JACR MONOGRAPH No

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1 台湾におけるがんのモニタリングとがん対策計画 CANCER MONITORING AND CONTROL PLANNING IN TAIWAN メイシュライ * Mei-Shu Lai Cancer surveillance systems provide timely information, not only on cancer incidence, mortality, and survival, but also on factors related to cancer prevention, early detection, treatment, and quality of care. In, the central cancer registry has been established since 1979 and collected data to evaluate cancer burden. After the Cancer Control Act promulgated in 2003, the completeness and data quality of cancer registry has achieved at the excellent level according to the NAACCR standard. In order to monitor the care patterns and evaluate the outcomes of cancer treatment, our cancer registry has been reformed twice since 2001 to include items of stage at diagnosis and their detail information (long form database) on the first course of treatment. Till now, total 53 hospitals, which count for more than 80% of total national cancer cases, join the long form reporting and apply it to the 10 major cancers which are cancers of oral cavity and pharynx, stomach, colon and rectum, liver, lung, female breast, uterine cervix, uterine corpus, ovary and bladder. Primary and secondary prevention of major cancers, such as high-risk factor avoidance and periodical cancer screening, がんのサーベイランスシステムはがん罹患死亡生存の情報だけでなくがん予防早期発見治療医療の質に関連する要因の情報をタイムリーに提供する台湾では 1979 年に中央がん登録が設立されて以来がんによる社会的負荷を評価するためにデータが収集されている 2003 年にがん対策法が公布されてからがん登録の完全性とデータ精度は北米中央登録室協議会 (NAACCR : North American Association of Central Cancer Registries) の定める優秀なレベルに達している台湾がん登録ではがん医療パターンの実態把握やがん治療成績評価のため 2001 年から登録項目が 2 度改編され長票を使って診断時進行度や初回治療の詳細な情報が収集されるようになった現在長票は口腔咽頭胃結腸直腸肝肺女性乳房子宮頸部子宮体部卵巣膀胱の主要 10 部位に適用されていて 53 病院からこの長票による届出があるなおこの 53 病院からの届出で台湾のがん患者の 80% 以上を占めている台湾行政院衛生署は高危険要因の除去や定期的ながん検診など主要ながんに対する一次予防や二次予防を実施している一次予防として禁煙や噛みタバコ ( ビンロウキンマ ) 禁止などの予防政策がありこれらは確実にがんリスク要因への曝露に影響を及ぼしているまた 1984 年から台湾全土において * 国立台湾大学公共衛生学院予防医学研究所 Inst. of Prev. Med. College of Public Health, Natl. Univ., 35

2 were implemented by the National Department of Health of. Certain preventive policies including smoking and betel quids cessation affect exposure to cancer risks. Since 1984, the nationwide hepatitis B vaccination program has been successful in preventing acute and chronic liver disease. Additionally, the government established periodical screening program for major cancers of uterine cervix, colon and rectum, female breast and oral cavity. Achieving a fully integrated national framework for cancer monitoring and controlling will require extensive collaborations and coordination to the existing systems. B 型肝炎ワクチンプログラムが開始され急性慢性肝炎予防に効果をあげているさらに台湾では二次予防として子宮頸がん結腸直腸がん女性乳がん卵巣がんに対する定期検診プログラムが実施されている今後国家レベルの総合的ながんモニタリングとがん克服に対する取り組みにおいて十分に成果をあげるには現存するシステムとの大規模な連携と調整が必要であろう 36

