20171021 Cancer prevention in malaysia

1. Cancer Prevention in
Malaysia
Fredie Robinson, MBBS, PhD
Universiti Malaysia Sabah

2. Malaysia National Cancer
Registry
• In 2002, the National Cancer Registry (NCR) was operating
under the Clinical Research Centre (CRC).
• In 2007, the NCR and the Regional Cancer Registries were
merged and managed by the Non-Communicable Disease
Sector, Disease Control Division of the Ministry of Health.
• The National Cancer Institute took over as the secretariat on
1st January 2015.
• The 2015 National Cancer Registry will be reporting on Cancer
Incidence of Malaysia. Much work has already been carried
out by the Disease Control Division of the Ministry of Health,
together with the State Epidemiology officers and staff of the
State Health Departments.
• The latest report produced in 2015 will be the data collected
from 2007 – 2011.

3. Six Zones of Regional Cancer Registry, Malaysia

4. Data Collection
• Cancer cases registration in Malaysia is based on primarily
voluntary notification by using standardized form through
healthcare workers help.
• However to ensure the completeness of data, active case
findings and routine checks are done for both government and
private hospitals through discharge records.
• Pathology records from public and private labs were obtained
as well. Case detection through National Registration
Department were done as well.

6. Cancer in Malaysia 2007 - 2011
• Malaysia reported a total number of 103,507 new cancer cases
were diagnosed in Malaysia during the period of 2007 to 2011
which accounts for 46,794 (45.2%) males and 56,713 (54.8%)
females.
• A total of 64,275 medically certified and non-medically certified
cancer deaths were reported by the National Registration
Department of the period 2007 to 2011.
• Over the years, the numbers of medically certified cancer deaths
have gradually increased.

7. AnnualAge-Standardizedrate(ASR)CancerIncidencebysex,
Malaysia(2007–2011)

8. Common Cancers in Malaysia
• The three most common cancers among Malaysian
residents were breast, followed by colorectal and lung.
Sites Number Percentage (%)
Breast 18,343 17.7
Colorectal 13,693 13.2
Trachea, Bronchus, Lung 10,608 10.2
Lymphoma 5,374 5.2
Nasopharynx 5,090 4.9
Leukaemia 4,573 4.4
Cervix Uteri 4,352 4.2
Liver 4,128 4.0
Ovary 3,472 3.4
Stomach 3,461 3.3
Others 30,413 29.4

9. Cancer % for Males
Sites %
Colorectal 16.3
Trachea, Bronchus, Lung 15.8
Nasopharynx 8.1
Lymphoma 6.8
Prostate 6.7
Liver 6.5
Leukaemia 5.4
Stomach 4.3
Bladder 3.2
Other Skin 3.0

10. Cancer % for Females
Sites %
Breast 32.1
Colorectal 10.7
Cervix Uteri 7.7
Ovary 6.1
Trachea, Bronchus, Lung 5.6
Lymphoma 3.9
Corpus Uteri 3.8
Leukaemia 3.6
Thyroid 3.0
Stomach 2.6

11. Stage of Cancer Reporting
• A total of 103,507 new cancer cases were
reported, of whom 52,794 (51.0%) had reports
on staging.
• Of the patients whose stages were reported,
9,029 (17.1%) were in stage I, 12,445 (23.6%) in
stage II, 12,135 (23.0%) in stage III and 18,885
(35.8%) in stage IV.
• Thus at the time of diagnosis, 31,020 (58.8%)
had advanced cancers (classified as either stage
III or IV).

12. Cancer as Principal Cause of Death
in Malaysia
2016 figures reported that Cancer or
Neoplasm as a cause of death was:
• No.3 in Government hospitals after
Circulatory and Respiratory system
•No.2 in Private hospitals after
Circulatory system

13. Cancer Control Programme in
Malaysia
• Recognizing the findings in 2015 when the National Cancer
Report was produced, the government of Malaysia
introduced The National Strategic Plan for Cancer Control
Programme (NSPCCP) 2016 – 2020.
• NSPCCP which would aim to:
• reduce the negative impact of cancer by decreasing the
resulting effects of cancer to the people on its morbidity,
mortality and
• improve the quality of life of the cancer patients or
survival as well as their families.

