National Cancer Control Strategy (NCCS)

(2013-2022)

National Cancer Control Strategy (NCCS)

The United Republic of Tanzania

Ministry of Health and Social Welfare

TABLE OF CONTENTS

ABBREVIATIONS AND ACRONYMS ... III FOREWORD ... VII ACKNOWLEDGEMENT ... VIII EXECUTIVE SUMMARY ... IX

CHAPTER 1: INTRODUCTION ... 1

đĔćĆđěĊėěĎĊĜǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕ ĆēĈĊėėĊěĊēęĎĔēĆēĉĔēęėĔđęėĆęĊČĎĊĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͘ čĊĆēĈĊėĔēęėĔđĔēęĎēĚĚĒǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙ ĆēĈĊėĈĔēęėĔđĘĎęĚĆęĎĔēĎēĆēğĆēĎĆǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙ Primary Prevention ... 6

Cancer Registration and surveillance ... 7

Early Detection (Screening and Diagnosis) ... 8

Treatment ... 10

Palliative Care ... 10

Training, Education, Research, and Human Resources Development ... 11

ĆęĎĔēĆđĊċĔėęčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͖ čĔĎĘęčĊęėĆęĊČĞċĔėǫǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͗ Strengths, Weaknesses, Opportunities, Challenges ... 14

CHAPTER 2: STRATEGIC FRAMEWORK TO GUIDE EXISTING AND FUTURE ACTIONS ... 15

ĎĘĎĔēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͙ ĎĘĘĎĔēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͙ ćďĊĈęĎěĊĘĔċęčĊĘęėĆęĊČĞǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͙ ėĎēĈĎĕđĊĘĔċęčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͚ ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͚ GOAL 1 PRIMARY PREVENTION: Reduce the incidence of cancer through primary prevention... 16

͚ǣȋ…”‡‡‹‰ƒ†‹ƒ‰‘•‹•Ȍǣ•—”‡‡ơ‡…–‹˜‡•…”‡‡‹‰ǡ‡ƒ”Ž›†‡–‡…–‹‘ƒ††‹ƒ‰‘•‹• to reduce cancer incidence and mortality ... 20

͛ǣǣ•—”‡‡ơ‡…–‹˜‡–”‡ƒ–‡–‘ˆ…ƒ…‡”–‘”‡†—…‡‘”„‹†‹–›ƒ†‘”–ƒŽ‹–› ... 22

Goal 4 [Palliative Care]: Improve quality of life for those living with, recovering from and dying of cancer and –Š‡‹”ˆƒ‹Ž‹‡•–Š”‘—‰Š•—’’‘”–ǡ”‡Šƒ„‹Ž‹–ƒ–‹‘ƒ†’ƒŽŽ‹ƒ–‹˜‡…ƒ”‡ ... 25

GOAL 5: CANCER REGISTRATION AND SURVEILLANCE:- Improve collection and analysis of information across the …ƒ…‡”…‘–”‘Ž…‘–‹——–Š”‘—‰Š‡ơ‡…–‹˜‡…ƒ…‡””‡‰‹•–”ƒ–‹‘ǡ•—”˜‡‹ŽŽƒ…‡ǡ‘‹–‘”‹‰ƒ†‡˜ƒŽ—ƒ–‹‘ 27 ͞ǣǡǣ’”‘˜‡‡ơ‡…–‹˜‡‡••‘ˆ…ƒ…‡”…‘–”‘Ž–Š”‘—‰Š–”ƒ‹‹‰ǡ education and research ... 28

–”ƒ–‡‰‹…„Œ‡…–‹˜‡͞Ǥ͚ǣ‘‡•–ƒ„Ž‹•Š…ƒ…‡”‡†—…ƒ–‹‘ƒ†–”ƒ‹‹‰’”‘‰”ƒ• ... 30

͟ǣǣ•–‹ŽŽƒ’’”‘’”‹ƒ–‡‘™Ž‡†‰‡ƒ†•‹ŽŽ•–‘•–”ƒ–‡‰‹…•–ƒơ‹ƒŽŽƒ”‡ƒ• of cancer control in Tanzania ... 30

‘ƒŽ͠ȏƒœƒ‹ƒƒ…‡”‘…‹‡–›Ȑǣ•–ƒ„Ž‹•Š…ƒ…‡”•‘…‹‡–›–Šƒ–™‹ŽŽƒ†˜‘…ƒ–‡ˆ‘”ƒ†‡ơ‡…–‹˜‡Ž›’ƒ”–‹…‹’ƒ–‡‹ •—•–ƒ‹ƒ„Ž‡…ƒ…‡”…‘–”‘Ž‹‹–‹ƒ–‹˜‡• ... 32

GOAL 9: INTEGRATION OF CANCER CONTROL INTO EXISTING HEALTH SYSTEM: Integrate cancer control interventions and services at all levels of the existing healthcare delivery system. ... 33

CHAPTER 3: INSTITUTIONAL AND MANAGEMENT FRAMEWORK ... 35

ĔĔėĉĎēĆęĎĔēĆēĉĆēĆČĊĒĊēęėĎēĈĎĕđĊĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͗ ĔĔėĉĎēĆęĎĔē ėĆĒĊĜĔėĐǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͗ Roles and Functions of the MoHSW... 36

Roles and Functions of ORCI ... 36

Roles and Functions of the Zonal Referral Level ... 37

Roles and Functions of the Regional and District Level ... 37

Roles and Functions of the Community Level ... 37

Civil society Organizations, Private Sector, and Associations of People Living with Cancer ... 37

Development Partners ... 37

ėĔĒęčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞęĔĎęĘĒĕđĊĒĊēęĆęĎĔēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͗͛ CHAPTER 4: NATIONAL HEALTH FINANCING OF CANCER ... 38

ĔěĊėēĒĊēęĚĉČĊęĆėĞđđĔĈĆęĎĔēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͗͜ ĆęĎĔēĆđ ĚēĉċĔėĆēĈĊėǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͗͜ CHAPTER 5: MONITORING AND EVALUATION FRAMEWORK ... 38

CHAPTER 6: ACTION PLAN ... 39

ĚėĕĔĘĊĔċĈęĎĔēđĆēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͗͝ ĒĕđĊĒĊēęĎēČęčĊĈęĎĔēđĆēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͔͘ Leadership for Implementation ... 40

Working in Partnership... 40

čĊĈęĎĔēđĆēǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͕͘ ǣ•—”‡‡ơ‡…–‹˜‡–”‡ƒ–‡–‘ˆ…ƒ…‡”–‘”‡†—…‡‘”„‹†‹–›ƒ†‘”–ƒŽ‹–› ... 47

„Œ‡…–‹˜‡ǣŽŽœ‘ƒŽƒ†”‡‰‹‘ƒŽŠ‘•’‹–ƒŽ•™‹–Š‡ơ‡…–‹˜‡–”‡ƒ–‡–•‡”˜‹…‡•„›͚͚͚͘ ... 47

Improve quality of life for those living with, recovering from and dying of cancer and their families through support, ”‡Šƒ„‹Ž‹–ƒ–‹‘ƒ†’ƒŽŽ‹ƒ–‹˜‡…ƒ”‡ ... 49

•–ƒ„Ž‹•Š…ƒ…‡”‡†—…ƒ–‹‘ƒ†–”ƒ‹‹‰’”‘‰”ƒ• ... 53

ǣ•–‹ŽŽƒ’’”‘’”‹ƒ–‡‘™Ž‡†‰‡ƒ†•‹ŽŽ•–‘•–”ƒ–‡‰‹…•–ƒơ‹ƒŽŽƒ”‡ƒ•‘ˆ…ƒ…‡” control in Tanzania ... 53

ǣ•–ƒ„Ž‹•Š…ƒ…‡”•‘…‹‡–›–Šƒ–™‹ŽŽƒ†˜‘…ƒ–‡ˆ‘”ƒ†‡ơ‡…–‹˜‡Ž›’ƒ”–‹…‹’ƒ–‡‹•—•–ƒ‹ƒ„Ž‡ cancer control initiatives ... 55

ƒ”‰‡–ǣ‘„‡…‘‡ƒŽ‡ƒ†‹‰ƒ†˜‘…ƒ–‡ƒ†ˆ—†”ƒ‹•‡”ˆ‘”…ƒ…‡”…‘–”‘Ž„›͚͚͚͘ ... 55

INTEGRATION OF CANCER CONTROL INTO EXISTING HEALTH SYSTEM: Integrate cancer control interventions and s ervices at all levels of the existing healthcare delivery system. ... 55

ƒ”‰‡–ǣƒ…‡”•‡”˜‹…‡•‹–‡‰”ƒ–‡†‹–‘–Š‡‡š‹•–‹‰Š‡ƒŽ–Š…ƒ”‡†‡Ž‹˜‡”›•›•–‡„›͚͚͚͘ ... 55

CHAPTER 8: THE NATIONAL CANCER CONTROL PROGRAM FRAMEWORK ... 56 ĆęĎĔēĆđĆēĈĊėĔēęėĔđėĔČėĆĒĔĒĕĔēĊēęĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͚

ĕĕĊēĉĎĝ͕ǣčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞęĊĊėĎēČĔĒĒĎęęĊĊǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͜

ĕĕĊēĉĎĝ͖ǣčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞĊĈėĊęĆėĎĆęĊĒćĊėĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͜

ĕĕĊēĉĎĝ͗ǣčĊĆęĎĔēĆđĆēĈĊėĔēęėĔđęėĆęĊČĞĔėĐĎēČėĔĚĕĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͝

ĕĕĊēĉĎĝ͘ǣęĆĐĊčĔđĉĊėĘǯĔėĐĘčĔĕĆėęĎĈĎĕĆęĎēČēĘęĎęĚęĎĔēĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͙͝

ĕĕĊēĉĎĝ͙ǣęėĆęĊČĞĊěĊđĔĕĒĊēęėĔĈĊĘĘǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ ͚͕

ABBREVIATIONS AND ACRONYMS

AIDS …“—‹”‡†—‘†‡Ƥ…‹‡…››†”‘‡

ARV –‹‡–”‘‹”ƒŽ†”—‰•

BCE ”‡ƒ•–Ž‹‹…ƒŽšƒ‹ƒ–‹‘

BSE ”‡ƒ•–‡Žˆšƒ‹ƒ–‹‘

CACX ƒ”…‹‘ƒ‘ˆ‡”˜‹š

CIN ‡”˜‹…ƒŽ–”ƒ‡’‹–Š‡Ž‹ƒŽ‡‘’Žƒ•

HBV ‡’ƒ–‹–‹•‹”—•

HEPS ‡ƒŽ–Š†—…ƒ–‹‘”‘‰”ƒ‡‡…–‹‘

HPV —ƒƒ’‹ŽŽ‘ƒ‹”—•

HIV —ƒ—‘†‡Ƥ…‹‡…›‹”—•

IAEA –‡”ƒ–‹‘ƒŽ–‘‹…‡”‰›‰‡…›

IARC –‡”ƒ–‹‘ƒŽ‰‡…›ˆ‘”‡•‡ƒ”…Š‘ƒ…‡”

INCTR –‡”ƒ–‹‘ƒŽ‡–™‘”‘ˆƒ…‡””‡ƒ–‡–ƒ†‡•‡ƒ”…Š KAP ‘™Ž‡†‰‡––‹–—†‡”ƒ…–‹…‡

KCMC ‹Ž‹ƒŒƒ”‘Š”‹•–‹ƒ‡†‹…ƒŽ‡–”‡

MEWATA ‡†‹…ƒŽ‘‡••‘…‹ƒ–‹‘‘ˆƒœƒ‹ƒ

MNH —Š‹„‹Ž‹ƒ–‹‘ƒŽ‘•’‹–ƒŽ

MoHSW ‹‹•–”›‘ˆ‡ƒŽ–Šƒ†‘…‹ƒŽ‡Žˆƒ”‡

NCCP ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž”‘‰”ƒ

NCCS ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž–”ƒ–‡‰›

NGOs ‘Ǧ‘˜‡”‡–ƒŽ”‰ƒ‹œƒ–‹‘•

ORCI …‡ƒ‘ƒ†ƒ…‡”•–‹–—–‡

PACT ”‘‰”ƒ…–‹‘ˆ‘”ƒ…‡”Š‡”ƒ’›

PASADA ƒ•–‘”ƒŽ…–‹˜‹–‹‡•ƒ†‡”˜‹…‡•ˆ‘”‡‘’Ž‡™‹–Š‹ƒ”‡•ƒŽƒƒ

PHC ”‹ƒ”›‡ƒŽ–Šƒ”‡

TACC ƒœƒ‹ƒƒ…‡”‘‹••‹‘

TPCA ƒœƒ‹ƒƒŽŽ‹ƒ–‹˜‡ƒ”‡••‘…‹ƒ–‹‘

VIA ‹•—ƒŽ•’‡…–‹‘™‹–Š…‡–‹……‹†

VILI ‹•—ƒŽ•’‡…–‹‘™‹–Š—‰‘Žǯ•‘†‹‡

WHO ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘

COMMON CANCER CASES

ƒ•‡†‘–Š‡•–”‡‰–Š‘ˆ•…‹‡–‹Ƥ…Ž‹–‡”ƒ–—”‡ǡ–Š‡ˆ‘ŽŽ‘™‹‰ƒ”‡–Š‡”‹•ˆƒ…–‘”•ˆ‘”–Š‡†‹ơ‡”‡––›’‡•‘ˆ…ƒ…‡”

™Š‹…Šƒ”‡’”‡˜ƒŽ‡–‹ƒœƒ‹ƒǣǦ Cancer of Cervix

Š‡ ”‹• ˆƒ…–‘”• ƒ”‡ ‹ˆ‡…–‹‘ ™‹–Š —ƒ ƒ’‹ŽŽ‘ƒ ‹”—•‡• ȋȌǡ ‡ƒ”Ž› ƒ‰‡ ƒ– Ƥ”•– •‡š—ƒŽ ‹–‡”…‘—”•‡ǡ ƒ›

•‡š—ƒŽ’ƒ”–‡”•‘”’ƒ”–‡”•™Š‘Šƒ˜‡Šƒ†ƒ›•‡š—ƒŽ’ƒ”–‡”•ǡ—Ž–‹’Ž‡„‹”–Š•ǡŽ‘‰Ǧ–‡”‘”ƒŽ…‘–”ƒ…‡’–‹˜‡—•‡ǡ

ƒ†…‹‰ƒ”‡––‡•‘‹‰Ǥ

Kaposi’s sarcoma

Š‡ƒ‹”‹•ˆƒ…–‘”‹•‹ˆ‡…–‹‘™‹–Š—ƒ—‘†‡Ƥ…‹‡…›‹”—•ȋȌǤ–Š‡””‹•ˆƒ…–‘”•‹…Ž—†‡ǡ„‡‹‰ƒƒŽ‡

ƒ†Šƒ˜‹‰—Ž–‹’Ž‡•‡š—ƒŽ’ƒ”–‡”•Ǥ Cancer of Oesophagus

Š‡ ‘•– ‹’‘”–ƒ– ”‹• ˆƒ…–‘”• ƒ”‡ –‘„ƒ……‘ —•‡ ƒ† ‡š…‡••‹˜‡ ƒŽ…‘Š‘Ž ‹‰‡•–‹‘Ǥ –Š‡” ’‘••‹„Ž‡ ”‹• ˆƒ…–‘”•

‹…Ž—†‡‘„‡•‹–›ǡ‹ƒ†‡“—ƒ–‡†‹‡–ǡ’‘‘”—–”‹–‹‘ǡ†‡…”‡ƒ•‡†Ž‡˜‡Ž•‘ˆ…‡”–ƒ‹—–”‹‡–•ȋ‡Ǥ‰Ǥ…ƒ”‘–‡‡ǡƒ•…‘”„‹…ƒ…‹†ǡ