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3 บḧ䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ Cancer Monitoring and Control Planning in 3UHVHQW DW WK -$&5 0HHWLQJ 3UHVHQW DW WK -$&5 0HHWLQJ 㪈㪐 ቇⴚ㓸ળ䈏䉖䈫 ળ䈫䈱 2FWREHU <RNRKDPD -DSDQ 㪈㪐 ቇⴚ㓸ળ䈏䉖䈫 ળ䈫䈱㪉㪇㪈㪇ᐕ㪈㪇㪈㪌ᣣ ᮮᵿ Mei-Shu Lai, M.D, Ph.D. 䊜䉟䉲䊠䊶䊤䉟 කᏧ䊶කቇඳ Institute of Preventive Medicine, College of Public Health, National University บḧᄢቇ ⴡ ቇ㒮㒐කቇ ᚲ The work of cancer registration in : บḧ䈮䈍䈔䉎䈏䉖䈱ᓎ 䋺 surveillance system 䉰䊷䊔䉟䊤䊮䉴䊶䉲䉴䊁䊛 7HFKQLFDO DVSHFWV RI FDQFHU UHJLVWUDWLRQ 6HHNLQJ LQIRUPDWLRQ IURP PXOWLSOH VRXUFHV DYDLODEOH LQ HOHFWURQLF GDWDEDVHV 4XDOLW\ RI FDQFHU UHJLVWU\ GDWD 䈏䉖䈱ᛛⴚ 㕙㔚ሶ䊂䊷䉺䊔䊷䉴䈮䈍䈇䈩 ᚻน 䈭ⶄᢙ䈱ᖱႎḮ䈎䉌䈱ᖱႎ 㓸䈏䉖䊂䊷䉺䈱 Aim: through national cancer registry system to set up the epidemiology surveillance system to see the trend of cancer-specific incidence 䈏䉖䉲䉴䊁䊛䉕ㅢ䈚䈩䇮䈏䉖䈮 ൻ䈚䈢 ᖚ 䉕ᛠ 䈜䉎䈢䉄䈱 ቇ䉰䊷䊔䉟䊤䊮䉴䉲䉴䊁䊛䉕䈤䈕䉎䈖䈫 Health reform : NHI 1995 ක 㒾ᡷ㕟 ஜᐽ 㒾 Phase I ( ) ( ) Set up in 1979 to provide epidemiologic information and cancer burden ᐕ䈮 ቇ ᖱႎ䉇䈏䉖䈮䉋䉎 ળ 䋨䈱ᄢ 䈐䈘䈱ᖱႎ䋩䉕ឭଏ䈜䉎䈢䉄䈮䈘䉏䈢 230 hospitals ( 50 beds) report in situ and invasive incident cancers annually ᐕ䈮䇮㪉㪊㪇ක ᯏ㑐䋨 ᐥએ 䋩䈎䉌䇮䈏䉖䊶ᶐẢ䈏䉖䈱ዯ 20 items (Short Form) are reported 㓸㗄䋺㪉㪇㗄 ᑼ 9Case demography, diagnostic age and methods, site and morphology, summary of treatment and death 9ᖚ ၮᧄᖱႎ䇮 ᢿ ᐕ㦂䇮 ᢿᣇᴺ䇮ㇱ䇮 ቇ ᢿ䇮ᴦ ᣇᴺ䇮ᱫ Cancer statistics in บḧ䈱䈏䉖 37

Problems of TCR บḧ䈏䉖䈱㗴ὐ Hospitals ක ᯏ㑐 Low priority, insufficient and untrained manpower, long lag of reporting, missing data in chart ఝవ㗅䈱ૐ䈘䊶 ᧚ਇ

䈘䉏䈭䈇 Department of Health Low priority, 1 person manage, prelimary data check ⴕ 㒮ⴡ ఝవ㗅䈱ૐ䈘䇮 ℂ 䈏㪈䈱䉂䇮䊂䊷䉺䉼䉢䉾䉪䈚䈩䈇䈭䈇 บḧᄢቇ䈻䈱บḧ䈏䉖䈱 ᆔ 䋨㪈㪐㪐㪍䋩 To commission

ℂ䈫ዯ 䉕ක ᯏ㑐䈮ଦ䈜䈱䈮චಽ䈭 ᧚ ቯ 䈭䉍 ᩏታᣉ䊶ቢ ᕈ㪐㪎䋦䈫䈭䉎 ක ᯏ㑐䈻䈱㔚ሶᇦ 䈮䉋䉎ዯ 䈱ផᅑ ቯ 䈭䊂䊷䉺䉼䉢䉾䉪䈫 ᱜ䊶 ක ᯏ㑐䈮䈍䈔䉎ዯ ೨䊂䊷䉺䉼䉢䉾䉪 ᣂ䈢䈭䊂䊷䉺䉕ട䈋䈢ᐕ ႎ๔ᦠᡷ Trace back unreported potential cases

check before sent out Revised annual report by adding more statistics Overview of Cancer system In Bureau of Health Promotion Department of Health Data

Audit Quality Accreditation National University Society (NTU) of 䊂䊷䉺㓸䊂䊷䉺 ℂ ᨆ ቇⴚ 䊂䊷䉺䊝䊆䉺䊥䊮䉫 ᩏ ቯ บḧᄢቇ 0CVKQPCN 6CKYCP 7PKXGTUKV[ 067 Cancer Central

