“5th Turkish Medical Oncology Congress” Antalya- Turkey

19-23 March, 2014.

Helidon Nina MD;PhD

Mediterranean Multidisciplinary Oncology Forum, Albania Representative

University Lecturer & Breast SurgeonUniversity Hospital Centre “Nene Tereza”Tirana-Albania

ONCOLOGICAL SITUATION IN ALBANIA

ALBANIAAlbania population is 3,215,988 (2011- INSTAT).

Is a country in development.

Surface 28.000 km2

Capital Tirana

There are 4 different religions

After 90’ has change the political situation in pluriparties parliamentary system.

Data in our country Information system on cancer is based in:

deaths on data collected by INSTAT, and

incidence of new cases, collected from oncology service at theUniversity Hospital Center 'Mother Teresa'.

However a best source information system, serves data oncancers in the world GLOBOCAN (which produces a realisticassessment of the situation in each country of the world,taking into account the quality of defective and gaps innational statistics).

Introduction: cancers a priority

Cancers are becoming a major priority for health policiesin Albania for two major reasons :

Increase of mortality and morbitity rates for a number ofcancers:

• Demographic transition

• Changes in lifestyle

Late diagnoses• Most are diagnosed in advance stages.

Proportional mortality INSTAT -2010

SKZ59%

Cancer18%

Respiratory Diseas. 3%

Diabetes 1%

Others NCD9%

Trauma5%

Infekt. perinat5%

Changing demography (1991, 2010)

Changing demography 2010

Demographic transition III

• Fertility

1965 1975 1985 2005 2010

6.1 4.9 3.7 2.2 1.6

• Yearly average increase

1925-1945 1950-1970 1990-2001

1.5% 2.9% -0.5%

• Infant mortality

1950 1960 1970 1980 1990 2000 2010

143 97 88 70 45 23 11*

Fertility rate in Albania

6,1

4,6

3,7

2,2

1,6

0

1

2

3

4

5

6

7

1965 1975 1985 2005 2010

Albania- early menarche (% before 12 years old)

23,6

13,8

9

0

5

10

15

20

25

20-29 30-39 40-50

% m

en

s a

rd

hu

r p

ara

m

osh

es 1

2 v

jec

Prirja ne kohe (grupmoshat)

17,416,4

7,2

0

5

10

15

20

tirana qytet tjeter fshat

% m

en

s a

rd

hu

r p

ara

m

osh

es 1

2

vje

c

Prirja sociale

Mean BMI in Albania

24

24,5

25

25,5

26

26,5

27

1980 1984 1988 1992 1996 2000 2004 2008

F

M

Physical activity in Albania Proporcion of those reporting less than 20 min for 3 or more days

33,6

22,4

0

5

10

15

20

25

30

35

40

2005 2009

Prevalence of smoking (%). DHS

Female Male

HPV Types (in Albania & Europe)

Mortality from cancer during the yearsINSTAT

60.856.6

67.0

75.8

69.573.5 75.5 78.3

82.886.9

95.5 93.188.1

92.7

-

20.0

40.0

60.0

80.0

100.0

120.0

Vd

ekje

/ 1

00

00

0

Age-specific incidence (15-44 years old) of cancers in women in Albania

BREAST CANCER IN ALBANIA

BC occupies first place in the general classification of malignant diseaseaffecting women.

BC is about 25% of all malignant tumors affecting female sex.

Annually there are about 500 new cases of BC.

Each year 140 women die from breast cancer.

They constitute about 14.3% of all deaths caused by malignant tumors inwomen.

BREAST CANCER IN ALBANIA Period 2006-2010

The incidence of breast ca was about 22 - 25 new cases per 100,000 women.

Age groups most affected by this cancer were ages 45 to 74 yearsthe highest incidence was observed in the: - age group 50-54 (inc.74.6)

- age group 55-59 (inc.69.1)

Tirana represents nearly 30% of new cases with an incidence of 28.3/100.000.