”‹„‘ƪƒ˜‹ǡ‹ƒ…‹ǡ–Š‹ƒ‹‡ǡœ‹…ǡƒ‰‡•‹—ǡƒ†•‡Ž‡‹—Ȍǡƒ†‹•—ƥ…‹‡–…‘•—’–‹‘‘ˆˆ”—‹–•ƒ†˜‡‰‡–ƒ„Ž‡•Ǥ Breast Cancer

Š‡”‹•ˆƒ…–‘”•ƒ”‡ˆƒ‹Ž›Š‹•–‘”›ȋ‡•’‡…‹ƒŽŽ›‘–Š‡”‘”•‹•–‡”Ȍ‘ˆ„”‡ƒ•–…ƒ…‡”ǡ’‡”•‘ƒŽŠ‹•–‘”›‘ˆ„”‡ƒ•–ǡ‘˜ƒ”‹ƒǡ

‘” ‡†‘‡–”‹ƒŽ …ƒ…‡”ǡ •—•…‡’–‹„‹Ž‹–› ‰‡‡• ȋǦ͕ǡ Ǧ͖Ȍǡ •‘‡ ˆ‘”• ‘ˆ „‡‹‰ „”‡ƒ•– †‹•‡ƒ•‡ ȋƒ–›’‹…ƒŽ

Š›’‡”’Žƒ•‹ƒȌǡ ‡•–”—ƒ–‹‘ ƒ– ƒ ‡ƒ”Ž› ƒ‰‡ǡ Žƒ–‡ ‡‘’ƒ—•‡ǡ ‡˜‡” „‡ƒ”‹‰ …Š‹Ž†”‡ǡ Ƥ”•– …Š‹Ž† „‘” ƒˆ–‡” ƒ‰‡

͔͗ǡ Š‹‰Š †‘•‡• ‘ˆ ‹‘‹œ‹‰ ”ƒ†‹ƒ–‹‘ǡ Ž‘‰ –‡” —•‡ ‘ˆ ’‘•–Ǧ‡‘’ƒ—•‡ ‡•–”‘‰‡• ƒ† ’”‘‰‡•–‹ǡ ‘„‡•‹–› ƒˆ–‡”

‡‘’ƒ—•‡ǡƒ†‡š…‡••‹˜‡ƒŽ…‘Š‘Ž…‘•—’–‹‘Ǥ–Š‡”’‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡†‹‡–ƒ”›ˆƒ–ƒ†’Š›•‹…ƒŽ‹ƒ…–‹˜‹–›Ǥ

Cancers of Head & Neck

‘„ƒ……‘ƒ†ƒŽ…‘Š‘Ž—•ƒ‰‡ƒ……‘—–ˆ‘”‘•–Š‡ƒ†Ƭ‡……ƒ…‡”•Ǥ‘–Š‡””‹•ˆƒ…–‘”‹•ƒ†‹‡–Ž‘™‹ˆ”—‹–•ƒ†

˜‡‰‡–ƒ„Ž‡•Ǥ–Š‡”’‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡’‘‘”‘”ƒŽŠ›‰‹‡‡ǡ–”ƒ—ƒƒ†—•‡‘ˆ‘—–Š™ƒ•Š‡•™‹–ŠŠ‹‰ŠƒŽ…‘Š‘Ž

…‘–‡–Ǥ

Non-Hodgkin Lymphoma

‹• ˆƒ…–‘”• ƒ”‡ ”‡†—…‡† ‹—‡ ˆ—…–‹‘ ’ƒ”–‹…—Žƒ”Ž› †—‡ –‘ ‹ˆ‡…–‹‘ ™‹–Š ǡ ’•–‡‹Ǧƒ”” ‘” Š—ƒ Ǧ…‡ŽŽ

Ž‡—ƒ‡‹ƒȀ Ž›’Š‘ƒ ˜‹”—•Ǥ ‘••‹„Ž‡ ”‹• ˆƒ…–‘”• ƒ”‡ ‘”‰ƒ –”ƒ•’Žƒ–ǡ ‘……—’ƒ–‹‘ƒŽ ‡š’‘•—”‡ –‘ ’‡•–‹…‹†‡•ǡ

Š‡”„‹…‹†‡•ǡ‘”‘”‰ƒ‹…•‘Ž˜‡–•Ǥ Hodgkin Lymphoma

‹•ˆƒ…–‘”•ƒ”‡‹ˆ‡…–‹‘—•‘‘—…Ž‡‘•‹•ƒ†’•–‡‹Ǧƒ””˜‹”—•‹ˆ‡…–‹‘Ǥ‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡ˆƒ‹Ž›Š‹•–‘”›

‘ˆ‘†‰‹Ž›’Š‘ƒ‡•’‡…‹ƒŽŽ›ƒ‘‰•‹„Ž‹‰•ƒ†‰‡‡–‹…ˆƒ…–‘”•Ǥ Skin Cancer

ƒŒ‘”‹–› ‘ˆ –Š‡ ’ƒ–‹‡–• ™‹–Š •‹ …ƒ…‡”• ‹ ƒœƒ‹ƒ ƒ”‡ ƒŽ„‹‘•Ǥ Š‡ ”‹• ˆƒ…–‘”• ƒ”‡ —Ž–”ƒ˜‹‘Ž‡– ”ƒ†‹ƒ–‹‘

ȋ•—Ž‹‰Š–Ȍǡˆƒ‹”•‹ǡŠ‹‰Š†‘•‡•‘ˆ‹‘‹œ‹‰”ƒ†‹ƒ–‹‘ǡ‘……—’ƒ–‹‘ƒŽ‡š’‘•—”‡–‘ƒ”•‡‹…ǡ’‘Ž›…›…Ž‹…Š›†”‘…ƒ”„‘•

ȋ…‘ƒŽ–ƒ”•ǡ’‹–…Š‡•ǡƒ†ƒ•’ŠƒŽ–ǡ…”‡‘•‘–‡ǡ•‘‘–ǡŽ—„”‹…ƒ–‹‰ƒ†…—––‹‰‘‹Ž•Ȍƒ†”ƒ”‡Š‡”‡†‹–ƒ”›†‹•‡ƒ•‡••—…Šƒ•

—Ž–‹’Ž‡„ƒ•ƒŽ…‡ŽŽ…ƒ”…‹‘ƒ•›†”‘‡ǡš‡”‘†‡”ƒ’‹‰‡–‘•—ǡƒ†ƒŽ„‹‹•Ǥ‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡„—”

•…ƒ”•ǡ…Š”‘‹…‹ˆ‡…–‹‘•ǡƒ†’Š‘–‘•‡•‹–‹œ‡”•‹–ƒ‹‰ǡ…‘•‡–‹…•ǡƒ†‡†‹…‹‡•Ǥ Bladder Carcinoma

Š‡‘•–‹’‘”–ƒ–”‹•ˆƒ…–‘”‹•„Žƒ††‡”‹ˆ‡…–‹‘™‹–Š•…Š‹•–‘•‘ƒŠƒ‡ƒ–‘„‹—ȋƒ’ƒ”ƒ•‹–‹…ƪƒ–™‘”Ȍƒ†

…‹‰ƒ”‡––‡•‘‹‰Ǣ‘–Š‡””‹•ˆƒ…–‘”•ƒ”‡‘……—’ƒ–‹‘ƒŽ‡š’‘•—”‡–‘„‡œ‹†‹‡ƒ†͖Ǧƒ’Š–Š›Žƒ‹‡ƒ†‘……—’ƒ–‹‘•

‹–Š‡†›‡ǡŽ‡ƒ–Š‡”‘””—„„‡”‹†—•–”›Ǥ‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡Š‡ƒ˜›…‘ơ‡‡…‘•—’–‹‘ǡ—”‹ƒ”›–”ƒ…–‹ˆ‡…–‹‘•

‘”Ž‘™—”‹‡ƪ‘™ǡ†‹‡–ƒ”›ˆƒ…–‘”•ǡ–‘„ƒ……‘—•‡ƒ†‰‡‡–‹…ˆƒ…–‘”•Ǥ

Leukaemia

Š‡”‹•ˆƒ…–‘”•ƒ”‡ˆƒ‹Ž›Š‹•–‘”›ǡŠ‹‰Š†‘•‡•‘ˆ‹‘‹œ‹‰”ƒ†‹ƒ–‹‘ǡƒŽ›Žƒ–‹‰†”—‰•—•‡†–‘–”‡ƒ–…ƒ…‡”ƒ†‘–Š‡”

†‹•‡ƒ•‡•ǡ ƒ† ‘……—’ƒ–‹‘ƒŽ‡š’‘•—”‡ –‘ „‡œ‡‡Ǥ ‘••‹„Ž‡ ”‹• ˆƒ…–‘”• ƒ”‡ ‡š’‘•—”‡ –‘ ‡Ž‡…–”‘ƒ‰‡–‹… Ƥ‡Ž†•ǡ

’‡•–‹…‹†‡•ǡ•‘‹‰ǡƒ†•‡˜‡”ƒŽ‹—‡Ǧ”‡Žƒ–‡††‹•‡ƒ•‡•Ǥ

Š‡”‹•ˆƒ…–‘”•ˆ‘”‘–Š‡”…ƒ…‡”•‘„•‡”˜‡†ƒ–ǡƒŽ–Š‘—‰Š‘–•‘ˆ”‡“—‡–Ž›ǣǦ Liver

Š‡”‹•ˆƒ…–‘”•ƒ”‡…Š”‘‹…‹ˆ‡…–‹‘™‹–ŠŠ‡’ƒ–‹–‹•‘”˜‹”—•ǡ…‹””Š‘•‹•‘ˆ–Š‡Ž‹˜‡”ȋ…Š”‘‹…Ž‹˜‡”‹Œ—”›ǡ—•—ƒŽŽ›

†—‡–‘ƒŽ…‘Š‘Žƒ„—•‡Ȍǡƒƪƒ–‘š‹‹‰‡•–‹‘ȋ’”‘†—…‡†„›ƒ…‘‘‘Ž†–Šƒ–‹˜ƒ†‡•’‘‘”Ž›•–‘”‡†’‡ƒ—–•ƒ†

‘–Š‡”ˆ‘‘†•Ȍǡƒ†‘……—’ƒ–‹‘ƒŽ‡š’‘•—”‡–‘–Š‘”‹—†‹‘š‹†‡‘”˜‹›Ž…ŠŽ‘”‹†‡Ǥ Lung

‘„ƒ……‘•‘‹‰‹•”‡•’‘•‹„Ž‡ˆ‘”‡ƒ”Ž›͔͝Ψ‘ˆƒŽŽŽ—‰…ƒ…‡”•Ǥ–Š‡”…‘–”‹„—–‹‰”‹•ˆƒ…–‘”•ƒ”‡‡˜‹”‘‡–ƒŽ

–‘„ƒ……‘•‘‡ȋ•‡…‘†ǦŠƒ†•‘‡ȌǤ‹‰Š†‘•‡•‘ˆ‹‘‹œ‹‰”ƒ†‹ƒ–‹‘ǡ”‡•‹†‡–‹ƒŽ”ƒ†‘‡š’‘•—”‡ƒ†‘……—’ƒ–‹‘ƒŽ

‡š’‘•—”‡–‘—•–ƒ”†‰ƒ•ǡ…ŠŽ‘”‘‡–Š›Ž‡–Š‡”•ǡ‹‘”‰ƒ‹…ƒ”•‡‹…ǡ…Š”‘‹—ǡ‹…‡Žǡ˜‹›Ž…ŠŽ‘”‹†‡ǡ”ƒ†‘ǡƒ•„‡•–‘•

‘”„›Ǧ’”‘†—…–•‘ˆˆ‘••‹Žˆ—‡Žƒ”‡ƒŽ•‘–Š‘—‰Š––‘‹…”‡ƒ•‡”‹•Ǥ‘••‹„Ž‡”‹•ˆƒ…–‘”•ƒ”‡ƒ‹”’‘ŽŽ—–‹‘ƒ†‹•—ƥ…‹‡–

…‘•—’–‹‘‘ˆˆ”—‹–•ƒ†˜‡‰‡–ƒ„Ž‡•Ǥ Larynx

‘•–…ƒ•‡•ƒ”‡…ƒ—•‡†„›…‹‰ƒ”‡––‡•‘‹‰Ǥ–Š‡””‹•ˆƒ…–‘”•ƒ”‡ƒŽ…‘Š‘Žƒ†‘……—’ƒ–‹‘ƒŽ‡š’‘•—”‡–‘ƒ•„‡•–‘•Ǥ Prostate

‹•ˆƒ…–‘”•ƒ”‡•‘‡–›’‡•‘ˆ’”‘•–ƒ–‹…Š›’‡”’Žƒ•‹ƒƒ†ƒˆƒ‹Ž›Š‹•–‘”›ǡ‡•’‡…‹ƒŽŽ›ƒˆƒ–Š‡”‘”„”‘–Š‡”Ǥ‘••‹„Ž‡

”‹•ˆƒ…–‘”•ƒ”‡ƒ†‹‡–Š‹‰Š‹ƒ‹ƒŽˆƒ–ǡ‘„‡•‹–›ǡŠ‘”‘ƒŽˆƒ…–‘”•ǡƒ•‡š—ƒŽŽ›–”ƒ•‹––‡†ƒ‰‡–ǡ•‘‹‰ǡƒŽ…‘Š‘Žǡ

ƒ†’Š›•‹…ƒŽ‹ƒ…–‹˜‹–›Ǥ

FOREWORD

ƒ…‡”‹•‘™”‡…‘‰‹œ‡†‰Ž‘„ƒŽŽ›ƒ•‘‡‘ˆ–Š‡Ž‡ƒ†‹‰‘Ǧ…‘—‹…ƒ„Ž‡†‹•‡ƒ•‡•Ǣ‰Ž‘„ƒŽŽ›†‹ơ‡”‡–…ƒ…‡”•

…‘–”‹„—–‡ –‘ ‘˜‡” ͛Ǥ͝ ‹ŽŽ‹‘ †‡ƒ–Š• ‡“—‹˜ƒŽ‡– –‘ ͕͗Ψ ‘ˆ –‘–ƒŽ ‰Ž‘„ƒŽ ‘”–ƒŽ‹–›Ȍ ‡ƒ…Š ›‡ƒ” ƒ† –Š‹• Ƥ‰—”‡ ‹•

’”‘Œ‡…–‡†–‘”‹•‡–‘‡ƒ”Ž›͕͔‹ŽŽ‹‘—Ž‡••–Š‡’”‘„Ž‡‹•ƒ††”‡••‡†—”‰‡–Ž›Ǥ

ƒœƒ‹ƒ‹•‘–•’ƒ”‡†ˆ”‘–Š‡†‡˜ƒ•–ƒ–‹‰‡ơ‡…–•‘ˆ…ƒ…‡”Ǣ‹–‹•‡•–‹ƒ–‡†–Šƒ–͔͘ǡ͔͔͔‡™…ƒ…‡”…ƒ•‡•ƒ”‡

”‡’‘”–‡†‘ˆ™Š‹…Š͔͜Ψ‘ˆ–Š‘•‡˜‹…–‹•†‹‡‡˜‡”››‡ƒ”ƒ†–Š‡—„‡”‹•”‡’‘”–‡†–‘„‡‹…”‡ƒ•‹‰„‘–Š‹ƒœƒ‹ƒ

ƒ† ™‘”Ž†™‹†‡Ǥ Š‡ ‰‘˜‡”‡–ǡ –Š”‘—‰Š –Š‡ ‹‹•–”› ‘ˆ ‡ƒŽ–Š ƒ† ‘…‹ƒŽ ‡Žˆƒ”‡ ȋ‘Ȍ ™ƒ• ƒŽƒ”‡†

