Nguyen Dinh Tung,MD,PhDHue Central Hospital

Hue College of Medicine & Pharmacy

o INTRODUCTIONoCANCER PROBLEMS IN THUA THIEN- HUEoCANCER CONTROL ACTIVITIES

THUA THIEN-HUE PROVINCEArea : 5,054km SPopulation : 1,119,800 inhabitants

Districs: 09+ Phong dien+ Quang dien+ Huong tra+ Phu vang+ Huong thuy+ Phu loc+ Nam dong + A luoi+ Hue City

HUE CITYo One of places which has many cultural heritages. Up to

now, there is no places like Hue remaining a lot of originally historical vestiges as in this ancient Capital City.

o An important center of Buddhism with hundred of temples and pagodas constructed more 300 years ago.

o One of the most important education center in Vietnam. Hue University composed the Hue Colleges : Economic, Medicine, Pedagogic, Forestry and Agriculture, Science, Arts, Music , Foreign Languages. Quoc Hoc School is also one of the famous high schools in Vietnam.

o December 1993, Hue has been recognized as a World Cultural Heritage Site by UNESCO

HUE CENTRAL HOSPITAL TODAY

+ One of three biggest hospitals under the management of Ministry of Health

Medical Staff : 2,300

- Profs, PhDs : 18

- Post-graduated cards: 450

+ 52 Clinic & Para-clinic Departments

+ Annually Carry out :

-250,000-300,000 medical examinations

- 64,000 in-patients treatment

- 18,000 surgical performances

  

• It is estimate that 7,324 new cancer cases were registered in the period 2001-2009.• 55.54% in males and 44.46% in females.• Hue city has highest cancer incidence than the others in Thua thien- Hue province ( 37.76%)• The crude rate is 123.9, the age-standardized rate is 173.5 per 100,000 inhabitants in males; females is 95.3 and 103.9, respectively.

Ten leading cancers in males ( per 100,000 inhabitants )

Ten leading cancers in females ( per 100,000 inhabitants )

Age - specific incidence rate : all sites, males and females

Age- specific incidence rate for Liver cancer

Age-specific incidence rate for Stomach cancer 

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Axis Title Males

Females

Age -specific incidence rate for Lung cancer

 Age-specific incidence rate for Breast & Cervix Cancer

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Axis Title

Breast

Cervix

• Liver, stomach, lung , oral cavity , lymphoma are leading cancers in males ( liver cancer : 34.8 ).• The leading cancers in females are breast, stomach, lung, liver and oral cavity ( breast cancer : 21.7 ).• Cancer disease has increased after 40 years old in the Thua thien Hue inhabitants, males increased rapidly than females and both gender came to the top of the age-specific rate at 70-74 years old.

Primary Prevention

Secondary Prevention

Tertiary Prevention

Training and Research

Vietnam :

+ Very high level of tobacco production and consumption : 24.000 ha ( 1994 ) ; 2 billion parks of cigarettes .

+ Smoker ( 2000) : 73,4% of males, 3.9% of females.

70% began under 25 years old.

+ “Water pipe” smoking strongly related to lung cancer

Thua thien Hue :

+ A factory of tobacco production

+ Tobacco plant grew in the rural area.

+ Tobacco Consumption

The Directory Committee of Tobacco Control was headed by Ministry of Health, Vietnam participated the International Non-Smoking Day.

1999 : The Plan of Tobacco Control was approved .

Thua Thien Hue :

+ Tobacco factory does not work.

+ Forbid smoking in the public places.

+ Decrease import the foreign cigarettes.

+ Increase the consumption tax.

+ 2005 : Tobacco punishment for smoker in public places, seller cigarettes for children under 16 years old…

+ 2008 : Campaign for Tobacco Control

Decrease the financial benefit for government.

Not evaluated efficacy in mass media.

Advertisement still remain.

1995 : Vaccine against HBV was produced in Vietnam.

1997 : Extended program of immunization for newborns.

Single use facilities for injection and transfusion.

1999 : Immunization for 60.000 children from 1 to 10 years old.