Urban areas are affected 3-4 times more than rural areasincidence in urban areas 40.1 and in rural areas 10.8.

By stage : Stage I - 14%Stage II - 55%Stage III - 25%Stage IV - 6%

High incidence of LABC is correlated with:

Educational Status

Poverty

Age

Missing of screening, Mammography programs

In populations that receive regular screening mammography, the percentage of patients with locally advanced disease is less than 5%.

Knowledge in Albanian populationregarding mammography & pap test

76.6

48.5

0

10

20

30

40

50

60

70

80

90

Mamografi Paptest

%

77% of women have knowledge according to demographic and health study in 2010.There is a significant increase compared with the 2002 study

Knowledge on the screening of mammogram & pap test 2010

Albania - Breast cancer mortality rateINSTAT-ISHP

(/100000)

0,0

2,0

4,0

6,0

8,0

10,0

12,0

1987 1988 1989 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Breast cancer mortality trends Standardized rate

Year Death Level of mortality Mortaliteti I standartizuar

1987 71 4.76 5.58

1988 58 3.81 4.72

1989 70 4.53 5.33

1992 72 4.50 5.16

1993 66 4.12 4.62

1994 63 3.90 4.56

1995 86 5.24 5.54

1996 92 5.55 6.07

1997 82 4.84 5.24

1998 95 5.57 6.03

1999 130 7.60 8.40

2005 119 7.82 8.52

2008 102 6.63 6.44

2010 105 6.79 6.47

2011 138 8.87 8.39

Main cancers among males GLOBOCANCancer type Incidenc / 100 000 Mortalit / 100 000

% NSM % NSM

Goja (mouth) 3.4 7.3 1.8 2.7

Nazofarinks 1.4 3.1 1.3 1.9

Ezofag 1.6 3.4 1.8 2.7

Stomak 12.1 25.4 14.1 21.1

Kolon, rektum 5.3 11.2 4.1 6.2

Hepar 2.8 5.8 5.1 7.6

Pankreas 5.1 10.6 7.2 10.7

Larinks 2.8 6.0 2.6 3.8

Mushkeri (lung) 20.9 44.0 25.9 38.6

Melanoma 1.0 2.2 0.7 1.0

Prostata 10.0 20.5 7.6 10.9

Testet 1.0 2.3 0.3 0.5

Veshkat 5.1 11.0 3.1 4.7

Fshikeza urines 7.3 15.3 3.9 5.7

Tru, (CNS) 3.4 7.7 3.6 5.6

Tiroide 1.2 2.6 0.4 0.6

Limfoma 2.8 6.4 1.6 2.6

Mieloma 0.4 0.8 0.4 0.6

Leucemi 3.2 7.3 3.2 5.2

Lung Ca in Albania in years

Viti Vdekjet Niveli Mortaliteti i

standartizuar per moshen

1987 374 23.61 35.27

1988 414 25.62 37.66

1989 367 22.41 32.86

1992 331 20.82 27.40

1993 313 19.99 25.11

1994 276 17.40 21.43

1995 432 26.87 33.00

1996 473 29.12 35.25

1997 485 29.78 36.57

1998 481 29.16 35.58

1999 488 29.36 36.18

2000 452 28.39 35.09

2001 411 26.85 27.04

2002 459 29.85 29.45

2003 507 32.78 32.05

Lung cancer in Albania: Estimated numberof new cases now and in the future

Viti Numri i vleresuar i

rasteve te reja

Meshkuj Femra Total

2008795 403 1198

Nen 65 vjec 303 139 442

Mbi 65 vjec 492 264 756

2010837 425 1262

Nen 65 vjec 318 146 464

Mbi 65 vjec 519 279 798

2015943 485 1428

Nen 65 vjec 354 163 517

Mbi 65 vjec 589 322 911

20201048 547 1595

Nen 65 vjec 382 177 559

Mbi 65 vjec 666 370 1036

20251160 620 1780

Nen 65 vjec 370 180 550

Mbi 65 vjec 790 440 1230

20301275 699 1974

Nen 65 vjec 359 182 541

Mbi 65 vjec 916 517 1433

Survival of some cancers(after five years)