™‹–Š–Š‡•‹–—ƒ–‹‘ƒ†‡•–ƒ„Ž‹•Š‡†…ƒ…‡”•‡”˜‹…‡•‹–Š‡…‘—–”›•‹…‡͕͔͛͝•Ǥ‡‘ˆ–Š‡‡›‹Ž‡•–‘‡•™ƒ•–Š‡

‡•–ƒ„Ž‹•Š‡–‘ˆ–Š‡ƒ–‹‘ƒŽƒ…‡”•–‹–—–‡Ǧ…‡ƒ‘ƒ†ƒ…‡”•–‹–—–‡ȋȌǡ‹͕͚͝͝–Š”‘—‰Šƒƒ…–‘ˆ

ƒ”Ž‹ƒ‡–Ǥ‹…‡–Š‡ǡ–Š‡ǡ–‡”ƒ–‹‘ƒŽ–‘‹…‡”‰›‰‡…›ȋȌǡƒ†‘–Š‡”’ƒ”–‡”•Šƒ˜‡„‡‡

‹–Š‡†”‹˜‡”ǯ••‡ƒ–‹…‘„ƒ–‹‰…ƒ…‡”‹–Š‡…‘—–”›†‡•’‹–‡Ž‹‹–‡†”‡•‘—”…‡•ǡ„‘–ŠƤƒ…‹ƒŽƒ†Š—ƒǤ

‘‡‘ˆ–Š‡•‹‰‹Ƥ…ƒ–•–‡’•ƒ†‡„›–Š‡‹…‘ŽŽƒ„‘”ƒ–‹‘™‹–Š‹–•’ƒ”–‡”•‹…Ž—†‡‡•–ƒ„Ž‹•Š‡–‘ˆŠ‘•’‹–ƒŽǦ

„ƒ•‡†…ƒ…‡””‡‰‹•–”›ǡ…ƒ…‡”ƒ™ƒ”‡‡••‡†—…ƒ–‹‘–‘–Š‡’—„Ž‹…ǡˆƒ…‹Ž‹–›Ǧ„ƒ•‡†ƒ•™‡ŽŽƒ•‘—–”‡ƒ…ŠǦ„ƒ•‡†…‡”˜‹…ƒŽ

ƒ†„”‡ƒ•–…ƒ…‡”•…”‡‡‹‰•‡”˜‹…‡•ǡ’ƒŽŽ‹ƒ–‹˜‡…ƒ”‡•‡”˜‹…‡•ƒ†…‘†—…–‹‰Ž‘…ƒŽƒ†—Ž–‹Ǧ…‡–”‡”‡•‡ƒ”…Š‡•Ǥ

Ž–Š‘—‰Š‘Ž›͕͔Ψ‘ˆ…ƒ…‡”…ƒ•‡•”‡ƒ…Š–Š‡ˆ‘”–”‡ƒ–‡–ǡ͔͜Ψ‘ˆ…ƒ•‡•”‡’‘”––‘–Š‡‹•–‹–—–‡ƒ†ƒŒ‘”‹–›

‘ˆ–Š‡ƒ–Žƒ–‡•–ƒ‰‡•‘ˆ–Š‡†‹•‡ƒ•‡Ǥ‘”‡‘˜‡”ǡ‘™Ž‡†‰‡‘…ƒ…‡”’”‡˜‡–‹‘ǡ…—”‡ƒ†…ƒ”‡‹••–‹ŽŽƒ›•–‡”›

–‘ƒ›’‡‘’Ž‡‹…Ž—†‹‰–Š‡˜‹…–‹•‘ˆ–Š‡†‹•‡ƒ•‡†‡•’‹–‡–Š‡ˆƒ…––Šƒ–‘‡–Š‹”†‘ˆ…ƒ…‡”…ƒ„‡’”‡˜‡–‡†ƒ†

‡ƒ”Ž›†‡–‡…–‹‘ƒ†‡ơ‡…–‹˜‡–”‡ƒ–‡–‘ˆƒˆ—”–Š‡”–Š‹”†‹•ƒŽ•‘’‘••‹„Ž‡Ǥ

Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ƒ†˜‘…ƒ–‡•ˆ‘”†‡˜‡Ž‘’‡–‘ˆƒ–‹‘ƒŽ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒ•ƒ•–Š‡„‡•–‡ƒ•

‘ˆ”‡†—…‹‰–Š‡‹…‹†‡…‡•ƒ†‹’ƒ…–•‘ˆ…ƒ…‡”ƒ†‹’”‘˜‹‰–Š‡“—ƒŽ‹–›‘ˆŽ‹ˆ‡‘ˆ–Š‘•‡™‹–Š…ƒ…‡”™‹–Š‹

ƒ˜ƒ‹Žƒ„Ž‡”‡•‘—”…‡•ǤŠ‹•‹˜‘Ž˜‡•ƒ…‘’”‡Š‡•‹˜‡ǡ’Žƒ‡†ƒ’’”‘ƒ…Š–Šƒ–™‹ŽŽ‹†‡–‹ˆ›ƒ†‹’Ž‡‡–’”‹‘”‹–‹‡•

ˆ‘”ƒ…–‹‘ˆ”‘…ƒ…‡”’”‡˜‡–‹‘ƒ…–‹˜‹–‹‡•–Š”‘—‰Š–”‡ƒ–‡–ǡ”‡Šƒ„‹Ž‹–ƒ–‹‘ƒ†’ƒŽŽ‹ƒ–‹˜‡…ƒ”‡Ǥ

—– –Š‡•‡ ‡ơ‘”–• ƒ† •‡”˜‹…‡• ‡‡† –‘ „‡ …‘‘”†‹ƒ–‡† ‹ ƒ …‘Š‡”‡– ƒ† ‘•– …‘•– ‡ơ‡…–‹˜‡ ƒ‡” Š‡…‡

–Š‡ ‡‡† ˆ‘” ƒ ƒ–‹‘ƒŽ ƒ…‡” ‘–”‘Ž –”ƒ–‡‰› ȋȌ ™Š‹…Š ‹• ƒ ˆ—†ƒ‡–ƒŽ •–‡’ ‹ –Š‡ †‡˜‡Ž‘’‡– ƒ†

‹’Ž‡‡–ƒ–‹‘‘ˆƒ…‘’”‡Š‡•‹˜‡ƒ†…‘‘”†‹ƒ–‡†’”‘‰”ƒ–‘…‘–”‘Ž…ƒ…‡”‹ƒœƒ‹ƒǤŠ‡‰‘˜‡”‡–

‘ˆ ƒœƒ‹ƒ –Š”‘—‰Š –Š‡ ‘ ‡•–ƒ„Ž‹•Š‡† ƒ ƒ–‹‘ƒŽ •–‡‡”‹‰ …‘‹––‡‡ –‘ Ž‡ƒ† ƒ† ‘˜‡”•‡‡ –Š‡ ™‘” ‘ˆ

ˆ‘”—Žƒ–‹‘ƒ†‹’Ž‡‡–ƒ–‹‘‘ˆƒƒ–‹‘ƒŽ…ƒ…‡”…‘–”‘Ž•–”ƒ–‡‰›ƒ†ƒ…–‹‘’ŽƒǤ‡…‘‰‹œ‹‰–Š‡‹’‘”–ƒ…‡

‘ˆ‡ơ‡…–‹˜‡…‘‘”†‹ƒ–‹‘‘ˆƒ–‹‘ƒŽƒ…‡”…‘–”‘Žƒ†’”‡˜‡–‹‘•‡”˜‹…‡•‹–Š‡‡–‹”‡…‘—–”›ǡ–Š‡‘Šƒ•

‡ơ‡…–‡†ƒƒ–‹‘ƒŽ…‘‘”†‹ƒ–‹‘‘ƥ…‡Ǥ

Š‡†‡˜‡Ž‘’‡–‘ˆ–Š‹••–”ƒ–‡‰›”‡ƪ‡…–•ƒ•Šƒ”‡†…‘‹–‡––‘”‡†—…‹‰–Š‡‹…‹†‡…‡‘ˆ…ƒ…‡”ƒ†‹’”‘˜‹‰

–Š‡“—ƒŽ‹–›‘ˆŽ‹ˆ‡‘ˆ–Š‘•‡™Š‘†‡˜‡Ž‘’…ƒ…‡”‡•’‡…‹ƒŽŽ›–Š‡‘•–˜—Ž‡”ƒ„Ž‡ǡƒ†‹–‡‰”ƒ–‹‰…ƒ…‡”…‘–”‘Ž

•‡”˜‹…‡•ƒ†‹–‡”˜‡–‹‘‹–Š‡‡š‹•–‹‰Š‡ƒŽ–Š…ƒ”‡•‡”˜‹…‡•Ǥ™‘—Ž†Ž‹‡–‘…ƒŽŽ—’‘†‡˜‡Ž‘’‡–’ƒ”–‡”•ƒ†

‘–Š‡”•–ƒ‡Š‘Ž†‡”•–‘•—’’‘”–—•‹–Š‡•‡‡†‡ƒ˜‘”•‰‹˜‡–Šƒ––Š‹••–”ƒ–‡‰›ƒ†ƒ…–‹‘’Žƒ…ƒ‘–„‡‹’Ž‡‡–‡†

™‹–Š‘—–‹–‡”ƒŽƒ†‡š–‡”ƒŽ•‘—”…‡•Ƥƒ…‹ƒŽ”‡•‘—”…‡•Ǥ

………

Regina L. Kikuli

ACTING PERMANENT SECRETARY

ACKNOWLEDGEMENT

™‘—Ž† Ž‹‡ –‘ –Šƒ ƒŽŽ –Š‡ Ž‘…ƒŽ ƒ• ™‡ŽŽ ƒ• ‹–‡”ƒ–‹‘ƒŽ ’ƒ”–‡”• ˆ‘” –Š‡‹” ˜ƒŽ—ƒ„Ž‡ …‘–”‹„—–‹‘• –‘™ƒ”†•

…‘’Ž‡–‹‘‘ˆ–Š‹•†‘…—‡–ǤŠ‡•—……‡••ˆ—Ž†‡˜‡Ž‘’‡–‘ˆ–Š‡ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž–”ƒ–‡‰›ƒ†ƒ…–‹‘

’Žƒ‹˜‘Ž˜‡†Ž‘‰…‘•—Ž–ƒ–‹˜‡‡‡–‹‰•‘ˆ–Š‡ƒ–‹‘ƒŽ•–‡‡”‹‰…‘‹––‡‡ˆ‘”…ƒ…‡”…‘–”‘Žƒ†˜ƒŽ—‡†‹’—–

ˆ”‘ƒ™‹†‡”ƒ‰‡‘ˆ•–ƒ‡Š‘Ž†‡”•Ǥ

—”–Š‡”‘”‡ǡ–Š‡•—……‡••ˆ—Ž…‘’Ž‡–‹‘‘ˆ–Š‹•†‘…—‡–™ƒ•ƒ†‡’‘••‹„Ž‡„›‡„‡”•‘ˆ‰‘˜‡”‡–ƒŽƒ•

™‡ŽŽƒ•‘‰‘˜‡”‡–ƒŽ‘”‰ƒ‹œƒ–‹‘•†—”‹‰•–ƒ‡Š‘Ž†‡”•ǯ™‘”•Š‘’ǤŠ‡…‘–”‹„—–‹‘ˆ”‘–Š‡‹†‹˜‹†—ƒŽ•ƒ†

‘”‰ƒ‹œƒ–‹‘•‹•Š‹‰ŠŽ›ƒ…‘™Ž‡†‰‡†Ǥ

Š‡ ™‘—Ž† Ž‹‡ –‘ ƒ…‘™Ž‡†‰‡ ƒŽŽ –Š‘•‡ ™Š‘ …‘–”‹„—–‡† ‹ ‘‡ ™ƒ› ‘” ƒ‘–Š‡” –‘ –Š‡ •—……‡••ˆ—Ž

†‡˜‡Ž‘’‡–‘ˆ–Š‹•†‘…—‡–ǤŠ‡‹‹•–”›’ƒ”–‹…—Žƒ”Ž›™‹•Š‡•–‘ƒ…‘™Ž‡†‰‡–Š‡‹˜ƒŽ—ƒ„Ž‡…‘–”‹„—–‹‘‘ˆ

ǡ”‘‰”ƒ…–‹‘ˆ‘”ƒ…‡”Š‡”ƒ’›ȋȌƒ†–‡”ƒ–‹‘ƒŽ–‘‹…‡”‰›‰‡…›ȋȌˆ‘”–Š‡‹”Ƥƒ…‹ƒŽ

ƒ†–‡…Š‹…ƒŽ•—’’‘”–Ǥ

ƒ•– „—– ‘– Ž‡ƒ•–ǡ –Š‡ ‹‹•–”› ™‘—Ž† Ž‹‡ –‘ ƒ…‘™Ž‡†‰‡ –Š‡ ‰‘˜‡”‡– ‘ˆ ƒœƒ‹ƒ –Š”‘—‰Š –Š‡ ˆ‘”‡”

‹‹•–‡”•ˆ‘”‡ƒŽ–Šƒ†‘…‹ƒŽ‡Žˆƒ”‡ˆ‘”•—’’‘”–‹‰–Š‹•‹‹–‹ƒ–‹˜‡Ǥ

ǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǥǤ Dr Donan W. Mmbando

ACTING CHIEF MEDICAL OFFICER

EXECUTIVE SUMMARY

˜‡”–Š‡›‡ƒ”•ǡƒœƒ‹ƒŠƒ•”‡…‘”†‡†‹…”‡ƒ•‡‹–Š‡—„‡”‘ˆ‡™…ƒ…‡”…ƒ•‡•ƒ††‡ƒ–Š•ǢŽƒ…‘ˆ…‘‘”†‹ƒ–‡†

ƒ†ˆ—†‡†ƒ–‹‘ƒŽ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒŠƒ•”‡•—Ž–‡†‹‹‡“—‹–ƒ„Ž‡ƒ……‡••–‘•‡”˜‹…‡•ǡŽƒ–‡•–ƒ‰‡’”‡•‡–ƒ–‹‘•

ƒ†’‘‘”–”‡ƒ–‡–‘—–…‘‡•Ž‡ƒ†‹‰–‘•‹‰‹Ƥ…ƒ–—„‡”‘ˆ…ƒ…‡”’ƒ–‹‡–†›‹‰”ƒ–Š‡”–Šƒ‰‡––‹‰…—”‡†Ǥ

Š‡ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž–”ƒ–‡‰›ȋȌ‹•ƒ”‘ƒ†ƒ’–‘™ƒ”†–Š‡†‡˜‡Ž‘’‡–ƒ†‹’Ž‡‡–ƒ–‹‘‘ˆƒ

…‘’”‡Š‡•‹˜‡ ƒ† …‘‘”†‹ƒ–‡† ƒ–‹‘ƒŽ ”‡•’‘•‡ –‘ …ƒ…‡” ‹ ƒœƒ‹ƒǤ Š‡ •—……‡••ˆ—Ž †‡˜‡Ž‘’‡– ‘ˆ –Š‡

ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž–”ƒ–‡‰›ƒ†ƒ…–‹‘’Žƒ‹˜‘Ž˜‡†Ž‘‰…‘•—Ž–ƒ–‹˜‡‡‡–‹‰•‘ˆ–Š‡ƒ–‹‘ƒŽ•–‡‡”‹‰

…‘‹––‡‡ ˆ‘” …ƒ…‡” …‘–”‘Ž ƒ† ˜ƒŽ—‡† ‹’—– ˆ”‘ ƒ ™‹†‡ ”ƒ‰‡ ‘ˆ ‹†‹˜‹†—ƒŽ•ǡ ‰”‘—’•ǡ ‘”‰ƒ‹œƒ–‹‘• ƒ†