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4 Problems of TCR บḧ䈏䉖䈱㗴ὐ Hospitals ක ᯏ㑐 Low priority, insufficient and untrained manpower, long lag of reporting, missing data in chart ఝవ㗅䈱ૐ䈘䊶 ᧚ਇ 䈫䊃䊧䊷䊆䊮䉫䈘䉏䈩䈇䈭䈇 ᧚䊶ዯ ㆃ䉏䉦䊦䊁タ䈱ṳ䉏 Registrars Lack of training, no support from doctors/peers, and hospitals 䊃䊧䊷䊆䊮䉫䈱 ᅤ䇮කᏧ䉇ห 䈎䉌䈱䉰䊘䊷䊃䈏 ฃ䈔䉌䉏䈭䈇䇮䈜䉎వ䈏䈭䈇䇮ኾ㐷䈫䈚䈩䈘䉏䈭䈇 Department of Health Low priority, 1 person manage, prelimary data check ⴕ 㒮ⴡ ఝవ㗅䈱ૐ䈘䇮 ℂ 䈏㪈䈱䉂䇮䊂䊷䉺䉼䉢䉾䉪䈚䈩䈇䈭䈇 บḧᄢቇ䈻䈱บḧ䈏䉖䈱 ᆔ 䋨㪈㪐㪐㪍䋩 To commission TCR to NTU since 1996 Closely work with senior registrars and doctors ਥછ 䈫කᏧ䈫䈱 ኒ䈭දജ Enough manpower to manage data and remind hospitals to report 䊂䊷䉺 ℂ䈫ዯ 䉕ක ᯏ㑐䈮ଦ䈜䈱䈮චಽ䈭 ᧚ ቯ 䈭䉍 ᩏታᣉ䊶ቢ ᕈ㪐㪎䋦䈫䈭䉎 ක ᯏ㑐䈻䈱㔚ሶᇦ 䈮䉋䉎ዯ 䈱ផᅑ ቯ 䈭䊂䊷䉺䉼䉢䉾䉪䈫 ᱜ䊶 ක ᯏ㑐䈮䈍䈔䉎ዯ ೨䊂䊷䉺䉼䉢䉾䉪 ᣂ䈢䈭䊂䊷䉺䉕ട䈋䈢ᐕ ႎ๔ᦠᡷ Trace back unreported potential cases regularly and completeness reach to 97% Encourage hospital report by electronic form Data check and corrigendum run regularly and hospitals proceed data check before sent out Revised annual report by adding more statistics Overview of Cancer system In Bureau of Health Promotion Department of Health Data Collection Data Management Analysis Academic use บḧ䈱䈏䉖䉲䉴䊁䊛䈱 ஜᐽዪ ⴕ 㒮ⴡ $WTGCW QH *GCNVJ 2TQOQVKQP $*2 &GRCTVOGPV QH *GCNVJ Policy Making Data Monitoring, Audit Quality Accreditation National University Society (NTU) of 䊂䊷䉺㓸䊂䊷䉺 ℂ ᨆ ቇⴚ 䊂䊷䉺䊝䊆䉺䊥䊮䉫 ᩏ ቯ บḧᄢቇ 0CVKQPCN 6CKYCP 7PKXGTUKV[ 067 Cancer Central Cancer (Short Form Database) Central Cancer (Long Form Database) บḧ 䈏䉖 ቇળ 䋨บἨ䈏䉖 ቑᦩ䋩 ਛᄩ䈏䉖䊂䊷䉺䊔䊷䉴 Training course Certified cancer registrars ਛᄩ䈏䉖㐳䊂䊷䉺䊔䊷䉴䊃䊧䊷䊆䊮䉫䉮䊷䉴䈱 ቯ The work of cancer registration in : บḧ䈮䈍䈔䉎䈏䉖䈱ᓎ 䋺 Cancer monitoring-surveillance system 䈏䉖䊝䊆䉺䊥䊮䉫 - 䉰䊷䊔䉟䊤䊮䉴䊶䉲䉴䊁䊛 7HFKQLFDO DVSHFWV RI FDQFHU UHJLVWUDWLRQ 6HHNLQJ LQIRUPDWLRQ IURP PXOWLSOH VRXUFHV DYDLODEOH LQ HOHFWURQLF GDWDEDVHV 4XDOLW\ RI FDQFHU UHJLVWU\ GDWD 䈏䉖䈱ᛛⴚ 㕙㔚ሶ䊂䊷䉺䊔䊷䉴䈮䈍䈇䈩 ᚻน 䈭ⶄᢙ䈱ᖱႎḮ䈎䉌䈱ᖱႎ 㓸䈏䉖䊂䊷䉺䈱 38

