different$regions$in$Kazakhstan$$ (Astana,$Almaty$and$Shymkent)$and,$in$general,$we$no6ced$ $ • $a$low$quality$of$mammography$ $$$N$equipments$and$technical$assistance$ $$$N$professional$training$and$clinical$skill$$ $$$$ • $a$low$level$of$interdisciplinarity$ $$$N$low$level$of$coNopera6on$betweeen$radiologists,$surgeons$ $$$$$$and$pathologists$ $ $ $$$N$low$level$of$preNopera6ve$diagnosis$ $ • Lack$of$reference$guidelines$

50 years – no symptoms– PE: Negative 2756363

Ultrasound-guided core-needle biopsy of the breast

European Guidelines for Quality Assurance in Breast Cancer Screening 39 Performance Indicators 1. EPIDEMIOLOGY 2. PHYSICO-TECHN. (Digital MX incl.) 3. RADIOGRAPHY 4. RADIOLOGY 5. DIAGNOSIS (Multid.) 6. PATHOLOGY 7. SURGERY 8. DATA COLLECTION 9. BREAST UNIT 10. CERTIFICATION (by EUSOMA) 11. COMMUNICATION

The$main$ques6ons$were:$ $ • $Is$breast$cancer$screening$an$oncological$$priority$in$kazakhstan?$ $ • $The$$improvement$of$quality$of$breast$cancer$screening$would$have$ $$$a$posi6ve$impact$also$on$breast$cancer$care?$ $ • $ How$can$ESO$most$efficiently$support$the$NaSonal$Kazakhstan$ $$$health$system$in$this$field?$ $ $ $

The$Kazakhstan$Project$for$Quality$Assurance$in$ Breast$cancer$Screening $ $ Supported$by$the$European$School$of$Oncology $ $ Agreed$Targets$ $ ! To$approve$defined$Guidelines$$ ! $To$$Establish$a$Na6onal$Quality$Assurance$Reference$Centre$at$the$Kazakh$ Scien6fic$and$Research$Ins6tute$of$Oncology$and$Radiology$(KSRIOR)$ ! $To$establish$mul6disciplinary$groups$in$each$regional$oncology$hospital$in$ Kazakhstan$ ! $To$implement$a$comprehensive$mul6disciplinary$training$programme$ Not$just$lectures$and$seminars $ but$a$comprehensive$program! $

Breast$Cancer$Screening$Joint$Project$$ $ (and$CRC$screening$project$in$2011)$ $ Astana$Nov.$ 2008 $(MRDT)N$Preliminary$mee6ng$and$$planning$ Almaty,$Nov.$ 2009 $(DM,MRDT)$N$Training$Course$and$$Site$visit$$ London,$July$–$August$ 2010 $N$Training$of$two$KZ$Radiologists$ $at$the$Breast$Screening$Unit$$(Rosalind$GivenNWilson)$ $ Almaty,$Nov.$ 2010 $DM,MRDT).$Conf.$and$live$surgery$session$ $ $Astana/Almaty$May$ 2011 $(TW,$DM$and$MRDT)$ N$$Breast$and$CRC$screening$$ N$$Training$seminar$for$screening$$ $Pathologists,$Radiologists$and$Radiographers$ N$$Site$visit$to$screening$program$$ $ $ $

CRC$screening$project$started$in$2011$ N Site$visit$to$the$units$implemen6ng$CRC$screening$$ N$$Mee6ng$and$lectures$in$Almaty$(November$2011)$ N $Prepara6on$of$Na6onal$Guidelines$for$CRC$Screening$ N $Visi6ng$professor$of$Epidemiology$(L.$G.)$to$Almaty$(July$2012)$ $$$to$improve$quality$of$data$collec6on$and$analysis$ N Training$$of$2$endoscopists$$in$Europe$(NL$or$UK)$in$2012$ N $Seminar$on$CRC$Screening$in$November$2012$ $ $

GLOBOCAN 2008 ColoNrectum,$both$sexes,$all$ages,$wNage$standardised$ incidence$ Kazakhstan 36,4 Canada 38,1 $ $ $

GLOBOCAN 2008 ColoNrectum,$both$sexes,$all$ages,$wNage$standardised$ mortality$ $ Kazakhstan 12,3 Canada 11,7 $ $ $

Future$PotenSal$OpportuniSes$in$the$area$ $ Breast$Cancer$Screening$in$Georgia:$ $ • $site$visit$in$Tbilisi,$9N11$October$2011$ • Seminar$in$Tbilisi$in$December$2011$for$radiologists$and$ radiographers$ • Training$for$2$weeks$of$a$Georgian$radiologist$at$the$ Florence$(I)$breast$cancer$screening$programme$(April$ 2012)$ • Training$for$2$weeks$of$a$Georgian$Physicist$at$the$LRCB$ (Na6onal$Reference$Center$of$The$Netherlands)$in$ Nijmegen$(2012)$ • New$seminars$planned$for$November$2012$ $ $

THE$CASPIAN$REGION$PROGRAMME$ STRENGHTS:$ • Priori6es$are$chosen$by$the$na6onal$Ins6tu6ons$ • European$Guidelines$(to$be$translated$into$Russian$language)$ • $Many$centralised$European$screening$programmes$can$be$ $$$$$$good$training$centres$ • Large$interest$from$the$local$specialists$$ $ WEAKNESSES$ • $Long$6me$needed$to$achieve$results$(mortality$reduc6on)$ • Possible$ changes$ of$ referent$ persons:$ need$ for$ a$ strong$ na6onal$commitment.$

Thank you for attention! $ $ $