‡„‡”•†—”‹‰ƒ•–ƒ‡Š‘Ž†‡”•ǯ™‘”•Š‘’Ǥ

Š‡ •‡–•’”‹…‹’Ž‡•ƒ†‰‘ƒŽ•–‘‰—‹†‡‡š‹•–‹‰ƒ†ˆ—–—”‡ƒ…–‹‘•–‘…‘–”‘Ž…ƒ…‡”ǤŠ‡‡›’—”’‘•‡•‘ˆ–Š‡

•–”ƒ–‡‰›ƒ”‡–‘‹–‡‰”ƒ–‡…ƒ…‡”…‘–”‘Ž‹–‘‡š‹•–‹‰Š‡ƒŽ–Š…ƒ”‡†‡Ž‹˜‡”›•›•–‡ǡ”‡†—…‡–Š‡‹…‹†‡…‡ƒ†‹’ƒ…–

‘ˆ…ƒ…‡”ǡ‡Šƒ…‡“—ƒŽ‹–›‘ˆŽ‹ˆ‡ˆ‘”–Š‘•‡™‹–Š…ƒ…‡”ƒ†”‡†—…‡‹‡“—ƒŽ‹–‹‡•™‹–Š”‡•’‡…––‘ƒ……‡••–‘…ƒ…‡”

…ƒ”‡Ǥ

VISION

‘ƒ‡ƒœƒ‹ƒƒ‘‰…‘—–”‹‡•™‹–ŠŽ‘™…ƒ…‡”„—”†‡

MISSION

‘’”‘˜‹†‡ƒ…‘‘”†‹ƒ–‡†ǡ…‘’”‡Š‡•‹˜‡ƒ†”‡•’‘•‹˜‡ǡ

ƒ–‹‘ƒŽ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒˆ‘”ƒœƒ‹ƒǤ

Š‡‘˜‡”ƒŽŽ‘„Œ‡…–‹˜‡‘ˆ–Š‹••–”ƒ–‡‰›‹•–‘…‘˜‡”–Š‡‡–‹”‡…‘–‹——‘ˆ…ƒ…‡”’”‡˜‡–‹‘ƒ†…‘–”‘ŽǢ‹–•’‡…‹Ƥ…ƒŽŽ›

ƒ‹•–‘’”‘‘–‡…ƒ…‡”’”‡˜‡–‹‘ƒ†‡ƒ”Ž›†‡–‡…–‹‘ƒ†‹’”‘˜‡†‹ƒ‰‘•‹•ƒ†–”‡ƒ–‡–‹…Ž—†‹‰’ƒŽŽ‹ƒ–‹˜‡

…ƒ”‡ǤŠ‡•–”ƒ–‡‰›ƒŽ•‘ƒ‹•–‘’”‘‘–‡…ƒ…‡”•—”˜‡‹ŽŽƒ…‡ǡ”‡‰‹•–”ƒ–‹‘ƒ†”‡•‡ƒ”…ŠǤ Key interventions

i. Primary prevention: –Š‹•‹•–Š‡‘•–‡ƥ…‹‡–ƒ†…‘•–Ǧ‡ơ‡…–‹˜‡ˆ‘”‘ˆ…ƒ…‡”…‘–”‘ŽǢ–Š‡‰‘ƒŽ‘ˆ’”‹ƒ”›

’”‡˜‡–‹‘‹•–‘”‡†—…‡‡š’‘•—”‡–‘…ƒ…‡”–Šƒ–™‹ŽŽŽƒ–‡”Ž‡ƒ†–‘”‹•ˆƒ…–‘”•Ǥ’‡…‹Ƥ…‹–‡”˜‡–‹‘•‹…Ž—†‡

’”‘˜‹•‹‘‘ˆ˜ƒ……‹ƒ–‹‘ˆ‘”‰‹”Ž•ƒ‰‡†͝Ȃ͕͗›‡ƒ”•ƒ†’”‘‘–‡ƒ–‹Ǧ–‘„ƒ……‘…ƒ’ƒ‹‰•Ǥ

ii. Early detection (screening and diagnosis): Š‹•‹–‡”˜‡–‹‘‹•‘™–‘‰”‡ƒ–Ž›”‡†—…‡–Š‡„—”†‡‘ˆ

…ƒ…‡”•ƒ†‹’”‘˜‡‘—–…‘‡•Ǥ–•ƒ‹‹•–‘†‡–‡…––Š‡…ƒ…‡”™Š‡‹–‹•Ž‘…ƒŽ‹œ‡†–‘–Š‡„‘†›‘”‰ƒ‘ˆ

‘”‹‰‹ǡ„‡ˆ‘”‡‹–Šƒ•–‹‡–‘•’”‡ƒ†–‘‘–Š‡”’ƒ”–•‘ˆ–Š‡„‘†›Ǥš’ƒ•‹‘‘ˆ–”ƒ‹‹‰ƒ†•…”‡‡‹‰‘ˆ

…‡”˜‹…ƒŽ…ƒ…‡”ƒ•™‡ŽŽƒ•†‡–‡…–‹‘ˆ‘”„”‡ƒ•–ǡ’”‘•–ƒ–‡ƒ†…Š‹Ž†Š‘‘†…ƒ…‡”‹ƒŽŽœ‘ƒŽƒ†”‡‰‹‘ƒŽ

Š‘•’‹–ƒŽ•ƒ”‡ƒ‘‰’”‹‘”‹–›‹–‡”˜‡–‹‘•Ǥ

‹‹‹Ǥ Treatment: Š‡‹ˆ”ƒ•–”—…–—”‡ˆ‘”…ƒ…‡”–”‡ƒ–‡–‹•‹’‘”–ƒ––‘‡•—”‡”‡†—…–‹‘‹‘”–ƒŽ‹–›Ǥ Š‡

‡‡†ˆ‘”ƒ‘”‡‹–‡‰”ƒ–‡†ƒ’’”‘ƒ…Š–‘–”‡ƒ–‡–ƒ†…ƒ”‡ǡ™‹–Š–Š‡’ƒ–‹‡–ƒ•–Š‡ˆ‘…—•ǡ‹•”‡…‘‰‹œ‡†ƒ•

…”‹–‹…ƒŽˆ‘”…—”‹‰‘”’”‘Ž‘‰‹‰–Š‡Ž‹ˆ‡‘ˆ–Š‘•‡™‹–Š…ƒ…‡”Ǥ

iv. Palliative care: ƒŽŽ‹ƒ–‹˜‡ …ƒ”‡ ˆ‘…—•‡• ‘ ƒ‹–ƒ‹‹‰ ƒ† ‹’”‘˜‹‰ “—ƒŽ‹–› ‘ˆ Ž‹ˆ‡Ǥ Š‹• ‹• ‡•’‡…‹ƒŽŽ›

‹’‘”–ƒ–ˆ‘”–Š‘•‡’‡‘’Ž‡™Š‘ƒ”‡†‹ƒ‰‘•‡†™‹–Š…ƒ…‡”•–Šƒ–ƒ”‡Ž‹ˆ‡–Š”‡ƒ–‡‹‰ǡƒ†–Š‘•‡ˆ‘”™Š‘

…ƒ…‡”–”‡ƒ–‡–‹•‘Ž‘‰‡”‡ơ‡…–‹˜‡Ǥ”ƒ‹‹‰‘ˆ†‘…–‘”•ƒ–”‡‰‹‘ƒŽƒ†œ‘ƒŽŠ‘•’‹–ƒŽ•‘’ƒŽŽ‹ƒ–‹˜‡

…ƒ”‡ƒ†’”‘…—”‡‡–‘ˆ‘”ƒŽ‘”’Š‹‡ƒ††‹•–”‹„—–‹‘–‘–Š‡Š‘•’‹–ƒŽ•ƒ”‡ƒ‘‰’”‹‘”‹–›ƒ…–‹˜‹–‹‡•ˆ‘”

–Š‡Ƥ”•–͙›‡ƒ”•Ǥ

v. Cancer registration and surveillance: •ƒˆ—†ƒ‡–ƒŽ‡Ž‡‡–‘ˆƒ›…ƒ…‡”…‘–”‘Ž•–”ƒ–‡‰›ǡ

•—”˜‡‹ŽŽƒ…‡’”‘˜‹†‡•–Š‡ˆ‘—†ƒ–‹‘ˆ‘”ƒ†˜‘…ƒ…›ƒ†’‘Ž‹…›†‡˜‡Ž‘’‡–ǤŠ‹••–”ƒ–‡‰›™‹ŽŽ

‡•—”‡…‘ŽŽ‡…–‹‘ǡ‘‹–‘”‹‰ƒ†”‡’‘”–‹‰‘ˆƒ–‹‘ƒŽ…ƒ…‡”†ƒ–ƒ•‘ƒ•–‘ˆƒ…‹Ž‹–ƒ–‡…ƒ…‡”…‘–”‘Ž

‹–‡”˜‡–‹‘•‹…Ž—†‹‰‡•–ƒ„Ž‹•Š‡–‘ˆ’‘’—Žƒ–‹‘Ǧ„ƒ•‡†…ƒ…‡””‡‰‹•–”›Ǥ

vi. Training, Education and Research: ‹˜‡–Š‡•Š‘”–ƒ‰‡‘ˆ…ƒ…‡”‡š’‡”–••—…Šƒ•‘…‘Ž‘‰‹•–•ǡ’ƒ–Š‘Ž‘‰‹•–•

ƒ†‘…‘Ž‘‰›—”•‡•‹ƒœƒ‹ƒǡ–Š‹••–”ƒ–‡‰›•—‰‰‡•–•‹’Ž‡‡–ƒ–‹‘‘ˆ–Š‡ˆ‘ŽŽ‘™‹‰‹–‡”˜‡–‹‘•

™‹–Š‹–Š‡Ƥ”•–Ƥ˜‡ȋ͙Ȍ›‡ƒ”•

Ȉ •–ƒ„Ž‹•Š‡–‘ˆ’‘•–‰”ƒ†—ƒ–‡‘…‘Ž‘‰›†‡‰”‡‡ǡ Ȉ •–ƒ„Ž‹•Š‡–‘ˆ”ƒ†‹ƒ–‹‘–Š‡”ƒ’›–‡…Š‘Ž‘‰›†‡‰”‡‡ǡ Ȉ •–ƒ„Ž‹•Š‡–‘ˆ—†‡”‰”ƒ†—ƒ–‡†‡‰”‡‡ˆ‘”‘…‘Ž‘‰›Ǧ—”•‹‰ǡ Ȉ …”‡ƒ•‡ˆ—†‹‰ˆ‘”…ƒ…‡””‡•‡ƒ”…Šǡ

vii. Integration and Coordination of Cancer Control into existing health services: ‘”†‡”–‘‡•—”‡‡ơ‡…–‹˜‡

‹’Ž‡‡–ƒ–‹‘‘ˆ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒ•ǡ‹–‡‰”ƒ–‹‘‹–‘–Š‡‡š‹•–‹‰Š‡ƒŽ–Š…ƒ”‡•›•–‡‹•‡••‡–‹ƒŽǤ

–‹•ƒŽ•‘‹’‘”–ƒ––‘Šƒ˜‡ƒ‘˜‡”•‡‡‹‰’”‘‰”ƒˆ‘”…ƒ…‡”…‘–”‘Ž‹ƒœƒ‹ƒǤ‡…‡–Š‡•–”ƒ–‡‰›™‹ŽŽ

ˆ‘…—•‘‡•–ƒ„Ž‹•Š‡–‘ˆƒ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒƒ†…‘–”ƒ…–‹‘‘ˆƒƒ–‹‘ƒŽƒ…‡”•–‹–—–‡Ǥ Institution and management framework

Š‡ ™‹ŽŽ „‡ ‘’‡”ƒ–‹‘ƒŽ‹œ‡† ƒ– –Š”‡‡ Ž‡˜‡Ž• Ȃ ƒ–‹‘ƒŽǡ ”‡‰‹‘ƒŽǡ ƒ† †‹•–”‹…– Ȃ ‹ ƒ ‘˜‡”Žƒ’’‹‰ ˆƒ•Š‹‘Ǥ

Š‡ ‰‘ƒŽ ‹• –‘ ’”‘˜‹†‡ ™‡ŽŽ Ȃ …‘‘”†‹ƒ–‡†ǡ ‡ơ‡…–‹˜‡ǡ –”ƒ•’ƒ”‡–ǡ ƒ……‘—–ƒ„Ž‡ ƒ† •—•–ƒ‹ƒ„Ž‡ Ž‡ƒ†‡”•Š‹’ ƒ†

ƒƒ‰‡‡–•–”—…–—”‡•ƒ–ƒ–‹‘ƒŽǡ”‡‰‹‘ƒŽƒ††‹•–”‹…–Ž‡˜‡Ž•–‘‹’Ž‡‡––Š‡•–”ƒ–‡‰›ƒ•™‡ŽŽƒ•‹˜‘Ž˜‡‘–Š‡”

•–ƒ‡Š‘Ž†‡”•ˆ”‘–Š‡’—„Ž‹…ǡ’”‹˜ƒ–‡ƒ†…‹˜‹Ž•‘…‹‡–›•‡…–‘”•ǤŠ‡™‹ŽŽ„‡ƒƒ‰‡†„›†‹ơ‡”‡–•–”—…–—”‡•

ƒ–†‹ơ‡”‡–Ž‡˜‡Ž•Ǥ–ƒ–‹‘ƒŽŽ‡˜‡Ž–Š‡”‹‡‹‹•–‡”ǯ•ƥ…‡ƒ†‹‹•–”›‘ˆ‡ƒŽ–Šƒ†‘…‹ƒŽ‡Žˆƒ”‡ƒ”‡–Š‡

ƒ‹‘˜‡”•‹‰Š–•–”—…–—”‡•ǤŠ‡›™‹ŽŽ‘˜‡”•‡‡–Š‡‹’Ž‡‡–ƒ–‹‘‘ˆƒ…–‹˜‹–‹‡•„›†‹ơ‡”‡–•–ƒ‡Š‘Ž†‡”•ƒ†™‹ŽŽ

ƒŽ•‘‡•—”‡–Šƒ––Š‡˜ƒ”‹‘—•‡›’Žƒ›‡”•’Žƒƒ†‹’Ž‡‡––Š‡‹”…ƒ…‡””‡Žƒ–‡†‹–‡”˜‡–‹‘•‹ƒ–‹‡Ž›ƒ‡”Ǥ

ƒ–‹‘ƒŽŠ‡ƒŽ–ŠƤƒ…‹‰ˆ‘”…ƒ…‡”

Š‡‘˜‡”‡–‘ˆƒœƒ‹ƒ–Š”‘—‰Š–Š‡‹‹•–”›‘ˆ ‹ƒ…‡ƒ†…‘‘‹…ơƒ‹”••Š‘—Ž†‡•—”‡–Š‡›‘„–ƒ‹ˆ—†•

ˆ”‘‹–‡”ƒ–‹‘ƒŽ‘”Ž‘…ƒŽˆ—†‹‰‘”‰ƒ‹œƒ–‹‘•–‘‹’Ž‡‡––Š‡ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž”‘‰”ƒƒ…–‹˜‹–‹‡•Ǥ —”–Š‡”‘”‡ǡ –Š‡ ”‹‡ ‹‹•–‡”ǯ• ƥ…‡ ƒ† ‹‹•–”› ‘ˆ ‡ƒŽ–Š ƒ† ‘…‹ƒŽ ‡Žˆƒ”‡ •Š‘—Ž† ‡•—”‡ ƒ†‡“—ƒ–‡

ˆ—†‹‰–‘†‹•–”‹…–ǡ”‡‰‹‘ƒŽǡ”‡ˆ‡””ƒŽƒ†•’‡…‹ƒŽ‹•‡†Š‘•’‹–ƒŽ•ˆ‘”‡š’‡†‹–—”‡‘…ƒ…‡”…‘–”‘Žƒ…–‹˜‹–‹‡•ǤŠ‡

‹‹•–”›‘ˆ ‹ƒ…‡•Š‘—Ž†‡•—”‡ƒ†‡“—ƒ–‡ˆ—†‹‰–‘–Š‡‹‹•–”›‘ˆ‡ƒŽ–Šƒ†‘…‹ƒŽ‡Žˆƒ”‡–‘‡ƒ„Ž‡‹––‘

‡•—”‡…‘‘”†‹ƒ–‹‘ƒ†‘‹–‘”‹‰‘ˆ–Š‡ƒ–‹‘ƒŽƒ…‡”‘–”‘Ž…–‹˜‹–‹‡•Ǥ

–‡”ƒ–‹‘ƒŽ†‘‘”ƒ‰‡…‹‡•’ƒ”–‹…—Žƒ”Ž›”‘‰”ƒ…–‹‘ˆ‘”ƒ…‡”Š‡”ƒ’›ȋȌƒ†‹–•’ƒ”–‡”•™‘—Ž†„‡

‡š’‡…–‡†–‘’Žƒ›ƒ‹’‘”–ƒ–”‘Ž‡ˆ‘”‘„‹Ž‹œƒ–‹‘‘ˆ”‡•‘—”…‡•ƒ†’”‘˜‹•‹‘‘ˆ–‡…Š‹…ƒŽ•—’’‘”–‹–Š‡ƒ–‹‘ƒŽ

”‡•’‘•‡‹‹–‹ƒ–‹˜‡–‘…‘„ƒ–…ƒ…‡”Ǥ‘•–‹‰‘ˆ–Š‹••–”ƒ–‡‰›™‹ŽŽ„‡…‘†—…–‡†–‘ƒ•…‡”–ƒ‹–Š‡–‘–ƒŽ„—†‰‡–ˆ‘”

–Š‡ƒ…–‹˜‹–‹‡•Ǥ

CHAPTER 1: INTRODUCTION

What is Cancer?