Data Collection and Management Procedure of TCR in NTU Hospitals with over 50

confirmed Return questionable data to reconfirm Data Check & Corrigendum Data

and Cancer cancer Screening Program cases Correct data Data Input &

Cancer Office Aim: requests DOH to promote the cancer care quality Health

Act promulgated in 2003 which requests DOH to promote the cancer care quality

2002 and further to 95 in 2007 which modified from US FORDS Case demography,

treatment information and follow-up 53 hospitals (500 annual incident cases)

counted for 80% of total national cancer cases Consolidate registrars Trained

training courses, maintain FAQ, hospital audit Certify registrar (coding short

5 Data Collection and Management Procedure of TCR in NTU Hospitals with over 50 beds Reporting cancer cases electronically, data correction, trace-back cases confirmed Return questionable data to reconfirm Data Check & Corrigendum Data Linkage from profiles of Death Certificates, Catastrophic Illnesses, Potential and Cancer cancer Screening Program cases Correct data Data Input & Consolidation Data Integration Trace potential cancer cases back to Hospitals Cancer Office Aim: requests DOH to promote the cancer care quality Health reform : National cancer control act 2003 Phase II (after 2002) Cancer Control Act promulgated in 2003 which requests DOH to promote the cancer care quality To know the treatment patterns, we extended reported items from 20 to 65 in 2002 and further to 95 in 2007 which modified from US FORDS Case demography, diagnostic age and methods, site and morphology, TNM Staging, more detail treatment information and follow-up 53 hospitals (500 annual incident cases) report long form information on 6 to 14 major cancers Long form cases are counted for 80% of total national cancer cases Consolidate registrars Trained senior registrars and organie a tutor group Help to form future plan, provide training courses, maintain FAQ, hospital audit Certify registrar (coding short form) since 2004 Society of Cancer was established in 2006 Carry out BHP programs including audit, ducation, certification and FAQ 39

Cancer Control Act milestone for TCR quality Cancer Control Act requires hospitals to follow DOH rules on cancer registration, $300-1600 penalty for not reporting DOH s rules for cancer registration

6 Cancer Control Act milestone for TCR quality Cancer Control Act requires hospitals to follow DOH rules on cancer registration, $ penalty for not reporting DOH s rules for cancer registration (2005) Dr lead and report before 1 year after diagnosis Manpower: 1 registrar/ cases Perform self-audit and 10% reviewed by cancer committee 70% case FU, Should be used in care quality improvement Summary of Central Cancer Database Short Form Database Long Form Database Phase I III II III Data Available Year Reporting Cancers Hospitals Data & Item Numbers until now All Cancers REQUIRED From 100 to 223 hospitals Diagnosis, treatment: 20 Diagnosis, treatment: until now Cervix: REQUIRED Breast, liver, lung, oral cavity, colon & rectum: OPTIONAL hospitals Cervix, breast, liver, lung, oral cavity, colon & rectum: REQUIRED hospitals Diagnosis, stage, Diagnosis, stage, treatment, treatment, follow-up: Cancer 65 follow-up: 65 Cervix, breast, liver, lung, oral cavity, colon & rectum: REQUIRED (2007) Prostate, esophagus, stomach, bladder: ADD REQUIRED (2008) Nasopharynx, Corpus, ovary, Lymphoma & Leukemia: ADD REQUIRED (2009) hospitals Diagnosis, stage, treatment, follow-up: 95 (2007) (2008) (2009) Accreditation cancer care quality Subsidie hospitals to fulfill DOH rules on CR and improve care quality during Upgrade CR to the level of cancer committee which is in charge of its quality and application Doctor leader bridges registrars and clinicians Accredit hospitals for cancer care quality since of 30 points are related to CR A level hospitals can apply medical center accreditation which influence NHI payment Data Quality Indices for Subsequent to Cancer Control Act enacted Criterion Completeness, % DCO % M/I % MV % Timeliness, months Note: 1. Death Certificate Only percentage 2. Mortality : Incidence ratio 3. Microscopically Verified percentage Note: 1. Death Certificate Only percentage 2. Mortality : Incidence ratio 3. Microscopically Verified percentage 40

Year 1979 2002 2004 2007 1979 2002 2004 2007 1995 2003

started Cancer Control Act enacted & trace-back

cancer cases identified in hospitals with more than 50

0 cases/year Central Cancer Database Short Form (SF)

separate DB in year 2002-2003 SF & LF data were combined

were officially merged since 2007 Evolution of Cancer

1 Top 10 Cancer in 2007 70 66.1 60.0 60 53.1 53.1 50.

5 23.8 19.5 15.7 15.4 50 40 30 20 45.8 44 37.1 36.4 39.

6 10.3 8.4 8.3 10 12.5 12.2 10.6 10.3 8.4 8.3 0.

