Planning for cancer control
A national cancer control program is the total of all cancer control activities taken by a whole country to address the cancer issue in that country. It should result from a national cancer control plan (NCCP) that is developed as an achievable strategic plan to control cancer, based on the country’s cancer risk factor burden, cancer burden and the resources available to implement the plan in the context of the culture and health-care system in that country. In order to develop a NCCP the following information should be collected:
- The cancer burden – The minimum data needed is a realistic estimate of the number of new cases each year, and a reliable estimate of the proportion that is curable, as opposed to incurable at diagnosis. These data should provide a rank order of the common cancers, which will indicate those cancers for which effective prevention is possible, and those for which early diagnosis and screening are important. Cancer mortality, prevalence and five-year survival from diagnosis are helpful additional datasets, but most countries do not have them
- The cancer risk factor burden – Some countries will not have a significant cancer burden but will have a significant prevalence of cancer risk factors. The common cancers can give clues to the risks, e.g., lung cancer and smoking. However, a population-based random survey will be necessary to measure these and indicate priorities for action.
- The resources of skills and infrastructure available for cancer control – A realistic inventory that will enable planners to decide the country’s resource level must be taken. This will determine what cancer control actions are possible. For many countries that are ranked by the World Bank as having a very low level of resources, only cancer prevention and palliative care are possible for the whole population, although segments of the population may be able to obtain more.
With this knowledge, planning authorities can decide whether or not to proceed with the development of a NCCP. This will require political will and appropriate resources. A NCCP that does not have the support of the government is most unlikely to be implemented. If planning is to proceed, then a planning framework that covers the spectrum of cancer control is strongly recommended, even if the final plan must recommend a restricted range of actions, for example, only prevention.
National cancer control planning: responding to the challenge of cancer burden
Current cancer patterns reflect the way we live, and global trends for cancer burden are on the rise, in both developed and developing countries. Today, cancer causes 7 million deaths every year, corresponding to 12.5% of deaths worldwide. Over 11 million people are diagnosed with cancer every year, a figure estimated to rise to a staggering 16 million by 2020.
Cancer risk factors, such as tobacco smoking, unhealthy diet and physical inactivity, exposure to infections and carcinogens, and longer life expectancy, all contribute to these rising trends. And yet we know from research that through appropriate lifestyle choices, up to one-third of all cancers could be prevented; through early detection and effective treatment, lethal consequences could be avoided in another third; and pain relief and palliative care would increase the quality of life of cancer patients even in low-resource settings.
Cancer control is a public health approach aimed at reducing the burden of cancer in a population. Planning integrated, evidence-based and cost-effective interventions across the cancer continuum (research, prevention, early detection, treatment, and palliative care) is the most effective way to tackle the cancer problem and reduce the suffering of patients and their families.
In response to the enormous burden of cancer, some countries have already developed national cancer plans and others are currently developing them. These plans are based on a systematic review of the national cancer burden and scientific knowledge of what has proven effective in decreasing the burden. The plans identify the priorities a country should set and specific actions it should take to reduce its cancer burden.
Most countries, however, have yet to begin a systematic national cancer planning effort and many are just becoming aware of the opportunity to do so. Where governments are concentrating on other immediate health priorities, NGOs can play a critically important role in increasing public and leadership awareness of the cancer problem and in developing effective partnerships that can take on the responsibility of cancer planning.