ƒ…‡”‹•ƒ‰‡‡”‹…–‡”—•‡†–‘†‡•…”‹„‡ƒ‰”‘—’‘ˆ‘˜‡”͕͔͔†‹•‡ƒ•‡•–Šƒ–‘……—”™Š‡ƒŽ‹‰ƒ–ˆ‘”•‘ˆƒ„‘”ƒŽ

…‡ŽŽ‰”‘™–Š†‡˜‡Ž‘’‹‘‡‘”‘”‡„‘†›‘”‰ƒ•ǤŠ‡•‡…ƒ…‡”…‡ŽŽ•…‘–‹—‡–‘†‹˜‹†‡–‘’”‘†—…‡–—‘”•Ǥƒ…‡”

…‡ŽŽ•…ƒ‹˜ƒ†‡ƒ†Œƒ…‡–•–”—…–—”‡•ƒ†•’”‡ƒ†˜‹ƒ–Š‡Ž›’Š‘”„Ž‘‘†–‘†‹•–ƒ–‘”‰ƒ•Ǥ‘‡‘ˆ–Š‡„‹‘Ž‘‰‹…ƒŽ

‡…Šƒ‹••–Šƒ–…Šƒ‰‡ƒ‘”ƒŽ…‡ŽŽ‹–‘ƒ…ƒ…‡”…‡ŽŽƒ”‡‘™ǡ™Š‹Ž‡‘–Š‡”•ƒ”‡‘–Ǥƒ…‡”†‹ơ‡”•ˆ”‘‘•–

‘–Š‡”†‹•‡ƒ•‡•‹–Šƒ–‹–…ƒ†‡˜‡Ž‘’ƒ–ƒ›•–ƒ‰‡‹Ž‹ˆ‡ƒ†‹ƒ›„‘†›‘”‰ƒǤ

‘–™‘…ƒ…‡”•„‡Šƒ˜‡‡šƒ…–Ž›–Š‡•ƒ‡™ƒ›Ǥ‘‡ƒ›ˆ‘ŽŽ‘™ƒƒ‰‰”‡••‹˜‡…‘—”•‡•—…Š–Šƒ––Š‡…ƒ…‡”‰”‘™•

”ƒ’‹†Ž›Ǥ–Š‡”–›’‡•‰”‘™•Ž‘™Ž›‘”ƒ›”‡ƒ‹†‘”ƒ–ˆ‘”›‡ƒ”•Ǥ‡”›Š‹‰Š…—”‡”ƒ–‡•…ƒ„‡ƒ…Š‹‡˜‡†ˆ‘”•‘‡

–›’‡•‘ˆ…ƒ…‡”•ǡ™Š‹Ž‡ˆ‘”‘–Š‡”•–Š‡…—”‡”ƒ–‡•ƒ”‡†‹•ƒ’’‘‹–‹‰Ž›Ž‘™ƒ†ƒ™ƒ‹–‹’”‘˜‡†‡–Š‘†•‘ˆ†‡–‡…–‹‘

ƒ†–”‡ƒ–‡–ǤŠ‡™‹†‡”ƒ‰‡‘ˆ…ƒ…‡”–”‡ƒ–‡–•ƒ†ƒ••‘…‹ƒ–‡†•‡”˜‹…‡•”‡ƪ‡…–•–Š‡„‹‘Ž‘‰‹…ƒŽ†‹˜‡”•‹–›‘ˆ

…ƒ…‡”Ǥ

‹ơ‡”‡…‡•‹‹…‹†‡…‡‘ˆ–Š‡ƒ›–›’‡•‘ˆ…ƒ…‡”„‡–™‡‡…‘—–”‹‡•ǡƒˆ–‡”‹‰”ƒ–‹‘ƒ†‘˜‡”–‹‡Šƒ˜‡Ž‡†

–‘–Š‡…‘…Ž—•‹‘–Šƒ––Š‡‰”‡ƒ–ƒŒ‘”‹–›‘ˆ…ƒ…‡”•ƒ”‡…ƒ—•‡†„›ˆƒ…–‘”•‹‘—”Ž‹ˆ‡•–›Ž‡•‘”‡˜‹”‘‡–Ǥ‡…‡ǡ

”‡†—…‹‰–Š‡‡š’‘•—”‡‘ˆ’‘’—Žƒ–‹‘•–‘–Š‡•‡ˆƒ…–‘”•Šƒ•–Š‡’‘–‡–‹ƒŽ–‘”‡†—…‡–Š‡—„‡”‘ˆ’‡‘’Ž‡™Š‘

†‡˜‡Ž‘’…ƒ…‡”Ǥ

–Ž‡ƒ•–͔͗Ψ‘ˆˆ—–—”‡…ƒ…‡”…ƒ•‡•

ƒ”‡’”‡˜‡–ƒ„Ž‡„›…‘’”‡Š‡•‹˜‡

ƒ†…ƒ”‡ˆ—ŽŽ›…‘•‹†‡”‡†ƒ…–‹‘

–ƒ‡Ǥȋ͕͙͝͝ȌǤ

Source: NCD report 2010

—””‡–Ž› ‹– ‹• ‡•–‹ƒ–‡† –Šƒ– ƒ„‘—– ͔͜ ’‡”…‡– ‘ˆ …ƒ…‡”•

ƒ”‡ †—‡ –‘ ‘—” ‡˜‹”‘‡– ‘” Ž‹ˆ‡•–›Ž‡ ƒ† –Š‡”‡ˆ‘”‡ ƒ”‡

’‘–‡–‹ƒŽŽ› ’”‡˜‡–ƒ„Ž‡Ǥ^͕ ‘” •‘‡ …ƒ…‡”• –Š‡ ”‹• ˆƒ…–‘”•

Šƒ˜‡„‡‡…Ž‡ƒ”Ž›‹†‡–‹Ƥ‡†ǡ™Š‹Ž‡ˆ‘”‘–Š‡”•ˆ—”–Š‡””‡•‡ƒ”…Š

‹•‡‡†‡†Ǥ Global Overview

ƒ…‡”Šƒ•„‡‡‘–‡†ƒ•‘‡‘ˆƒŒ‘”Ž‹ˆ‡–Š”‡ƒ–‡‹‰‘

‘—‹…ƒ„Ž‡‹•‡ƒ•‡•™‘”Ž†™‹†‡Ǥ„‘—–͛Ǥ͚‹ŽŽ‹‘’‡‘’Ž‡

†‹‡ˆ”‘…ƒ…‡”™Š‹…Š‹•‡“—‹˜ƒŽ‡––‘͖͕Ψ‘ˆƒŽŽ†‡ƒ–Š•

‰Ž‘„ƒŽŽ›Ǥ‡ƒ”Ž›–™‘–Š‹”†•‘ˆƒŽŽ…ƒ…‡”†‹ƒ‰‘•‡•‘……—””‹‰

‹Ž‘™Ǧƒ†‹††Ž‡Ǧ‹…‘‡…‘—–”‹‡•Ǥ^͖ Cancer burden in Tanzania

ƒœƒ‹ƒǡŽ‹‡ƒ›‘–Š‡”…‘—–”‹‡•ǡŠƒ•ƒ‹…”‡ƒ•‹‰—„‡”

‘ˆ’‡‘’Ž‡™Š‘ƒ”‡†‡˜‡Ž‘’‹‰…ƒ…‡”†—‡–‘†‹˜‡”•‡”‡ƒ•‘•Ǥ

ƒ…‡” ‹• ‘™ ƒ ƒŒ‘” …ƒ—•‡ ‘ˆ ‘”„‹†‹–› ƒ† ‘”–ƒŽ‹–› ‹

ƒœƒ‹ƒǡ„‡‹‰–Š‡͙^–Š…ƒ—•‡‘ˆ†‡ƒ–Šƒ‘‰ƒ†—Ž–‡ƒ†

͖^† ƒ‘‰ ˆ‡ƒŽ‡ ƒ†—Ž–•Ǥ^͗ – ’”‡•‡– ƒ„‘—– ͙͗ǡ͔͔͔ ’‡‘’Ž‡

†‡˜‡Ž‘’…ƒ…‡”‡ƒ…Š›‡ƒ”ǡƒ†”‡…‡–ˆ‘”‡…ƒ•–••—‰‰‡•––Šƒ–

„› ͖͔͖͔ –Š‹• —„‡” ™‹ŽŽ ‹…”‡ƒ•‡ „› ͙͔ΨǤ Š‹• ™‹ŽŽ …ƒ—•‡

‹…”‡ƒ•‹‰ •–”ƒ‹ ‘ ƒŽ”‡ƒ†› •–”‡–…Š‡† Š‡ƒŽ–Š •›•–‡• ƒ†

”‡•‘—”…‡•Ǥ^͘

Š‡”‡Šƒ•ƒŽ•‘„‡‡ƒ‘–ƒ„Ž‡‹…”‡ƒ•‡‹–Š‡—„‡”‘ˆ‡™

…ƒ…‡”…ƒ•‡•ˆ‘”–Š‡’ƒ•––‡›‡ƒ”•ǤŠ‡–ƒ„Ž‡„‡Ž‘™‹†‹…ƒ–‡•

–Š‡”ƒ’‹†‹…”‡ƒ•‹‰‹—„‡”‘ˆ‡™…ƒ…‡”…ƒ•‡•–Šƒ–Šƒ˜‡

„‡‡”‡’‘”–‡†‹ƒœƒ‹ƒ„‡–™‡‡͕͔͝͝ƒ†͖͔͔͚Ǥ

͕‘ŽŽƒ†‡–‘͕͕͜͝

͖Ž‘„ƒŽ•–ƒ–—•”‡’‘”–‘‘…‘—‹…ƒ„Ž‡†‹•‡ƒ•‡•͖͔͕͔

͗ƒ—•‡‘ˆ‡ƒ–Š•ȋǡ͖͔͔͘Ȍ

͘Ž‘„ƒŽƒ…–‹‘ƒ‰ƒ‹•–…ƒ…‡”ǡǡ͖͔͔͙

Figure1ǣ”‘’‘”–‹‘‘ˆ‰Ž‘„ƒŽ†‡ƒ–Š•—†‡”–Š‡

ƒ‰‡‘ˆ͘͟ǡ„›…ƒ—•‡‘ˆ†‡ƒ–Šǡ͚͘͘͠

Figure 2: Reported Cancer Cases at the ORCI

Š‡—„‡”‘ˆ…ƒ•‡•‹†‹…ƒ–‡†Š‡”‡ƒ›Š‘™‡˜‡”‘–†‡’‹…––Š‡ƒ…–—ƒŽ•‹–—ƒ–‹‘‹–Š‡…‘—–”›†—‡–‘–Š‡ˆƒ…–

–Šƒ–ƒ„‘—–͔͜Ǧ͔͝Ψ‘ˆ…ƒ…‡”’ƒ–‹‡–•ƒ”‡—ƒ„Ž‡–‘ƒ……‡••†‹ƒ‰‘•–‹…ƒ†–”‡ƒ–‡–ˆƒ…‹Ž‹–‹‡•ƒ†‡†—’†›‹‰ƒ–

Š‘‡‘”ƒ––”ƒ†‹–‹‘ƒŽŠ‡ƒŽ‡”•ǯ…Ž‹‹…•Ǥ–‹•ƒŽ•‘ƒƒ––‡”‘ˆ…‘…‡”„‡…ƒ—•‡ƒ„‘—–͙͛Ǧ͔͜Ψ‘ˆ–Š‡’ƒ–‹‡–•ƒ––‡†–‘

Š‘•’‹–ƒŽ•ƒ–ƒ†˜ƒ…‡†•–ƒ‰‡•™Š‡‹–‹•‘–’‘••‹„Ž‡–‘…‘’Ž‡–‡Ž›…—”‡–Š‡Ǥ

ƒœƒ‹ƒ–Š‡Ž‡ƒ†‹‰…ƒ…‡”•ˆ‘”„‘–Š•‡š‡•ƒ”‡…ƒ”…‹‘ƒ‘ˆ…‡”˜‹šǡƒ’‘•‹ǯ••ƒ”…‘ƒƒ†„”‡ƒ•–…ƒ…‡”ǤŠ‡

Ƥ”•–ƒ†–Š‡–Š‹”†…ƒ„‡•…”‡‡‡†ƒ††‡–‡…–‡†‹–Š‡‹”‡ƒ”Ž›•–ƒ‰‡•‹ˆ‡ơ‡…–‹˜‡ƒơ‘”†ƒ„Ž‡…ƒ…‡”…‘–”‘Ž’”‘‰”ƒ•

ƒ”‡’—–‹’Žƒ…‡ǤŠ‹•Šƒ’’‡‡†‹–Š‡™‡•–‡”…‘—–”‹‡•†—”‹‰–Š‡Žƒ•––Š‹”–››‡ƒ”•ƒ†–Š‡”‡Šƒ•„‡‡ƒ•‹‰‹Ƥ…ƒ–

†‡…”‡ƒ•‡‹–Š‡‹…‹†‡…‡ƒ†‘”–ƒŽ‹–›‘ˆ…‡”˜‹…ƒŽ…ƒ…‡”•Ǥ^͙ Figure 3: Top 10 Cancer among males in Tanzania

͙Ž‘„‘…ƒǡǡ͖͔͔͖

Figure 4: Top 10 Cancer among Females in Tanzania

Figure 5:ƒ’‘ˆƒœƒ‹ƒ•Š‘™‹‰‡•–‹ƒ–‡†‡™…ƒ…‡”…ƒ•‡•‹‡ƒ…Š”‡‰‹‘ˆ‘”͖͔͔͛ȋƒ’’”‘š͕‹͕͔͔͔

ƒœƒ‹ƒ•†‡˜‡Ž‘’•…ƒ…‡”‡ƒ…Š›‡ƒ”Ȍ‘˜‡ƒ’–‘ƒ…‡”‹–—ƒ–‹‘‹ƒœƒ‹ƒǤ

Cancer Prevention and Control Strategies

‘–”‘Žƒ†’”‡˜‡–‹‘‘ˆ…ƒ…‡””‡“—‹”‡•ƒ’Žƒ‡†ǡ•›•–‡ƒ–‹…ƒ†…‘‘”†‹ƒ–‡†ƒ’’”‘ƒ…Šƒ–ƒŽŽ•–ƒ‰‡•‘ˆƒ…ƒ…‡”