Bronchial carcinoma: 6-12%

Breast cancer: 50-85% depending on the application of the screening

Stomach cancer: 8-10%

Cancer of the colon and rectum: 40-60%

Cervical cancer: 60% -95% depending on the application of the screening

Prostate cancer: 40-90%

Laryngeal Cancer / esophagus: 60-70%

Service of Oncology in University Hospital Centre “Nene Tereza”Tirana , is the only public health structure that offer multidisciplinarytreatment for cancer patients , in Albania.

Every year there are:

• 10 000 patients is recovered

• 3800 surgical oncologic visits

• 1800 gynaecologic oncologic visits

• 3000 patients takes chemotherapy treatment

• 1800 patients takes radiotherapy

Medical staff in Service of Oncology:

8 Medical Oncologist 6 Radiotherapist 6 Surgeons 4 Gynaecologist 2 Anatomopathologist3 Radiologist

Economic status and knowledge on cancer screening

0

10

20

30

40

50

60

70

80

90

Me e ulta E dyta E mesmja E katerta Me e larta

% k

an

e d

eg

juar p

er p

ap

ate

sti

n

31

Problems and Opportunity for screening

• Problems – Lack of traditional structures – Very few qualified specialists for screening and diagnosis: – Radiologist, pathologist etc..– The low use of existing services (2-3 mamography/day)– Over 80% of cases of breast cancer at diagnosis moment, have a

diameter of 3-5 cm

• Opportunity – 80% of women have heard of mammography(50% - 2002)– Investments in mammography device in recent years– Women's centers

• Better coverage of the population• Training people • Relationship of trust with the community

Secondary prevention - breast cancer

Ongoing project with the support of IAEA :

Building capacities for diagnoses and treatment

Buliding capacities at PHC level. Focus on CBE (400 GPs trained)

Suporting the organisations by working with PH managers

Informing women on cancer and screening

Supporting survivals with information

Secondary prevention – cervical cancer

This year starts a project supported by UNFPA and ECCA forsystematically building capacities and standards in the field:

Setting up national center of screening Building capacities at PHC Training specialists for paptest and colposcopy (diagnoses and

treatment) Information and awareness Guidelines, quality standards and performance indicators

A conference on screening was organised in January and anotherconference (on screening and HPV vaccine) was organised lastmonth

Diagnosis and Treatment

Improvement in human resources with professionals oncancer care. Oncologist, surgeons, radiologists, pathologists,palliative care experts (almost 30 people trained abroad)

Improvement in technology and infrastructure in UHC.Pathology, Radiology, Radiotherapy (cobalt, brachiterapie,camera gama, better maintenance systems, ect)

Planning of drug politics with cost- effectiveness and coverageof selected drugs for all patients and all year. This year it wasincrease with 2.5 times, budget for cytostatic drugs. Despiteincrease in financing there are many insuficiencies

Private sector is growing faster: oportunities and threats

Palliative care Finalizing a low on palliative care with participation of specialists and stakeholders

Order of the Minister of Health No 531 of 18.10.2012 “On the establishment and functioning of palliative services in regional hospitals in the country” was issued.

Draft guidelines on palliative care guide were prepared by NCQSA-HI and submitted to Ministry of Health. The document is still being reviewed.

A project of strengthening capacities and setting up standards is being negotiated with IAEA

Five years before palliative care, started to be part in the education program of Medicine Faculty.

Paliative care is presented by different NGO project. (Ryder Albania; Mary Potter-Korca, etc)

Cancer registry

Activity for breast cancer sensibilisation at Albania Parlament

Albanian politicians, in a march for awareness to the fight against cancer

Thank You for your attention!