the principles behind WHO's guidance in national cancer
control planning, and the ideas which govern its support for
good planning in general, as formulated in the WHO Country
Cooperation Strategy (CCS) (3). It will show how NCCP
planning follows the principles of CCS. Once a decision is
taken by national health authorities to include cancer as a
national health priority, the collaboration in cancer planning
between the national government and WHO, as well as with
other partners, needs to follow the principles of the CCS so
that cancer is part of the broader national health agenda and
NCCP translates into implementation and impact on cancer
for that country.
The content of NCCPs
According to the WHO definition, a national cancer control
plan is a public health programme with the overall objective
of reducing the number of new cancer cases by lessening
population exposure to cancer risks as well as strengthening
health-care systems to provide equitable access to services
for the early detection and management of cancer. NCCPs
encompass prevention, early detection, treatment and
palliative care. There are in principal two major areas of
interventions which govern cancer control planning:
population-wide interventions to reduction cancer risks and
interventions which reorient health-care systems to deliver
individual services for cancer patients. Early detection and
screening relates to interventions at both the population
and individual levels, as it is aimed at reaching out to a
asymptomatic target population in order to identify
individuals who might have early cancer or pre-cancer. This
process of "looking for the needle in a haystack" requires a
health-care delivery system which provides equal access to
early detection and follow-up for those who are detected as
potential cancer cases. Two principles govern early
detection: screening as the systematic application of a test
to a target 'at risk' population or general awareness-raising
about signs and symptoms of cancer.
Reducing cancer risks as part of NCCPs
With regard to reducing population exposure to behavioural
cancer risks such as tobacco use, obesity, alcohol use and
lack of physical activity, programme planning requires
multisectoral approaches mainly outside the health-care
system. The WHO NCD action plan 2013-2020 (4)
addresses these cancer risks and gives strategic direction
using a set of voluntary targets (5) for the reduction of, for
example, tobacco consumption, as part of the NCD
monitoring framework. WHO has developed global
strategies and guidelines for policies and strategies which
target tobacco use (6), unhealthy diet and physical inactivity
(Global Strategy on Diet, Physical Activity and Health 2004
(7) and alcohol (Global Strategy to Reduce Harmful Use of
Alcohol 2010 (8). To make effective use of these strategies,
there is a need for collaboration between national health
authorities and WHO and other partners to support national
planning and implementation. It has been forecast that by
achieving the voluntary targets of the NCD Action Plan by
2025, 7% of all cancer deaths would be avoided which is
equivalent to 2.4 million deaths in the 30 - 69 year age group
and 2.1 million cancer in the over 70 year age group (10).
Another key area of cancer prevention which requires
careful planning is lessening the exposure to infectious
causes of cancer such as HBV and HPV infections through
mass immunization. WHO has develop detailed guidance on
how to plan and implement immunization programmes for
HPV by targeting adolescent girls to avoid HPV chronic
infections and for infant immunization against HBV infection
to reduce HBV-caused liver cancer (hepatocellular cancer
HCC). Both cancer types are of major relevance in LMICs.
The roll-out of immunization programmes which may be
school-based or health facility-based requires governmental
planning with support from WHO and other partners such as
the Global Alliance for Vaccines and Immunization.
Legislative and regulatory interventions are key methods
of reducing environmental and occupational exposure to
pollutants such as asbestos and other carcinogens. With its
monograph programme, IARC, the WHO cancer research
centre, is continuously increasing knowledge about
environmental and other causes of cancer which has
initiated changes in national regulations and legislation, for
example, regulations to reduce exposure to asbestos.
Plans for strengthening health-care systems to deliver
the early detection and management of cancer
Cancer treatment is at its most effective in reducing case
fatality rates and in increasing long-term survival rates when
diagnosed at early stages and managed in accordance with
best practice and international standards. Planning will
therefore require a combined strategy of early detection and
screening with a strategy for cancer treatment capacitybuilding
at all levels of care. The assessment of the current
situation of existing services, including their effectiveness
and safety, and the setting of priorities and objectives for
cancer management, is the starting point of the planning
process. Once agreed upon priorities, cancer management
service infrastructure at all levels of care will need to be
developed which includes cancer specialized surgery,
chemotherapy and radiotherapy in specialized radiotherapy
CANCER CONTROL PLANNING
CANCER CONTROL 2015 15