…‘–‹——ȋ’”‹ƒ”›’”‡˜‡–‹‘ǡ‡ƒ”Ž›†‡–‡…–‹‘ǡ”‡‰‹•–”ƒ–‹‘ǡ–”ƒ‹‹‰ǡ‡†—…ƒ–‹‘ǡ†‹ƒ‰‘•‹•ǡ–”‡ƒ–‡–ǡ’ƒŽŽ‹ƒ–‹˜‡

…ƒ”‡ǡƒ†”‡•‡ƒ”…ŠȌǤ–ƒŽ•‘”‡“—‹”‡•”‡•‘—”…‡•ǡ™Š‹…Šƒ”‡ƒŽ™ƒ›•Ž‹‡Ž›–‘„‡Ž‹‹–‡†Ǥ–‹•‡‹‡––Šƒ––Š‡†‹•‡ƒ•‡

…ƒ‘–„‡…‘’Ž‡–‡Ž›‡”ƒ†‹…ƒ–‡†‹–Š‡ˆ‘”‡•‡‡ƒ„Ž‡ˆ—–—”‡ǡ„—–‹–•‡ơ‡…–•…ƒ„‡‹‹‹œ‡†ǤŠ‡‡•–ƒ„Ž‹•Š‡–‘ˆ

–Š‡‘ơ‡”•–Š‡‘•–”ƒ–‹‘ƒŽ‡ƒ•‘ˆƒ…Š‹‡˜‹‰–Š‡ƒš‹—†‡‰”‡‡‘ˆ…ƒ…‡”…‘–”‘Žǡ‡˜‡™Š‡”‡•‘—”…‡•

ƒ”‡…‘•–”ƒ‹‡†Ǥ

ƒ…‡” …‘–”‘Ž •–”ƒ–‡‰› ‡…‘’ƒ•• ƒŽŽ ƒ•’‡…–• ‘ˆ …ƒ…‡” …ƒ”‡ǡ Š‘™‡˜‡” ‹ ‹–• †‘…—‡– ‘Managerial Guidelines of National Cancer Control ProgramȋȌŠƒ•‹†‡–‹Ƥ‡†ƒ†…Žƒ••‹Ƥ‡†…ƒ…‡”•™Š‹…Šƒ”‡’”‡˜‡–ƒ„Ž‡ǡ

‡ƒ•‹Ž›†‡–‡…–ƒ„Ž‡ǡƒ†‡ơ‡…–‹˜‡Ž›–”‡ƒ–ƒ„Ž‡ƒ•™‡ŽŽƒ•–Š‘•‡ˆ‘”™Š‹…Š‘Ž›’ƒŽŽ‹ƒ–‹˜‡…ƒ”‡‹•ƒ˜ƒ‹Žƒ„Ž‡Ǥ–Š‡”ƒ”‡ƒ•

–Šƒ–‡‡†–‘„‡…‘•‹†‡”‡†ƒ”‡‡“—‹–›‘ˆƒ……‡••–‘•‡”˜‹…‡•ǡ™‘”ˆ‘”…‡†‡˜‡Ž‘’‡–ǡ‡‡†ˆ‘””‡Ž‡˜ƒ–”‡•‡ƒ”…Šǡ

‘‹–‘”‹‰ǡ†ƒ–ƒ…‘ŽŽ‡…–‹‘ƒ†ƒƒŽ›•‡•Ǥ

Š‹• ’”‘˜‹†‡• –Š‡ …‘”‡”•–‘‡ ˆ‘” ˆ‘”—Žƒ–‹‘ ‘ˆ †‡’‡†‹‰ ‘ …‘—–”›ǯ• …ƒ…‡” Ž‘ƒ† ƒ† ’ƒ––‡”Ǥ

–Š—•‹ƒ•–‹……‘‹–‡–‘ˆ–Š‡‰‘˜‡”‡–ƒ•™‡ŽŽƒ•–Š‘•‡‘ˆ‘Ǧ‰‘˜‡”‡–‘”‰ƒ‹œƒ–‹‘•ƒ”‡Š‹‰ŠŽ›‡‡†‡†

–‘ ƒ‡ –Š‡ •–”ƒ–‡‰› ‡ơ‡…–‹˜‡Ǥ ‰Ž‘••› †‘…—‡– –Šƒ– ‹• ‘– ƒ…–‡† —’‘ ™‹ŽŽ Šƒ˜‡ Ž‹––Ž‡ ‡ơ‡…– ‘ …ƒ…‡” ‹

ƒœƒ‹ƒǤ–ƒ‡Š‘Ž†‡”‹’—–ƒ†Ž‘‰Ǧ–‡”‹˜‘Ž˜‡‡–ƒ”‡‡••‡–‹ƒŽ–‘–Š‡•—……‡••‘ˆ–Š‹•‹’‘”–ƒ–‹‹–‹ƒ–‹˜‡Ǥ The Cancer Control Continuum

‡†—…‹‰–Š‡‹…‹†‡…‡ƒ†‹’ƒ…–‘ˆ…ƒ…‡””‡“—‹”‡•ƒ’Žƒ‡†ǡ•›•–‡ƒ–‹…ƒ†…‘‘”†‹ƒ–‡†ƒ’’”‘ƒ…Š–‘ƒ›”‹ƒ†

‘ˆƒ…–‹˜‹–‹‡•™‹–Š‹™Šƒ–‹•‘™ƒ•–Š‡Ǯ…ƒ…‡”…‘–”‘Ž…‘–‹——ǯǤ

Cancer control situation in Tanzania

ƒ…‡”…‘–”‘Ž‹•ƒ‘”‰ƒ‹œ‡†ƒ’’”‘ƒ…Š–‘”‡†—…‹‰–Š‡„—”†‡‘ˆ…ƒ…‡”–Š”‘—‰Š’”‡˜‡–‹‘Ǣ…ƒ…‡””‡‰‹•–”ƒ–‹‘Ǣ

•…”‡‡‹‰ƒ†‡ƒ”Ž›†‡–‡…–‹‘Ǣ–”‡ƒ–‡–Ǣ‡†—…ƒ–‹‘ǡ–”ƒ‹‹‰ƒ†Š—ƒ”‡•‘—”…‡†‡˜‡Ž‘’‡–Ǣƒ†’ƒŽŽ‹ƒ–‹˜‡

…ƒ”‡Ǥ^͚ƒœƒ‹ƒǡ…ƒ…‡”…‘–”‘Žƒ…–‹˜‹–‹‡•ƒ†•‡”˜‹…‡•ƒ”‡—†‡”–ƒ‡„›ƒ™‹†‡”ƒ‰‡‘ˆ‰‘˜‡”‡–ƒ†‘Ǧ

‰‘˜‡”‡–ƒ‰‡…‹‡•‹˜‘Ž˜‹‰„‘–Šƒ’ƒ‹†ƒ†ƒ˜‘Ž—–‡‡”™‘”ˆ‘”…‡Ǥ ‘”–Š‡’ƒ•–†‡…ƒ†‡•ǡ‘•–‘ˆ–Š‡…ƒ…‡”

…‘–”‘Ž‹‹–‹ƒ–‹˜‡•Šƒ˜‡„‡‡†‘‡„›ƒ†–‘ƒŽ‡••‡”‡š–‡–„›••—…Šƒ•ǡǡ ǡǡ

—Š‡œƒƒ†‡Ž‹ƒ‘•’‹–ƒŽǤŠ‡‹”ƒ…–‹˜‹–‹‡•‡š–‡†ˆ”‘”‡†—…‹‰‘—””‹•‘ˆ†‡˜‡Ž‘’‹‰…ƒ…‡”ǡ–‘–Š‡…ƒ”‡

‘ˆ–Š‘•‡‘ˆ—•™Š‘™‹ŽŽ—Ž–‹ƒ–‡Ž›†‹‡ˆ”‘–Š‡†‹•‡ƒ•‡Ǥ

 ͕͕͝͝ǡ –Š‡ ƒœƒ‹ƒ ƒ…‡” ‘…‹‡–› ™ƒ• ‡•–ƒ„Ž‹•Š‡† ™‹–Š –Š‡ ’”‹‘”‹–› ‘ˆ ƒ†˜ƒ…‡‡– ƒ† †‹••‡‹ƒ–‹‘ ‘ˆ

‘™Ž‡†‰‡…‘…‡”‹‰…ƒ…‡”ǡ‡…‘—”ƒ‰‡‡–‘ˆ”‡•‡ƒ”…Š…‘…‡”‹‰…ƒ…‡”ǡ’”‘‘–‹‘‘ˆ…ƒ…‡”’”‡˜‡–‹‘ǡ …ƒ…‡”•…”‡‡‹‰ǡ‡ƒ”Ž›†‹ƒ‰‘•‹•ǡ–”‡ƒ–‡–ƒ†‰‘‘†…ƒ”‡ˆ‘”ƒŽŽ’ƒ–‹‡–••—ơ‡”‹‰ˆ”‘…ƒ…‡”ǡ‹’”‘˜‡‡–‘ˆ

–”ƒ‹‹‰ƒ†–”‡ƒ–‡–ˆƒ…‹Ž‹–‹‡•‹–Š‡Ƥ‡Ž†‘ˆ…ƒ…‡”‡†‹…‹‡Ǥ‘™‡˜‡”ǡ–Š‡ƒ••‘…‹ƒ–‹‘Šƒ•„‡‡†‘”ƒ–ˆ‘”–Š‡

’ƒ•–͗Ǧ͘›‡ƒ”•†—‡–‘ƒ—„‡”‘ˆ”‡ƒ•‘•‹…Ž—†‹‰ǢŽƒ…‘ˆˆ—†•ƒ†Žƒ…‘ˆ…‘‹–‡–„›–Š‡‡„‡”•ƒˆ–‡”

‡•–ƒ„Ž‹•Š‡–‘ˆ‹‹†Ǧ͕͔͝͝•Ǥơ‘”–•ƒ”‡‘–Š‡™ƒ›–‘”‡˜‹˜‡–Š‡ƒ••‘…‹ƒ–‹‘Ǥ Primary Prevention

……‘”†‹‰–‘–Š‡ȋ͖͔͔͖Ȍǡ…ƒ…‡”’”‡˜‡–‹‘•Š‘—Ž†„‡ƒ‡›‡Ž‡‡–‹ƒŽŽ…ƒ…‡”…‘–”‘Ž’”‘‰”ƒ•Ǥƒ…‡”

’”‡˜‡–‹‘ˆ‘…—•‡•‘–‘Ž›‘ˆƒ…–‘”•–Šƒ–‹…”‡ƒ•‡ƒ’‡”•‘ǯ•…Šƒ…‡•‘ˆ†‡˜‡Ž‘’‹‰…ƒ…‡”ȋ•—…Šƒ•–‘„ƒ……‘

—•‡Ȍǡ„—–ƒŽ•‘‘’”‘–‡…–‹˜‡ˆƒ…–‘”••—…Šƒ•ƒŠ‡ƒŽ–Š›†‹‡–ƒ†’Š›•‹…ƒŽƒ…–‹˜‹–›Ǥ

”‡˜‡–‹‘•‡”˜‹…‡•‹…Ž—†‡–Š‡—•‡‘ˆŠ‡ƒŽ–Š’”‘–‡…–‹‘ǡŠ‡ƒŽ–Š’”‘‘–‹‘ƒ††‹•‡ƒ•‡’”‡˜‡–‹‘•–”ƒ–‡‰‹‡•–‘

ƒŽ‡”––Š‡’‘’—Žƒ–‹‘–‘…ƒ…‡””‹••ǡ’”‘‘–‡Š‡ƒŽ–Š‹‡”Ž‹ˆ‡•–›Ž‡•ƒ†…”‡ƒ–‡Š‡ƒŽ–Š‹‡”‡˜‹”‘‡–•–Šƒ–ƒ‹–‘

”‡†—…‡’‘–‡–‹ƒŽ…ƒ…‡””‹••ǤŠ‡’”‡˜‡–‹‘™‘”ˆ‘”…‡ǡ–Šƒ–‹˜‘Ž˜‡•„‘–Š‰‘˜‡”‡–ƒ†‘Ǧ‰‘˜‡”‡–

’‡”•‘‡Žǡ‹…Ž—†‡•’—„Ž‹…Š‡ƒŽ–ŠǡŠ‡ƒŽ–Š’”‘‘–‹‘ǡ’”‹ƒ”›Š‡ƒŽ–Š…ƒ”‡ƒ†…‘—‹–›’”‘˜‹†‡”•Ǥ

‡…ƒ—•‡’‡‘’Ž‡ǯ•‡š’‘•—”‡–‘”‹•ˆƒ…–‘”•‹•‰‡‡”ƒŽŽ›–Š‡”‡•—Ž–‘ˆƒ…‘’Ž‡š”ƒ‰‡‘ˆ„‡Šƒ˜‹‘”ƒŽǡ•‘…‹ƒŽǡ‡…‘‘‹…

ƒ†…—Ž–—”ƒŽˆƒ…–‘”•–Šƒ–ƒ”‡‘–‡ƒ•›–‘…Šƒ‰‡ǡ‡ơ‘”–•–‘”‡†—…‡–Š‡‹…‹†‡…‡‘ˆ–Š‡•‡Ž‹ˆ‡•–›Ž‡Ǧ”‡Žƒ–‡†…ƒ…‡”•

”‡“—‹”‡ ƒ …‘’”‡Š‡•‹˜‡ ƒ’’”‘ƒ…ŠǤ ˜‡”•‡ƒ• ‡š’‡”‹‡…‡ •Š‘™• –Šƒ– –Š‡ ‡ơ‡…–‹˜‡‡•• ‘ˆ •—…Š ƒ’’”‘ƒ…Š‡•

†‡’‡†•‘–Š‡‹”„‡‹‰‹’Ž‡‡–‡†™‹†‡Ž›‘˜‡”ƒ•—„•–ƒ–‹ƒŽ’‡”‹‘†‘ˆ–‹‡ǡ™‹–Šƒ†‡“—ƒ–‡”‡•‘—”…‡•ǡŽ‡ƒ†‡”•Š‹’

ƒ†ƒ•‘—†”‡•‡ƒ”…Š„ƒ•‡^͛Ǥ

Š‡‹’‘”–ƒ–ƒ’’”‘ƒ…Š‘ˆ’”‹ƒ”›…ƒ…‡”’”‡˜‡–‹‘‹•’—„Ž‹……ƒ…‡”‡†—…ƒ–‹‘‘‹••—‡•…‘…‡”‹‰’‘••‹„Ž‡

”‹•ˆƒ…–‘”•ǤŠ‡…ƒ…‡”‡†—…ƒ–‹‘…ƒ„‡…ƒ””‹‡†‘—–‹•‡˜‡”ƒŽ™ƒ›•‹…Ž—†‹‰—•‡‘ˆ’”‹–‡†‹ƒǡ‡Ž‡…–”‘‹…‡†‹ƒǡ

’—„Ž‹…”ƒŽŽ‹‡•ǡ’‘•–‡”•ǡ„”‘…Š—”‡•ǡ„ƒ‡”•ǡ‡†‹ƒ‹–‡”˜‹‡™•ǡ•…‹‡–‹Ƥ…•‡‹ƒ”•‡–…Ǥ

Š‡ƒ…–‹˜‹–‹‡•ˆ‘”’”‹ƒ”›…ƒ…‡”’”‡˜‡–‹‘‹ƒœƒ‹ƒˆ‘…—•‡†‘•’”‡ƒ†‹‰ƒ™ƒ”‡‡••‘ˆ„‡––‡”Ž‹ˆ‡•–›Ž‡••—…Š

