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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

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