C53 C44 C54 Note: age-adjusted rate which is calculated

7 Year Policy National Health Insurance (NHI) Program started Cancer Control Act enacted & trace-back procedure started Cancer Database set up to register all cancer cases identified in hospitals with more than 50 beds Cancer Database (TCDB) set up to register six major cancer cases identified in hospitals with more than 500 cases/year Central Cancer Database Short Form (SF) system only Short Form & Long Form (LF) were two separate DB in year SF & LF data were combined since 2004, but were still separate DB SF& LF system were officially merged since 2007 Evolution of Cancer Monitoring Cancer surveillance using CR database Top 10 Cancer in C50 C18-21 C22 C34 C61 C00-06, C16 C09-10, C12-14 C53 C44 C54 Note: age-adjusted rate which is calculated based on the 2000 world standard population 2000 LIVER 41

Studies of staging and pattern of care ㅴⴕᐲ䈫ᴦ

aiwan Cancer Ca ance er R egistry g y ᐕg Ta

䉺䉟䊒䈱ಽᏓ 㪈㪐㪐㪏㪄㪉㪇㪇㪎ᐕ บḧ䈮䈍䈔䉎ᅚᕈ 䈏䉖䈱 ಽᏓ Staging

2ᐕ 3ᐕ 4ᐕ 5ᐕ 0 99.6 99.1 98.6 97.8 96.8 I 99.

9 89.5 III 96.4 88.9 82.0 75.1 69.7 39.9 31.

8 IV 㪁㪉㪇㪇㪐ᐕ㪈㪉㪊㪈ᣣ䉁䈪ㅊ 䈘䉏䈢ᖚ Distribution of

Breast Cancer Diagnosed in 2007 2007ᐕ ᐕ ᢿ䈱

ᴺ ᚻⴚ䋧 ᴺ䋧䊖䊦䊝䊮 ᴺ ᚻⴚ䋧ൻቇ䊶 ᴺ䋧䊖䊦䊝䊮 ᴺ 䉬䉝䈱ᴦ 䈱䉂ว䉒䈞

8 Studies of staging and pattern of care ㅴⴕᐲ䈫ᴦ 䊌䉺䊷䊮䈱 6WDJLQJ and survival Pattern of care 拁嫛ㄵቋ䞮䘖 ᴦ 䊌䉺䊷䊮 ዊ 䈏䉖 ᚳᐔ 䈏䉖䈏䉖䈏䉖 ᐕ บḧ䈮䈍䈔䉎 ᕈ 䈏䉖䈱䉺䉟䊒䈱ಽᏓ 㪈㪐㪐㪏㪄㪉㪇㪇㪎ᐕ ዊ 䈏䉖 ᚳᐔ 䈏䉖䈏䉖䈏䉖 Ta aiwan Cancer Ca ance er R egistry g y ᐕg Ta aiwan Cancer Ca ance er y บḧ䈮䈍䈔䉎ᅚᕈ 䈏䉖䈱䉺䉟䊒䈱ಽᏓ 㪈㪐㪐㪏㪄㪉㪇㪇㪎ᐕ บḧ䈮䈍䈔䉎ᅚᕈ 䈏䉖䈱 ಽᏓ Staging and Survival for Female Breast Cancer 㪇㸇㪠㪠㪠㪠㪠㪠㪭 ᅚᕈ 䈏䉖䈫 ሽ ਇ ᐕ AJCC T aiiwan Cancer Canc cer R eg gisttry ታ ሽ 䋨䋦䋩, ᐕ 2ᐕ 3ᐕ 4ᐕ 5ᐕ I II III g y IV 㪁㪉㪇㪇㪐ᐕ㪈㪉㪊㪈ᣣ䉁䈪ㅊ 䈘䉏䈢ᖚ Distribution of First Course Treatment by Stage for Female Breast Cancer Diagnosed in ᐕ ᐕ ᢿ䈱䈏䉖䋨ᅚᕈ䋩䈮䈍䈔䉎䈗䈫䈱 ᴦ 䈱ಽᏓ ᚻⴚ䋧䊖䊦䊝䊮 ᴺ ᚻⴚ䋧ൻቇ ᴺ䋧䊖䊦䊝䊮 ᴺ ᚻⴚ䋧 ᴺ䋧䊖䊦䊝䊮 ᴺ ᚻⴚ䋧ൻቇ䊶 ᴺ䋧䊖䊦䊝䊮 ᴺ 䉬䉝䈱ᴦ 䈱䉂ว䉒䈞 T aiiwan Cancer Cancer R egi gisttry y T aiiwan Cancer Cancer Regi gisttry y 㪇 42 㸇㪠㪠㪠㪠㪠㪠㪭

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ᾍ䇮䉝䊦䉮䊷䊦䇮䊎䊮䊨䉡䉳䈭䈬䇮䈏䉖䈱䊥䉴䉪䉇ⷐ 䈻䈱ᦑ㔺䉕㒐䈓䇮䈅䉎䈇䈲ᦨዊ䈮䈜䉎 9 䊪䉪䉼䊮ធ 㪙 Ἳ䉡䉟䊦䉴䇮䊍䊃䊌䊏䊨䊷䊙䉡䉟䊦䉴 9 Tobacco control act 9 Health