ƒ•‘’–‹‹œ‹‰†‹‡–ƒ†’Š›•‹…ƒŽƒ…–‹˜‹–‹‡•ǡ”‡†—…‹‰‡š’‘•—”‡–‘‘™”‹•ˆƒ…–‘”•ƒ†‘”‡†—…‹‰‡š’‘•—”‡–‘

–‘„ƒ……‘•‘‡–Š”‘—‰Š•‘‹‰’”‡˜‡–‹‘ƒ†…‡••ƒ–‹‘ǤŠ‡ƒ…–‹˜‹–‹‡•‘ˆ…ƒ…‡”‡†—…ƒ–‹‘Šƒ˜‡„‡‡…ƒ””‹‡†

‘—–ƒ‹Ž›„›ǢŠ‘™‡˜‡”„‡…ƒ—•‡‘ˆƤƒ…‹ƒŽ…‘•–”ƒ‹–•ǡ–Š‡›Šƒ˜‡‘–”‡…‡‹˜‡†ƒ…‘•–ƒ–™‹†‡…‘˜‡”ƒ‰‡

‹–Š‡”‡‰‹‘Ǥ

‘‹‰‹•ƒ•‡”‹‘—•’—„Ž‹…Š‡ƒŽ–Š’”‘„Ž‡ƒ†Š—ƒ…‘•—’–‹‘‹•–Š‡‘Ž›ƒ†‡š…Ž—•‹˜‡‰‘ƒŽ‘ˆ–‘„ƒ……‘

’”‘†—…–‹‘Ǥ‘„ƒ……‘‹•ƒ••‘…‹ƒ–‡†™‹–Š͗‘ˆ–Š‡–‘’͙…ƒ…‡”•ƒ–‹Ǥ‡Ǥ…‡”˜‹…ƒŽ…ƒ…‡”ǡ‘‡•‘’Šƒ‰‡ƒŽ…ƒ…‡”

ƒ†Š‡ƒ†Ƭ‡……ƒ…‡”•Ǥƒœƒ‹ƒ’”‘†—…‡•ƒ„‘—–͝ǡ͚͔͔–‘•‘ˆ–‘„ƒ……‘ƒ—ƒŽŽ›Ǣ‹–‹•‡•–‹ƒ–‡†–Šƒ–ƒ„‘—–͙͗Ψ ȋ”ƒ‰‡ǣ͜Ψƒ”ƒ–‘͖͘Ψ‹Ž‹ƒŒƒ”‘Ȍ‘ˆƒœƒ‹ƒ•ƒ‰‡†͕͖ƒ†ƒ„‘˜‡•‘‡–‘„ƒ……‘”‡‰—Žƒ”Ž›Ǥ•–—†›†‘‡‹ƒ”

‡•ƒŽƒƒˆ‘—†–Šƒ–ƒ„‘—–͖͛Ψ‘ˆƒŽ‡•ƒ†͙Ψ‘ˆˆ‡ƒŽ‡•ƒ‰‡†͕͙ƒ†ƒ„‘˜‡Šƒ†Š‹•–‘”›‘ˆ•‘‹‰…‹‰ƒ”‡––‡•^͜Ǥ

͚Š––’ǣȀȀ™™™Ǥ‘ŠǤ‰‘˜–ǤœȀ…ƒ…‡”…‘–”‘Ž‡’–‡„‡”͕͘ǡ͖͔͔͛

͛ƒ…‡”‘—…‹Ž—•–”ƒŽ‹ƒ͖͔͔͕

͜ƒ‰‘‡‡–ƒŽǤǡ͖͔͔͖Ǥ

Š‡‘˜‡”‡–‘ˆƒœƒ‹ƒ–Š”‘—‰Š–Š‡‹‹•–”›‘ˆ‡ƒŽ–Š‡•–ƒ„Ž‹•Š‡†ƒƒ…–‘–‘„ƒ……‘‹͖͔͔͗™Š‹…Š™ƒ•

‡ƒ…–‡† „› –Š‡ ƒ”Ž‹ƒ‡– ‘ˆ ƒœƒ‹ƒǤ Š‡ ƒ…– …‘…‡”• ”‡‰—Žƒ–‹‘ ‘ˆ ƒ—ˆƒ…–—”‹‰ǡ Žƒ„‡ŽŽ‹‰ǡ †‹•–”‹„—–‹‘ǡ

•ƒŽ‡ǡ’”‘‘–‹‘‘ˆ–‘„ƒ……‘’”‘†—…–•ƒ†•‘‹‰‹•’‡…‹Ƥ‡†ƒ”‡ƒ•ǤŠ‡ƒŒ‘”’”‘„Ž‡Ž‹‡•‹–Š‡‡ˆ‘”…‡‡–

‘ˆ–Š‡ƒ„‘˜‡Žƒ™ƒ•–Š‡”‡‹•‘•’‡…‹Ƥ…‘”‰ƒ‡•–ƒ„Ž‹•Š‡†–‘‘˜‡”•‡‡–Š‡‹’Ž‡‡–ƒ–‹‘‘ˆ–Š‡ƒ„‘˜‡Žƒ™‹

…‡”–ƒ‹ƒ”‡ƒ•Ǥ ‘”‡šƒ’Ž‡ǡ‹–‹•’”‘Š‹„‹–‡†–‘•‡ŽŽ…‹‰ƒ”‡––‡•–‘—†‡”͕͜›‡ƒ”‘Ž†•ǡ„—–…—””‡–Ž›ƒ›„‘†›…ƒ„—›

…‹‰ƒ”‡––‡•™‹–Š‘—–„‡‹‰ƒ•‡†Š‹•ȀŠ‡”ƒ‰‡Ǣ‹–‹•ƒŽ•‘’”‘Š‹„‹–‡†–‘•‡ŽŽ–‘„ƒ……‘’”‘†—…–•™‹–Š‹ƒŠ‡ƒŽ–Š…ƒ”‡

‡•–ƒ„Ž‹•Š‡–ǡŠ‘™‡˜‡”–Š‹•Žƒ™‹•‘–ˆ‘ŽŽ‘™‡†Ǥ•–—†›‘•‘‹‰Šƒ„‹–•ƒ‘‰›‘—–Š•–—†‡–•‹•‡…‘†ƒ”›

•…Š‘‘Ž•‹ƒ”‡•ƒŽƒƒ•Š‘™‡†ƒ’”‡˜ƒŽ‡…‡‘ˆ‡˜‡”Ǧ•‘‹‰‘ˆ͛Ǥ͝Ψ^͝Ǥƒ‘–Š‡”•–—†›ƒ‘‰…ƒ…‡”’ƒ–‹‡–•

ƒ–^͕͔–Š‡’”‡˜ƒŽ‡…‡‘ˆ‡˜‡”Ǧ•‘‹‰ˆ‘”…‡”˜‹…ƒŽ…ƒ…‡”ȋ͙͗Ǥ͛ΨȌǡŽ—‰…ƒ…‡”ȋ͚͔Ǥ͔ΨȌǡŽƒ”›‰‡ƒŽ…ƒ…‡”ȋ͗͜Ǥ͔ΨȌ

ƒ† ‘‡•‘’Šƒ‰‡ƒŽ …ƒ…‡” ȋ͚͚Ǥ͛ΨȌ ™ƒ• Š‹‰Š‡” –Šƒ ˆ‘” ‘Ǧ…ƒ…‡” ’ƒ–‹‡–• ȋ͕͔Ǥ͙ΨȌǤ Š‡•‡ •–—†‹‡• Š‹‰ŠŽ‹‰Š– –Š‡

‹’‘”–ƒ…‡‘ˆ…‘–”‘ŽŽ‹‰–‘„ƒ……‘—•‡‹ƒœƒ‹ƒǤ

”‹ƒ”›Ž‹˜‡”…ƒ…‡”‹•‘•–Ž›ƒ––”‹„—–‡†–‘‡’ƒ–‹–‹•˜‹”—•Ǥ–‹•‡•–‹ƒ–‡†–Šƒ–„›–Š‡ƒ‰‡‘ˆ͕͙›‡ƒ”•ǡƒ„‘—–͔͜Ψ

‘ˆ…Š‹Ž†”‡‹ƒœƒ‹ƒ•Š‘™•‹‰•‘ˆ„‡‹‰‹ˆ‡…–‡†™‹–Š‡’ƒ–‹–‹•˜‹”—•ƒ†ƒ’’”‘š‹ƒ–‡Ž›͕͔Ψ„‡…‘‡…Š”‘‹…

…ƒ””‹‡”•Ǥ–Šƒ•„‡‡ˆ‘—†–Šƒ––Š‡ƒŒ‘”‹–›‘ˆ‹ˆ‡…–‹‘•ƒ”‡ƒ…“—‹”‡†„‡–™‡‡–Š‡ƒ‰‡‘ˆ͚‘–Š•ƒ†͙›‡ƒ”•Ǥ

‡’ƒ–‹–‹•‹•ƒƒŒ‘””‹•ˆƒ…–‘”ˆ‘”’”‹ƒ”›Ž‹˜‡”…ƒ…‡”ƒŽ–Š‘—‰Š–Š‡—„‡”‘ˆ‡™’ƒ–‹‡–••‡‡ƒ–‹•Ž‡••

–Šƒ͙͔’‡”›‡ƒ”ǤŽƒ”‰‡—„‡”‘ˆ’ƒ–‹‡–••‡‡‹…‘•—Ž–ƒ–Š‘•’‹–ƒŽ•ƒ”‡‘–”‡ˆ‡””‡†–‘†—‡–‘Ž‹‹–‡†

–”‡ƒ–‡–‘’–‹‘•Ǥ‡’ƒ–‹–‹•˜‹”ƒŽ‹ˆ‡…–‹‘…ƒ„‡’”‡˜‡–‡†„›˜ƒ……‹ƒ–‹‘™‹–Š‡’ƒ–‹–‹•˜ƒ……‹‡ǡƒ†–Š‹•

™‹ŽŽŠ‡Ž’–‘’”‡˜‡–Ž‹˜‡”…ƒ…‡”ƒ†‘–Š‡”Ž‹˜‡”†‹•‡ƒ•‡••—…Šƒ•Ž‹˜‡”…‹””Š‘•‹•Ǥ—””‡–Ž›ǡƒœƒ‹ƒ‘ơ‡”•–Š‹•

˜ƒ……‹‡‹‹–•š’ƒ†‡†”‘‰”ƒ‘—‹•ƒ–‹‘ȋȌǤ

‡”˜‹…ƒŽ…ƒ…‡”‹•…ƒ—•‡†„›—ƒƒ’‹ŽŽ‘ƒ‹”—•ȋȌǤƒŒ‘”‹–›‘ˆ™‘‡ƒ”‡‡š’‘•‡†–‘–Š‡˜‹”—•‘…‡–Š‡›

„‡…‘‡•‡š—ƒŽŽ›ƒ…–‹˜‡ǤŠ‡‹†‡ƒŽ™ƒ›–‘’”‡˜‡–‹ˆ‡…–‹‘™‘—Ž†„‡–Š”‘—‰Š˜ƒ……‹ƒ–‹‘’”‹‘”–‘‡š’‘•—”‡Ǥ

‡…‡–Ž›‹†‡˜‡Ž‘’‹‰…‘—–”‹‡•ǡ˜ƒ……‹‡•†‡•‹‰‡†–‘’”‘–‡…–ƒ‰ƒ‹•–‹ˆ‡…–‹‘•™‹–ŠŠ‹‰Š”‹•–›’‡•ȋ͕͚

ƒ†͕͜Ȍƒ”‡‰‹˜‡–‘‰‹”Ž••–ƒ”–‹‰ƒ–ƒƒ‰‡‘ˆ͝Ǥ‘™‡˜‡”–Š‡…‘•–‹••–‹ŽŽŠ‹‰Šƒ†‹–™‹ŽŽ‘–„‡ƒơ‘”†ƒ„Ž‡ˆ‘”

ƒŒ‘”‹–›‘ˆ’‡‘’Ž‡—Ž‡••‹–‹•‹…Ž—†‡†‹–‘‹†‡˜‡Ž‘’‹‰…‘—–”‹‡•Ǥƒœƒ‹ƒǡƒ––Š‡‘‡–˜ƒ……‹‡•

ƒ”‡ƒ˜ƒ‹Žƒ„Ž‡…‘‡”…‹ƒŽŽ›‹’”‹˜ƒ–‡Š‘•’‹–ƒŽ•ƒŽ–Š‘—‰Š–Š‡…‘•–‹•Š‹‰ŠǤ

–Š‡”’”‹ƒ”›…ƒ…‡”’”‡˜‡–‹‘‡ƒ•—”‡•‹ƒœƒ‹ƒƒŽ–Š‘—‰Š†‘‡‹ƒŽ‹‹–‡†…ƒ’ƒ…‹–›‹…Ž—†‡Ǣ‡†—…ƒ–‹‘‘

‹…”‡ƒ•‡††ƒ‹Ž›‹–ƒ‡‘ˆ˜‡‰‡–ƒ„Ž‡•ǡ‹…”‡ƒ•‡†’‡”…‡–ƒ‰‡‘ˆ’‡‘’Ž‡™Š‘‡ƒ–ˆ”—‹–•‡˜‡”›†ƒ›ǡ†‡…”‡ƒ•‹‰†ƒ‹Ž›

‹–ƒ‡‘ˆˆƒ–ǡ”‡†—…‹‰‹–ƒ‡‘ˆƒŽ…‘Š‘Ž–‘‘†‡•–ƒ‘—–•ǡƒ†™‡ŽŽ‹ˆ‘”‡†•‡š—ƒŽƒ†”‡’”‘†—…–‹˜‡Š‡ƒŽ–ŠǤ

•›•–‡ƒ–‹…„ƒ•‡Ž‹‡•–—†›‘†‹‡–ƒ”›…‘•—’–‹‘‘ˆ˜‡‰‡–ƒ„Ž‡•ǡˆ”—‹–•ǡˆƒ–•ƒ†ƒŽ…‘Š‘Žƒ‘‰Š‡ƒŽ–Š›ƒ•™‡ŽŽƒ•

…ƒ…‡”’ƒ–‹‡–•‹ƒœƒ‹ƒƒ›„‡Š‡Ž’ˆ—Žˆ‘”‡˜ƒŽ—ƒ–‹‘’—”’‘•‡•Ǥ Cancer Registration and surveillance

ƒ…‡””‡‰‹•–”›‹•ƒ‹ˆ‘”ƒ–‹‘•›•–‡†‡•‹‰‡†ˆ‘”–Š‡…‘ŽŽ‡…–‹‘ǡ•–‘”ƒ‰‡ǡƒƒ‰‡‡–ƒ†ƒƒŽ›•‹•‘ˆ†ƒ–ƒ‘

’‡”•‘•™‹–Š…ƒ…‡”ǤŠ‡”‡‹•‘†‘—„––Šƒ–…ƒ…‡”‹•ƒƒŒ‘”Š‡ƒŽ–Š’”‘„Ž‡‹ƒœƒ‹ƒƒ†–Š‡‡‡†‘ˆ•–—†›‹‰

‹–•‡’‹†‡‹‘Ž‘‰‹…ƒŽǡ…Ž‹‹…ƒŽƒ†’ƒ–Š‘Ž‘‰‹…ƒŽƒ•’‡…–•‹–Š‹•…‘—–”›…ƒ‘–„‡‘˜‡”‡’Šƒ•‹œ‡†Ǥ‡‘ˆ–Š‡ƒŒ‘”

