The$European$support$for$improvement$and$early$detec6on$of$cancer$in$the$Caspian$region$$$

$$Marco$Rosselli$Del$Turco$(Italy)$$

Caspian$Region$Programme$Coordinator$

$

$$

$

UICC$–$World$Cancer$Congress$2012$$ESO7EASO$SESSION$$$“An$European$support$to$Eurasia$and$Arab$World$$to$improve$the$access$to$care”$

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?$

$$

$

Kazakhstan 36,4 Canada 83,2

GLOBOCAN 2008

Breast$all$ages,$wNage$standardised$incidence$$

Breast$all$ages,$wNage$standardised$mortality$

$

$$

$

Canada 15,6 Kazhkhstan 19,7

GLOBOCAN 2008

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$$$$propor6on$of$advanced$cancers$$$$$

From

No screening Estimated

Screening

Observed

Estimated

$$

$

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?$

$$

$

.

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20 0

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58 7

30

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16 5

12 27 0

14

45 8

56

27 2

36

13 0

09

7 49

7

55 8

99

13 5

81

20 1

13

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12

11 6

60

48 2

41

0

10000

20000

3000040000

50000

60000

70000

Акмолинская

Актюбинская

Алматинская

Атырауская

ЗКО

Жамбылская

Карагандинская

Костанайская

Кызылординская

Мангистауская

ЮКО

Павлодарская

СКО

ВКО

г.Астана

г.Алматы

Fig.$1.$Distribu6on$of$the$women$examined$during$the$mammographic$$screening$by$regions$for$2011$(form:$KZ$na6onal$report$2011)$

Kz National breast cancer screening is covering

All female population 50-59 ys. (443,862 w/y)

(estimated attendance 70-80%)

$$

$

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

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

39 Performance Indicators

European Guidelines for Quality Assurance in Breast Cancer Screening

$$

$

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$Oncology$

$$

!  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!$

Agreed$Targets$

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$2012$

$

$

$$

$

Kazakhstan 36,4 Canada 38,1

GLOBOCAN 2008

ColoNrectum,$both$sexes,$all$ages,$wNage$standardised$incidence$

ColoNrectum,$both$sexes,$all$ages,$wNage$standardised$mortality$

$

$$

$

Kazakhstan 12,3

Canada 11,7

GLOBOCAN 2008

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!