䈏䉖䈮ኻ䈜䉎䉴䉪䊥䊷䊆䊮䉫䊒䊨䉫䊤䊛 Secondary Prevention 9 Cancer Screening/ Early Detection : 9 Cancer Control Act: screening

Surveillance Using CR Database 㒐 ஜᐽ䈭䇱㒐 ᣂⷙ䈮䈏䉖䈫 ᢿ䈘䉏䈢䇱㒐䈏䉖ᴦ 䉕ฃ 䈔䈢䇱䈏䉖䈫䈮䈐䉎䇱䈏䉖䈪 ᱫ 䈜䉎䇱 ᔅⷐ䈭ᖱႎ ᮮᢿ 㪁䈭䇮䈱䇮䉇

9 Cancer registry in cancer control 䈏䉖ኻ 䈮䈍䈔䉎䈏䉖,PSDFW RI WKH WREDFFR FRQWURO DFW WR OXQJ FDQFHU 7REDFFR FRQWURO DFW,PSDFW RI KHSDWLWLV % YDFFLQDWLRQ PDVV SURJUDP WR KHSDWRPD,PSDFW RI SDS VPHDU VFUHHQLQJ SURJUDP WR WKH FDUFLQRPDV LQ VLWX UDWLR RI LQ VLWX WR DGYDQFH FDQFHU RU WRWDO FDQFHU Geographic variation study on oral cancer 䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙ ᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙ ᴺ䋨㪈㪐㪐㪎䋩䈏䉖䈮ኻ䈜䉎䌂 Ἳ䉡䉟䊦䉴䊪䉪䉼䊮㒐ធ 䊒䊨䉫䊤䊛䈱ᓇ㗀 ሶች㗪䈏䉖䈮䈍䈔䉎䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲䈏䉖䋩䈮ኻ 䈜䉎ᡂㆊ ᬌ 䊒䊨䉫䊤䊛䈱ᓇ㗀 ญ 䈏䉖 ᖚ䈱 ℂቇ Cancer Prevention 䈏䉖㒐 ᖚ䈱 ὼ ㆊ Natural History of Disease X Y 5WUEGRVKDNG 5VCIG 2TGENKPKECN 5VCIG Z %NKPKECN 5VCIG [ &KUCDNG 5VCIG \ &GCVJ X ᓇ㗀䉕ฃ䈔䉇䈜䈇㓏 Y ೨ ᐥ 㓏 Z ᐥ 㓏 [ 㓚ኂ䈱㓏 \ ᱫ P ォ⒖䈱㒐 Q 䊥䊊䊎䊥䊁䊷䉲䊢䊮 PPrevention of metastasis QRehabilitation O 䈏䉖ᬌ 㪆ᣧ O Cancer Screening/ Early Detection Mᢎ N䊪䉪䉼䊮ធ MEducation NVaccination Cancer Control in บḧ䈮䈍䈔䉎䈏䉖ኻ Primary Prevention 㒐 9 National Policy and Health Education: 9 ஜᐽᢎ ᾍ䇮䉝䊦䉮䊷䊦䇮䊎䊮䊨䉡䉳䈭䈬䇮䈏䉖䈱䊥䉴䉪䉇ⷐ 䈻䈱ᦑ㔺䉕㒐䈓䇮䈅䉎䈇䈲ᦨዊ䈮䈜䉎 9 䊪䉪䉼䊮ធ 㪙 Ἳ䉡䉟䊦䉴䇮䊍䊃䊌䊏䊨䊷䊙䉡䉟䊦䉴 9 Tobacco control act 9 Health literacy 9 Vaccination: 9 Hepatitis B vaccine, 9 HPV vaccine g y 㒐 9 䈏䉖ᬌ 䈫ᣧ ሶች㗪䈏䉖䇮䈏䉖䇮䊶䈏䉖䇮ญ 䈏䉖䈮ኻ䈜䉎䉴䉪䊥䊷䊆䊮䉫䊒䊨䉫䊤䊛 Secondary Prevention 9 Cancer Screening/ Early Detection : 9 Cancer Control Act: screening program for cancers of cervix uteri, breast, colon-rectum and oral cavity 䈏䉖䊂䊷䉺䊔䊷䉴䉕䈚䈢䈏䉖䉰䊷䊔䉟䊤䊮䉴 Cancer Surveillance Using CR Database 㒐 ஜᐽ䈭䇱㒐 ᣂⷙ䈮䈏䉖䈫 ᢿ䈘䉏䈢䇱㒐䈏䉖ᴦ 䉕ฃ 䈔䈢䇱䈏䉖䈫䈮䈐䉎䇱䈏䉖䈪 ᱫ 䈜䉎䇱 ᔅⷐ䈭ᖱႎ ᮮᢿ 㪁䈭䇮䈱䇮䉇 ળ 䈱䈏䉖䈮䉋䉎䈱 ㅀ 㪁䇮 ᣖ䇮 ળ 䉇ᢥൻ䋻䇮 ળ 䇮 ቇ ሶ䋻䊒䊨䊋䉟䉻䈱䇮ᘒᐲ䇮ታ〣 ⴕ ෂ㒾 ሶ 䉴䉪䊥䊷䊆䊮䉫ᬌᩏ ⅣႺᦑ㔺 ળ 䊶ⅣႺ 䈏䉖 ᖚ ක 䈱 ᕈ ක 䉕ฃ䈔䉎ᯏળ ᵴ䈱 ว૬ ᦨవ 䈱ක 䉮䊮䊒䊤䉟䉝䊮䉴 ᵴ䈱 ว૬ ሽ 䈏䉖䈱 43 ක 䈱 ᕈ ක 䉕ฃ䈔䉎ᯏળ ᵴ䈱 ว૬ 䊖䉴䊏䉴䊶 ᧃ ක 䈏䉖ᱫ