–‘‘Ž•ˆ‘”ƒ…Š‹‡˜‹‰–Š‹•‰‘ƒŽ‹•–Š‡‡•–ƒ„Ž‹•Š‡–‘ˆƒ’‘’—Žƒ–‹‘Ǧ„ƒ•‡†…ƒ…‡””‡‰‹•–”›Ǥ—””‡–Ž›ƒœƒ‹ƒ†‘‡•

‘–Šƒ˜‡ƒ›•–ƒ†ƒ”†’‘’—Žƒ–‹‘Ǧ„ƒ•‡†…ƒ…‡””‡‰‹•–”›ǡ„—––Š‡”‡ƒ”‡ˆ‡™Š‘•’‹–ƒŽǦ„ƒ•‡†…ƒ…‡””‡‰‹•–”‹‡•Ǥ

ƒ…‡” …‘–”‘Ž ‘‹–‘”‹‰ ƒ† •—”˜‡‹ŽŽƒ…‡ ‹˜‘Ž˜‡ –Š‡ ”‘—–‹‡ ƒ† …‘–‹—‘—• …‘ŽŽ‡…–‹‘ ‘ˆ …ƒ…‡”Ǧ”‡Žƒ–‡†

‹ˆ‘”ƒ–‹‘‘–Š‡‹…‹†‡…‡ǡ’”‡˜ƒŽ‡…‡ǡ‘”–ƒŽ‹–›ǡ†‹ƒ‰‘•–‹…‡–Š‘†•ǡ•–ƒ‰‡†‹•–”‹„—–‹‘ǡƒ†•—”˜‹˜ƒŽ‘ˆ–Š‘•‡

™‹–Š…ƒ…‡”ƒ†ƒ•’‡…–•‘ˆ–Š‡…ƒ”‡”‡…‡‹˜‡†Ǥ‘‹–‘”‹‰‘ˆ‘™”‹•ˆƒ…–‘”••—…Šƒ•–‘„ƒ……‘•‘‹‰ƒ†–Š‡

’”‡˜ƒŽ‡…‡‘ˆ’‘’—Žƒ–‹‘‡š’‘•—”‡–‘–Š‘•‡”‹•ˆƒ…–‘”•‹•ƒŽ•‘’ƒ”–‘ˆ…ƒ…‡”…‘–”‘Ž•—”˜‡‹ŽŽƒ…‡Ǥ—”˜‡‹ŽŽƒ…‡

™‹ŽŽ„‡ƒˆ—†ƒ‡–ƒŽ‡Ž‡‡–‘ˆ–Š‡ǤŠ‡†ƒ–ƒ…‘ŽŽ‡…–‹‘”‡“—‹”‡†ˆ‘”•—”˜‡‹ŽŽƒ…‡‹˜‘Ž˜‡•…‘ŽŽƒ„‘”ƒ–‹‘‘ˆ

•‡”˜‹…‡’”‘˜‹†‡”•ƒ†ǡ™Š‡”‡‡…‡••ƒ”›ǡ…‘–‹—‹‰Ž‡‰‹•Žƒ–‹˜‡•—’’‘”–Ǥˆ—ŽŽ›ˆ—…–‹‘‹‰ƒ††‡†‹…ƒ–‡†…ƒ…‡”

”‡‰‹•–”›™‹–Šƒ’’”‘’”‹ƒ–‡‡š’‡”–‹•‡‹•ƒ…‘”‡”•–‘‡‘ˆ…ƒ…‡”…‘–”‘Ž•—”˜‡‹ŽŽƒ…‡Ǥ

͝ȋ‰‘ƒ‡–ƒŽǤǡ͖͔͔͛Ȍ

͕͔ȋ™ƒ‹•‡Žƒ‰‡‡–ƒŽǤǡ͖͔͔͛Ȍǡ

Š‡Š‘•’‹–ƒŽǦ„ƒ•‡†…ƒ…‡””‡‰‹•–”›™ƒ•‡•–ƒ„Ž‹•Š‡†‹͖͔͔͔™‹–Š–Š‡ƒ‹‘ˆ‹’”‘˜‹‰–Š‡…ƒ”‡‘ˆ…ƒ…‡”

’ƒ–‹‡–•‹–Š‡Š‘•’‹–ƒŽǡ”‡•‡ƒ”…Š‹–”‡ƒ–‡–ƒ†…‘–”‹„—–‹‰–‘–Š‡Š‘•’‹–ƒŽ’Žƒ‹‰ƒ†’”‘ˆ‡••‹‘ƒŽ‡†—…ƒ–‹‘Ǥ

Š‡…—””‡–”‡‰‹•–”›”‡…‘”†•…ƒ…‡”…ƒ•‡•ƒ––‡†‹‰—•‹‰ƒ—ƒŽˆ‘”•ƒ†–Š‡‹–‘͘…‘’—–‡”

•‘ˆ–™ƒ”‡Ǥ‘™‡˜‡”ǡ–Š‡”‡‰‹•–”›ˆƒ…‡†ƒ—„‡”‘ˆ’”‘„Ž‡•‹…Ž—†‹‰”‡‰—Žƒ”…”—•Š‹‰‘ˆ–Š‡…‘’—–‡”ǡ‘—–†ƒ–‡†

…‘’—–‡” ƒ† ‹ƒ†‡“—ƒ–‡ •–ƒơ ™‹–Š ”‡“—‹”‡† ‘™Ž‡†‰‡Ǥ Š‡ …ƒ…‡” ”‡‰‹•–”› ƒ– —Š‹„‹Ž‹ ƒ–‹‘ƒŽ ‘•’‹–ƒŽ

ȋȌ‹ƒ”‡•ƒŽƒƒ‹•ƒ’ƒ–Š‘Ž‘‰›Ǧ„ƒ•‡†”‡‰‹•–”›™Š‹…Š™ƒ•‡•–ƒ„Ž‹•Š‡†‹͕͚͚͝Ǥ‡…‘”†‹‰‘ˆ–Š‡…ƒ…‡”…ƒ•‡•

‹•†‘‡—•‹‰‹–•‘™ˆ‘”ƒ–ǤŠ‹•”‡‰‹•–”›‡‡’•”‡…‘”†‘ˆ…ƒ…‡”•†‹ƒ‰‘•‡†™‹–Š‹–Š‡’ƒ–Š‘Ž‘‰›Žƒ„‘”ƒ–‘”›Ǥ

‘™‡˜‡”ǡ–Š‹•”‡‰‹•–”›•–‘’’‡†™‘”‹‰ˆ‘”ƒ—„‡”‘ˆ›‡ƒ”•‘™Ǥ‹Ž‹ƒŒƒ”‘”‡‰‹‘Šƒ•ƒ’‘’—Žƒ–‹‘Ǧ„ƒ•‡†

…ƒ…‡””‡‰‹•–”›™Š‹…Š‹•”—„›•‹…‡͕͜͝͝ƒ†”‡…‘”†•ƒƒ˜‡”ƒ‰‡‘ˆ͖͚͚͔…ƒ•‡•’‡”ƒ—ǤŠ‡”‡‰‹•–”›

‘ƥ…‡‹•ƒ–„—–”‡‰‹•–”›•–ƒơ˜‹•‹–‘–Š‡”Š‘•’‹–ƒŽ•ˆ‘”ƒ„•–”ƒ…–‹‘‘ˆ…ƒ…‡”…ƒ•‡•ǡƒŽ–Š‘—‰Š˜‡”›‘……ƒ•‹‘ƒŽŽ›

†—‡–‘Ž‹‹–‡†”‡•‘—”…‡•Ǥ

‘”–Š‡’ƒ•–ˆ‡™›‡ƒ”•ǡƒ—„‡”‘ˆ‘–Š‡”ƒŒ‘”’”‹˜ƒ–‡Š‘•’‹–ƒŽ•‹ƒ”‡•ƒŽƒƒŠƒ˜‡‡’Ž‘›‡†ȋ‘’‡”ƒ‡–

‘”–‡’‘”ƒ”›–‡”•Ȍ’ƒ–Š‘Ž‘‰‹•–ˆ‘”–Š‡†‹ƒ‰‘•‹•‘ˆ…ƒ…‡”‹–Š‡‹”Š‘•’‹–ƒŽ•ǤŠ‡•‡Š‘•’‹–ƒŽ•†‘‡‡’”‡…‘”†•‘ˆ

–Š‡…ƒ…‡”†‹ƒ‰‘•‡†„›–Š‡‹”’ƒ–Š‘Ž‘‰›Žƒ„‘”ƒ–‘”›ǤŠ‡”‡ˆ‘”‡ǡ‹–‹•†‹ƥ…—Ž––‘‘™–Š‡–”—‡‹…‹†‡…‡‘ˆ…ƒ…‡”

™‹–Š•‡˜‡”ƒŽ•–ƒ†ǦƒŽ‘‡Š‘•’‹–ƒŽǦ„ƒ•‡†”‡‰‹•–”‹‡•ǤŠ‡‡•–ƒ„Ž‹•Š‡–‘ˆƒ’‘’—Žƒ–‹‘Ǧ„ƒ•‡†”‡‰‹•–”›™‹ŽŽŠ‡Ž’–‘

‰‹˜‡–Š‡–”—‡ƒ‰‹–—†‡‘ˆ…ƒ…‡”‹ƒœƒ‹ƒǤŠ‹•…ƒ„‡†‘‡–Š”‘—‰Šƒ…‘‹––‡‡…‘’”‹•‹‰‡„‡”•ˆ”‘

ƒŒ‘”Š‘•’‹–ƒŽ•ǡƒ†Ǥ Early Detection (Screening and Diagnosis)

Š‡ƒ‹‘ˆ‡ƒ”Ž›†‡–‡…–‹‘‹•–‘‹†‡–‹ˆ›–Š‡…ƒ…‡”™Š‡‹–‹•Ž‘…ƒŽ‹œ‡†ȋ„‡ˆ‘”‡‹–Šƒ•–‹‡–‘•’”‡ƒ†–‘‘–Š‡”’ƒ”–•

‘ˆ–Š‡„‘†›ȌǤ–‹•„ƒ•‡†‘–Š‡‘„•‡”˜ƒ–‹‘–Šƒ––”‡ƒ–‡–™‹ŽŽ„‡‘”‡‡ơ‡…–‹˜‡™Š‡–Š‡†‹•‡ƒ•‡‹•†‡–‡…–‡†

‡ƒ”Ž›ƒ•–Š‡”‡‹•ƒ‰”‡ƒ–‡”…Šƒ…‡–Šƒ–…—”ƒ–‹˜‡–”‡ƒ–‡–™‹ŽŽ„‡•—……‡••ˆ—ŽǤ

…”‡‡‹‰ˆ‘”…ƒ…‡”‹•ƒ‘”‰ƒ‹œ‡†’”‘…‡••ƒ‹‡†ƒ–”‡†—…‹‰–Š‡‹…‹†‡…‡‘”‘”–ƒŽ‹–›ˆ”‘…ƒ…‡”Ǥ‡‘’Ž‡

™Š‘Šƒ˜‡‘•›’–‘•ƒ”‡‹˜‹–‡†ȋ‡‹–Š‡”†‹”‡…–Ž›‘”–Š”‘—‰Š’—„Ž‹…‹–›Ȍ–‘—†‡”‰‘ƒ–‡•–‘”’”‘…‡†—”‡ǡ—•—ƒŽŽ›

ƒ–”‡‰—Žƒ”‹–‡”˜ƒŽ•ǤŽ–Š‘—‰Šƒ—„‡”‘ˆ…ƒ…‡”•…”‡‡‹‰–‡•–•Šƒ˜‡„‡‡†‡˜‡Ž‘’‡†ǡ‘Ž›ƒˆ‡™Šƒ˜‡„‡‡

’”‘˜‡‡ơ‡…–‹˜‡Ǥ‘„‡…‘•‹†‡”‡†‡ơ‡…–‹˜‡ƒ•…”‡‡‹‰–‡•–—•–‡‡–ƒ—„‡”‘ˆ”‡“—‹”‡‡–•‡•–ƒ„Ž‹•Š‡†„›

–Š‡ƒ†‘–Š‡”•Ǥ

ƒ”Ž›†‡–‡…–‹‘‡ơ‘”–••Š‘—Ž†„‡ˆ‘…—•‡†‘–Š‘•‡…ƒ…‡”•™Š‡”‡–Š‹•Šƒ•„‡‡•Š‘™–‘”‡†—…‡…ƒ…‡”‘”„‹†‹–›

ƒ†‘”–ƒŽ‹–›Ǥ‡…ƒ—•‡‡ƒ”Ž›†‡–‡…–‹‘‹•‘Ž›’ƒ”–‘ˆƒ™‹†‡”•–”ƒ–‡‰›‹…Ž—†‹‰†‹ƒ‰‘•‹•ǡ–”‡ƒ–‡–ƒ†ˆ‘ŽŽ‘™Ǧ

—’ǡ‹–•‡ơ‡…–‹˜‡‡••‹•†‡’‡†‡–‘–Š‡•—•–ƒ‹ƒ„‹Ž‹–›‘ˆ‘–Š‡”•‡”˜‹…‡•ƒŽ‘‰–Š‡…ƒ…‡”…‘–”‘Ž…‘–‹——ȋ

͖͔͔͖ȌǤ

ƒ”Ž›†‡–‡…–‹‘‘ˆ…ƒ…‡”…ƒ‹˜‘Ž˜‡•–”ƒ–‡‰‹‡•Ž‹‡‡†—…ƒ–‹‘ƒ„‘—–•‹‰•ƒ†•›’–‘•ƒ†‹’”‘˜‡†ƒ……‡••–‘

’”‹ƒ”›…ƒ”‡•‘ƒ•–‘’”‘‘–‡‡ƒ”Ž›’”‡•‡–ƒ–‹‘Ǥ—…Š•–”ƒ–‡‰‹‡•ƒ›ƒŽ•‘‹…Ž—†‡‡†‡ƒ˜‘”•–‘†‹•’‡Ž›–Š•ǡˆ‡ƒ”•

ƒ†‡‰ƒ–‹˜‹–›ƒ„‘—–…ƒ…‡”–Šƒ–ƒ›‹ƪ—‡…‡–Š‡Ž‹‡Ž‹Š‘‘†‘ˆ•‡‡‹‰‡†‹…ƒŽƒ†˜‹…‡Ǥƒ”Ž›†‡–‡…–‹‘‘ˆ…ƒ…‡”

’”‹‘”–‘–Š‡†‡˜‡Ž‘’‡–‘ˆ•›’–‘•ƒ›‘……—”–Š”‘—‰Š•…”‡‡‹‰Ǥ•‘‡‹•–ƒ…‡•ǡ–Š‡’—”’‘•‡‘ˆ•…”‡‡‹‰

‹•–‘†‡–‡…–…ƒ…‡”ƒ–ƒ‡ƒ”Ž›•–ƒ‰‡‘ˆ†‡˜‡Ž‘’‡–ǡ™Š‹Ž‡‹‘–Š‡”•…ƒ…‡”•…”‡‡‹‰‹†‡–‹Ƥ‡•’”‡…—”•‘”•‘ˆ

…ƒ…‡”ǡ–Š‡–”‡ƒ–‡–ˆ‘”™Š‹…Š…ƒ”‡†—…‡–Š‡”‹•‘ˆ…ƒ…‡”†‡˜‡Ž‘’‹‰Ǥ

ƒœƒ‹ƒǡ‡ơ‘”–•Šƒ˜‡„‡‡ƒ†‡„›–‘‡†—…ƒ–‡–Š‡’—„Ž‹…‘–Š‡‡ƒ”Ž›•‹‰•ƒ†•›’–‘•‘ˆ–Š‡…‘‘

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͖͔͔͕ǡ–Š‡‹…‘ŽŽƒ„‘”ƒ–‹‘™‹–Šƒ†‹–”‘†—…‡†ƒ…‡”˜‹…ƒŽ…ƒ…‡”•…”‡‡‹‰’”‘‰”ƒ—•‹‰‹•—ƒŽ

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