2009 : Immunization for the whole newborns and 10.000 children in schools

Improvement of the nutritional hygiene education.

Control the bad habits : preference for salty, pickled, deep-fried and grilled food, fermented vegetables…

Education for farmers.

Public education on safe sex.

SECONDARY PREVENTIONBreast cancer screening

N= 14,074 cases Introduction Breast-Self

Examination : Decrease the terminal stage .

There is 5 cases breast cancers among 68 suspected cases in 2008, 2009.

Observation the understanding on breast cancer ( N= 6,617 )

Questions Answers %

1 Understanding on breast cancer Do not know 50.76

2 Cause of breast cancer Do not know 45.34

3 Breast cancer is serious disease Do not know 29.97

4 Breast selft examination Never 52.09

5 Talking about breast selft examination Nobody 37.04

6 Description symptom of anormal breast tumor 22.88

7 To see doctor when they have tumor No 31.71

8 Understanding on methods of breast screening

Do not know 41.57

9 Worried about breast cancer Die, loss of breast, loss of finance

30.31

10 Prognostic of breast cancer disease Curability 61.67

Pap technique: The Viet-American Cervix Cancer Prevention Project:

+ Over 10.000 women has been screened

+ Exchange of specialists, training, management skill.

+ Cervix Screening for 14,074 women in Thuathien Hue: 196 cases Suspicious lesion and 6 cases as cancer.

Exam :PAP TEST in Quang dien District ( N = 6,014 cases )

Lsil, Hsil.. 24 00,36

ASC-US 25 00,37

Infection ( + ) 1209 18,27

Infection ( ++) 253 03,82

Infection ( +++) 32 00,48

Cervix Cancer : 02 cases

Lessons learned from successful Papanicolaou cytology cervical cancer prevention in Thua thien HueIF our ideological commitment is to improve health

outcomes as quicky as possible among many women as possible

THEN Papanicolaous screening services ( with or without HPV/VIA testing services) should be provided without further delay in any setting where cervical screening is appropriate but unavailable, with consideration given to HPV vaccination after, rather than before, the possibility has been excluded that HPV vaccination may be ineffective for cervical cancer prevention and/or full coverage of target demographic groups by screening services has been achieved, whichever comes first.

Training course in breast & cervix cancer screening in Phu loc district

One of three National Cancer Control Center of Vietnam: Connection to 16 provincial hospitals in Centre and Highland.Increasing : Beds, facilities as simulator, TPS system, Brachytherapy, linear accelerator (LINAC) …(a gamma knife machine in Hue College of Medicine and Pharmacy ).Palliative care.Workshops on the National and International level for Cancer Control .

COBALT 60 (1996) SIMULATOR( 2000)

HDR BRACHYTHERAPY FOR NASOPHARYNX CANCER

HDR BRACHYTHERAPY FOR CERVIX CANCER

Retinoblastoma

Neuroblastoma

Rhabdomyosarcoma

Requirement of palliative care in Hue Central Hospital in 2008

N0 Sites Cases

1 Bronchus, Lung Cancer 108

2 Head & Neck Cancer 40

3 Kidney Cancer 03

4 Cervix & Ovary cancer 24

5 Breast cancer 21

6 Digestive Organ 26

7 Lymphoma 07

8 Others 44

Total 273

Palliative Radiation

Delivering Morphine by EASY PUMP

Given the module of oncological basic for :

Specialists

Residents

Medical Students

Received support from Ministry of Health, UICC, IARC... in sharring experience, medical staff training and othersSuccessfully held the National conference on cancer control ,National conference on breast cancer , Pathology symposium, Radiation symposium …. Mass media in cancer prevention on television in Hanoi and Hue( 102 times), vaccination for cervical cancer, publishing document for cancer prevention ( 152 discs , 40.000 brochures....)

Although the Cancer Control Program is just begining in preparation , some efforts by the government have already been made with cancer control. However,the cancer control in Thua thien Hue still has

to deal with challenges such as poor quality of cancer morbidity and mortality data, shortage of resources and limited knowledge of general practitioners as well as the public about this disease.

Thank you for attention!