Cancer registry in cancer control Geographic variation study

Children 1980 1984.7-1986.6 HB 0,1,2,12B 1986.7-1987.

10 Cancer registry in cancer control Geographic variation study on oral cancer Nationwide HBV Vaccine Prevent Liver Cancer in Children HB 0,1,2,12B B ,1,63 MH Chang et al., N Engl J Med 1997;336: Cancer registry in cancer control Geographic variation study on oral cancer 44

11 Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Note: data from Cancer Incidence in five Continents Vol. IX, IARC Coverage of Pap Smear in annual screening rate 3-year screening rate From the website of Department of Health, 60 annual screening rate 3-year screening rate Improvement of Cervical Cancer Screening Program in From the website of Department of Health, Screening rate Invasive incidence rate Mortality rate In-situ incidence rate 45

Prediction of HPV Vaccination Impact on Disease 㵶 Vaccination was predicted to provide a reduction of 31.2% in the prevalence of high-grade lesions (i.e., CIN 2 + CIN 3) across all ages.

12 Prediction of HPV Vaccination Impact on Disease 㵶 Vaccination was predicted to provide a reduction of 31.2% in the prevalence of high-grade lesions (i.e., CIN 2 + CIN 3) across all ages. K G %+0 % Number of cases ᐕ㦂䈮䉒䈢䉍䇮䊪䉪䉼䊮䈮䉋䉍䇮㜞ᐲ ᒻᚑ䈱䈮䈍䈇䈩㪊㪈㪅㪉䋦䈱 ዋ䈏ㄟ䉁䉏䉎䇯 No vaccination coverage 3500 No䊪䉪䉼䊮ធ ᥉ 䈭䈚 vaccination coverage % vaccination coverage 3000 㪈㪇㪇䋦䊪䉪䉼䊮ធ ᥉ 100% vaccination coverage Number of cases ͻ 㪟㪧㪭䊪䉪䉼䊮䈱ᓇ㗀䈱 Cervical cancer ሶች㗪䈏 Cervical cancer 䉖 Cancer death 䊪䉪䉼䊮ធ ᥉ 䈭䈚䈏䉖䈮䉋䉎ᱫ Cancer death 䊪䉪䉼䊮ធ ᥉ Cancer registry in cancer control 䈏䉖ኻ 䈮䈍䈔䉎䈏䉖,PSDFW RI WKH WREDFFR FRQWURO DFW WR OXQJ FDQFHU 7REDFFR FRQWURO DFW,PSDFW RI KHSDWLWLV % YDFFLQDWLRQ PDVV SURJUDP WR KHSDWRPD,PSDFW RI SDS VPHDU VFUHHQLQJ SURJUDP WR WKH FDUFLQRPDV LQ VLWX UDWLR RI LQ VLWX WR DGYDQFH FDQFHU RU WRWDO FDQFHU Geographic variation study on oral cancer 䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙ ᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙ ᴺ䋨㪈㪐㪐㪎䋩䈏䉖䈮ኻ䈜䉎䌂 Ἳ䉡䉟䊦䉴䊪䉪䉼䊮㒐ធ 䊒䊨䉫䊤䊛䈱ᓇ㗀 ሶች㗪䈏䉖䈮䈍䈔䉎䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲䈏䉖䋩䈮ኻ 