14. Cancer Control Programme in
Malaysia
• NSPCCP 2016-2020 addressed the cancer care and
management in a holistic view from primary prevention
to the rehabilitative care.
• NSPCCP also calls for supports and commitment from
both public and private cancer care agencies,
professional bodies and NGOs to address cancer burden
an management issues.
• NSPCCP is part of the strategies in the Malaysia National
Strategic Plan for Non-Communicable Disease 2016 –
2025.

15. Cancer awareness and prevention works implemented
intheUniversityofMalaysiaSabah
 In the University of Malaysia Sabah (UMS), several newly designed
courses of CPD (Continuous Professional development) which run over
one to two days were introduced in year 2013 for all the university
staff including academic, technical and clerical level.
 These courses include
 ‘Cancer Awareness and Prevention’ and
 ‘Weight Management Challenge’
 These courses convey the knowledge on NCD including cancers, its’
nature, causes and risk factors of developing them.
 Simple health parameters screening and risk factors identification
were carried out on those who attended the symposium/courses.
 Follow up was also done with health parameters measurement post 6
months and 9 months. We are still following up the first and second
cohort groups.
 Nutritional counselling was also done

17. Cancer awareness and prevention works implemented
intheUniversityofMalaysiaSabah
 Symposium of Sabah Tobacco Control in collaboration with University
Malaya Centre of Addiction Sciences (UMCAS), University of Malaya
Social Preventive Medicine Department, QE Hospital and Sabah State
Health Department
 Participants are mainly the medical and health professionals and
advocates for Tobacco control works
 Participants get the knowledge on latest global and local smoking
prevalence and morbidity/mortality caused by smoking, the many
methods of quit smoking, the new approach through inter-
professional groups
 Get to test the level of carbon monoxide (CO) in their breaths, as good
portable device to decide smoking status in quit smoking clinics
 The symposium hoped the new knowledge will help all practitioners
to carry out awareness of tobacco smoking effects on NCD including
lung cancer in their own area of workplace or NGO’s.

19. Cancer awareness & prevention works implemented in
theruralcommunityofKudatbyUMSandPERDESA
The UMS School of Medicine works in
partnership with PERDESA (Sabah Rural
Medicine Association) a non-governmental
organization, in carrying works of health
promotion in the rural community especially in
Kudat, a northern district of Sabah.
We have carried out two major projects namely:
‘Exercise for Health’ (2009-2010) and
‘Men’s Health’ (2011-2013).
Both of these projects were funded by Health
Promotion Board, of Malaysia Ministry of
Health.

20. Cancer awareness & prevention works implemented in
thecommunitybyUMSandPERDESA
• These projects involved altogether 1000 rural
folks/communities with planned activities such as:
• educating them on non-communicable diseases e.g. cancer
• promoting healthy lifestyle e.g. no smoking and reduction intake of
alcohol
• supervising weekly aerobic exercises in selected villages through
training of trainers
• held simple health-checks with pre and post questionnaires and
• individual counselling on health and diet.

21. Exercise for Health

23. Men’s Health Programme

24. Cancer screening and early detection by UMS
Schoolof Medicine
 The UMS School of Medicine which has its own polyclinic in
the urban town and community clinic in the rural.
 These clinics also plays a role in cancer prevention work
through
 health education e.g. quit smoking advices and referals, regular
exercise
 Nutritional counselling
 pap-smear screening for cervical cancer started end 2012

25. Cancer Screening in Malaysia
• The top three cancers screening/diagnosing done in Malaysia
namely for the cancers of breast, cervix and colorectal.
• Ministry of Health provides screening for these cancers
however the approach is more of opportunistic rather than
community based or organized screening.
• The National Blue Ocean Strategy (NBOS) which was officially
launched the current Malaysia Prime Minister, Datuk Seri
Najib Tun Razak has in recent years been applied in all
activities combining efforts of the different ministries and
government agencies towrads achieving the same goal when
it comes to activities towards the public or communities.

26. Current and Future Plans on Cancer Screening
• Malaysia is gradually on the move from implementing
opportunistic form of screening for cancers at population
based towards a more organized type of screening.
• Cancer screening is still opportunistic and not organized at
population based.
• Organized cancer screening programme will be one of the
ideal ways to detect early the cancers at an early stage or
identification of risk factors which may be preventable if
lifestyle or behavioural changes occurred leading towards the
reduction in the progress and risk.