䈜䉎ᡂㆊ ᬌ 䊒䊨䉫䊤䊛䈱ᓇ㗀 ญ 䈏䉖 ᖚ䈱 ℂቇ บḧ 䉴䊨䊋䉨䉝䊐䊤䊮䉴䇮䉟䉷䊷䊦䉴䊨䊯䉢䊆䉝䉟䊮䊄䇮䊛䊮䊋䉟䊄䉟䉿䇮䉱䊷䊦䊤䊮䊃䉴䊕䉟䊮䇮䉝䉴䊃䉠䊥䉝䉴䉟䉺䊥䉝䇮䊔䊈䊃䉺䉟䇮䉸䊮䉪䊤䊷䊨䉲䉝䇮䉶䊮䊃䊕䊁䊦䉴䊑䊦䉫䉼䉢䉮䉴䉟䉴䇮䊁䉞䉼䊷䊉䊂䊮䊙䊷䉪䉝䊜䊥䉦䇮㪪㪜㪜㪩㩿㪈㪋㪀䉦䊅䉻䊘䊷䊤䊮䊄䇮䊪䊦䉲䊞䊪Ꮢ 䉥䊤䊮䉻䉝䉟䊦䊤䊮䊄䊉䊦䉡䉢䊷䊐䉞䊮䊤䊮䊄㪁䉝䊦䉳䉢䊥䉝䇮䉶䊁䉞䊐䊆䊠䊷䉳䊷䊤䊮䊄㪁ਛ 䇮㚅㪁䊐䉞䊥䊏䊮䇮䊙䊆䊤 ᣣᧄ䇮ᄢ㒋䉴䉡䉢䊷䊂䊮䉟䉩䊥䉴䇮䉟䊮䉫䊤䊮䊄ㇱ䉲䊮䉧䊘䊷䊦㖧䇮䉸䉡䊦䉟䉴䊤䉣䊦䉮䊨䊮䊎䉝䇮䉦䊥䉮䉴䉺䊥䉦䉪䉡䉢䊷䊃䋺䉪䉡䉢䊷䊃 ਛ 䇮 ᶏ ᅚ ᐕ㦂 ᢛ ᖚ 䋨 ญ㪈㪇䈅䈢䉍䋩 ญໃ䇮ญ 䇮ਛຜ㗡䇮ਅຜ㗡䈏䉖䈱ᐕ㦂 ᢛ ᖚ 䈱㓙セ Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 ᾖ䋺㪌ᄢ㒽䈱䈏䉖 ᖚ 䋹Ꮞ䇮㪠㪘㪚㪩㪃㪉㪇㪇㪎䈱䊂䊷䉺㪁䋺㜞 ᖚ *Red means high incidence *Green means low incidence 㪁䋺ૐ ᖚ *Red means high incidence *Green means low incidence Geographical Variation of Age-Adjusted Incidence Rates for Male Oral Cancer in, Cancer Geographical Variation of Age-Adjusted Incidence Rates for บḧ䈱 ᕈญ 䈏䉖ᐕ㦂 ᢛ ᖚ 䈱 ℂ 䈭䈇䇮㪈㪐㪏㪇㪄㪉㪇㪇㪇 Male Oral Cancer in, Cancer 46

13 Average betel nut consumption and incidence of male oral cancer in Age-adjusted incidence rate (per 100,000 populations) Age-adusted incidence rate Betel nut consumption Batel nut consumption Age-adjusted incidence rate Betel nut consumption (Kg per capita aged 15+) Age-adjusted incidence rate (per 100,000 populations) Age-adusted incidence rate Betel nut consumption Betel nut consumption (Kg per capita aged 15+) Secular Trend of male oral cancer incidence and betel nut consumption, Note: age-standardied rates based on the 2000 world standard population Denmark US, SEER SEER China, Shanghai Japan, Hiroshima Korea Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Screening Programs in *Data from Japanese Journal of Clinical Oncology Advance Access published on May 21, More Challenge than before More stakeholders in Cancer Monitoring and control planning Collaboration Cooperation Information system Sharing and benchmarking 47

14 Thank you! 䈅䉍䈏䈫䈉 Bureau of Health Promotion, DOH College of Public Health, NTU National University Cancer Task Force Dr. Mei-Hwei Chang Dr. San-Lin You Dr. Raoh-Fang Pwu Dr. Chun-Ju Chiang ⴕ 㒮ⴡ ஜᐽዪ บḧᄢቇ ⴡ ቇ㒮 บḧᄢቇ 䈏䉖㫮䉼䊷䊛 &T /GK *YGK %JCPI &T 5CP.KP ;QW &T 4CQJ (CPI 2YW &T %JWP,W %JKCPI 48

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